A I & the NHS

I went to a talk about this by a medical entrepreneur, Dr Michael Stein. He is developing a WhatsApp idea where patients can interact & tell their medical "Story". That can then be shared with medics & hopefully lead to better diagnostics & save time. I don't understand enough about what he is developing to know whether this is beneficial or not. But I am interested in the use of AI in medicine.

It has already had a big impact on current practice. We are all used to GP's interacting with their computer screens when we are lucky enough to get a face to face appointment. Hopefully, given that we no longer see a designated doctor, that means that they see a summary of our medical history before the consultation. But it goes a lot further than that. 

For example my osteopath uses software called AI Scribes when I have a consult. It records our conversation & then summarises it for her so she doesn't have to take notes. She can concentrate on me. I don't know whether my GP's or consultants use it. I regularly have scans, X rays & ECG's etc, AI assists radiologists & consultants reading these accurately. There are several Apps that offer real-time guidance during consultations, helping doctors evaluate differential diagnoses and check best-practice pathways. Everyone nowadays goes through a triage system before possibly getting a face to face consult. If you have ever contacted 111 online you will know that. They use automated triage systems, chatbots, and logic-based routing to help sort online consultation requests. Clinicians use AI assistants to look up clinical information. 

All of this seems to be beneficial when the NHS is under so much pressure. It seems to me we should embrace it as long as we control it & understand it. 

However I still think that there are 3 reasons why the NHS needs to change radically.

Firstly the siloed way the NHS works which can block communication & teamwork. The NHS is still based on little empires. That is true at Trust & Health Board level where each one organises themselves into operational divisions. Also within each hospital where there are about 9 medical specialist departments such as Neurology, Oncology, Rheumatology.....All of this means that if you are a patient no one looks at you holistically, as a whole person. For example I have several co morbid, chronic, conditions & take a pick & mix of drugs daily, but that is rarely considered. If I get a face to face appointment it is meant to only consider one aspect of my health. When I am treated by rheumatology they may well not consider my neurological or cardiac issues, or even know about them. Hopefully I can tell them & I always have a medical history printout with me. But that isn't the point.

Secondly, the whole issue of communication. Amazingly the NHS does not have a national computer system for patient care. There are different software systems used by various hospitals , GP's & Pharmacies. In the 21st century, an age of amazing technological innovation, that is ludicrous. If I'm involved in a traffic accident while on holiday there is no guarantee that the treating hospital will have access to my medical history. If I am unconscious & alone that is worrying. 

The third reason is simply time. All medics in the NHS have a patient load that is too high. A 10 minute consult is often not enough, especially if the doctor has never seen the patient before. Unfortunately that is very common. The days of a GP who treated you for years & even visited you at home are long gone. 

 

What Dr Stein seemed to be talking about was a simple WhatsApp "story" that could be shared between patient & medic. That story should be the patients medical history as a whole, complex person. I'm not sure if that is any better than the AI in use now. Especially as the NHS is like a super tanker that needs ages to do a 1 degree turn because of inertia. 

 

 

America - Home of the Brave & Land of the Free

Approximately 32% of U.S. adults personally own a gun, according to national polling data, while about 44% live in a household with a firearm. Americans can purchase rifles & shotguns at 18 & handguns at 21. That doesn't strike me as brave. Quite the opposite. 

The total incarcerated population in the States is 1.8 - 2 million in state & federal prisons, local jails & related facilities. Over two thirds of those are people of colour. (Roughly 40% of Americans are people of colour). The US has the largest total prison population in the world. Over 25% of those incarcerated have not been convicted of a crime. That doesn't strike me as a land of the free.

About .22% of the US population is homeless at any one time. That is recorded data, the actual figure is probably far higher. That was approximately 745,652 on a single night in January 2025.

8.3% of the US population, (about 28.0 million people) of all ages, do not have health insurance. Medical debt is the No 1 cause of bankruptcy in the US. 56 million people struggle with medical debt each year. Despite recent gains, U.S. life expectancy remains lower than the average of many comparable peer nations (such as Japan, Switzerland, Australia, and the U.K.), largely due to differences in chronic disease management, cardiovascular health, and preventable deaths.

The US minimum wage has been $7.25 p.h. since 2009. That's £4.5 p.h. & is substantially lower than almost all other developed countries.  

There are many allegations against Trump, but he is the first US president to be convicted of a crime. Unbelievably that does not bar him from being president. The Constitution does not bar individuals with felony convictions, indictments, or even those who are incarcerated from running for or holding the office. In 2019 a federal jury in New York awarded E Jean Carroll $83.3 million in damages after finding Trump liable for defaming her in 2019 when he denied her sexual assault allegations. In May 2024 Trump was found  guilty of 34 felony counts of falsifying business records related to hush money payments prior to the 2016 presidential election.

The American president has shown repeatedly, by his words & actions, that he is unfit for that great office. Many in the world find it inexplicable that he was voted into power twice. The democrats have just won both houses & taken much of his power away from him. But presidents have a pre-emptive veto & Trump has said he will use it. Two-thirds of congressional votes are needed to override presidential vetoes.

 

The democrats need to restore the checks & balances of democracy. There needs to be balance between the executive & the legislature. All is not lost, but it will be an uphill struggle. Personally I want to see Trump in front of a jury of his peers facing justice. But that can wait. Democracy is far more important. 

 

 

 

Assumptions & Politics

Our brains are amazing in all sorts of ways. We learn through our senses & our brains store the information & experience we build up. As we age, retrieval of that data might become more of a problem, but our brains function until we die. 

Consciousness is a state of being aware of internal thoughts, feelings & the external environment. It involves subjective experience, often described as "what it is like" to be an individual and perceive the world. 

All of this leads us to make assumptions all the time. About what will happen, about the character of people we meet, about good & bad....Our brains make assumptions for us & we base our behaviour on those assumptions. Hopefully we are intelligent enough to recognise that those assumptions can be right & wrong. 

I have never met a political leader as far as I can remember, but I make assumptions all the time about what I think about them as a person & how well they do their job. We all create an impression of ourselves to others. Politicians are trained to generate the impression they & their party want the public to see.  Sometimes that is fairly accurate, sometimes it could be a fiction. When we vote we are often voting for a particular person, rather than a manifesto, although that is very important too. Politics is often smoke & mirrors.

The USA voted in the mid terms yesterday. It's an important election because we knew that the control of the Senate & House of Representatives, (Congress), could change from republican to democrat. Trump is widely disliked & distrusted in countries other than America & has only a 26% approval rating at home. So my hope was that Americans would show clearly what they thought of the mess he has created in the world. I thought it would be good if his power were curtailed for the final couple of years of his presidency, because he is a wrecking ball both at home & internationally. Today I celebrated with American friends because Trump has lost both houses.

Listening to ordinary Americans on the news I feared that it may not be as clear cut as I hoped. I hoped that Trumps obvious unsuitability to be in charge of one of the most powerful countries in the world would result in a massive movement to democrats. However, politics is complex. People fear change & pursue self interest. American politics, probably more than any other country in the world, hinges on huge amounts of money, literally buying elections. Lobbying & publicity is an art form in America. So I hoped but didn't expect. 

 

Truth is often lost in the furore of mass indoctrination & hysteria. We can assume nothing today, but we can hope. I fervently hope that Trump & all his cohorts get their just deserts, but I assume he might well get away with it all. For now.    

  

 

 

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Peaceful Protest

I have had a poster in my front window saying "Starvation is being used as a weapon of war" for ages. I suspect that it has little effect because it has been there so long. I can no longer go on marches or demonstrations - I can barely walk to my local shops. I have considered what the impact of me having a heart attack on a march might be, but I don't really think it's a good idea!

I do support everyone's right to protest about things that are patently wrong. If that protest causes inconvenience I can accept that. We have a proud history of protest in the UK;-

• The Tolpuddle Martyrs 1834
• The Suffragettes & Suffragists in the 19th  20th centuries
• The anti apartheid movement in the 1970's - 1090's
• Access to the Countryside mass trespass 1930's 
• LGBT Section 28 marches 1970's - 2000's
• Justice for Gurkhas 2004
• Grenfell 2017
• Fracking 2011

The point is the public can make politicians take action about wrong. The mass voice of the public is very effective, because politicians know that it is us who elect them to power. Without that vote they are nothing. If we lose that power there is nothing to act as a check & balance to political power. The lobbyists will win & the public will be relegated to a voice crying in the wilderness. 

There are so many things happening today that are wrong. Despots wreaking death, injury & destruction all over the world. Bad actor counties interfering with due process & democracy. The climate emergency threatening our very existence. Species loss. Criminals seemingly rampant because law enforcement isn't effective. Huge international companies using great wealth & power to lobby & increase their profits...It's seemingly never ending.

If there is one thing that is important today it is the right of populations to protest. It is the only way that mass opinion can be heard on really important issues. If we allow that to be subsumed politically we only have the vote every 5 years & our voting system is unfair & not representative. 

   

You can't stop it, it became law this year. It is meant to tackle antisocial behaviour, knife crime, retail theft, public order, and violence against women and girls as part of the government's Safer Streets mission. But it does more than that. It gives the police powers that are quite concerning. It can curtail our right to protest drastically. Yes, there are people who deliberately disrupt peaceful protest & they need to be dealt with. But that is no reason to include those who have a legitimate right to protest & are behaving peacefully. They are actually risking a lot in order to make their voices heard.

Protest & Democracy are inextricable linked. It is arguable that disrupting people's lives is a way to get their attention to important issues. 

The Oxygen of Publicity

There is an appetite for news.We want to know what is happening, why & where. Who is doing what to who. We need to be informed. But we need truthful & accurate information. What we don't need is conspiracy theory, misdirection, greenwashing, whitewashing & gaslighting. We need to be able to trust our sources of information. 

I don't advocate censorship in any way. Freedom of speech is important in a democracy. However unpalatable I find someone's views, I do believe they have a right to speak. I just don't want to listen to them without being able to counter the rubbish they spout. I want to be able to provide accurate information rather than knee jerk, emotional, reaction. So I use trusted sources.

More & more I am irritated by people telling me I can't say something. I'm happy to argue my point with anyone. I'm happy to disagree, hopefully amicably. But I will not be told what I can & can't say. Sometimes that is difficult with friends, acquaintances & family. It's a fine line to tread to put your point forward without causing offence or creating a situation with those close to you.

The one area I do now think that we need to be more careful about is publicity. I hadn't thought about it before, but there are people whose views & behaviour are so toxic that I think they shouldn't be named publicly. The reason is that naming them makes them a focus for the elements of society who think & behave like they do. I am beginning to think that this then creates cults & groups of like minded people, who then become more & more influential & powerful. 

The obvious example is Trump & the MAGA movement. There has been reliable research into who MAGA people are, which indicates that at least 60% are white, and a majority are male. Roughly half are retired or over 65. A significant portion lacks a college degree—particularly working-class conservatives. There are concentrations in the deep south, suburban & rural areas & major cities. Hardliners are deeply religious nationalists & populists who view politics as an existential battle between good & evil. There are also relatively well off, politically active, anti woke, conservatives who are against change.

 

For all of these people, Trump manipulates the publicity machine, particularly social media. Everything is a photo opportunity for Trump. Similarly for Putin & Netenyahu, who also manipulate the media & news. Despots use the oxygen of publicity to stay in power & subjugate their people through indoctrination. 

https://en.wikipedia.org/wiki/Social_media_use_by_Donald_Trump  

https://en.wikipedia.org/wiki/Truth_Social 

Narcissism flourishes on the oxygen of publicity. So I wonder if we shouldn't seriously consider not actually naming people who are known to lack a moral compass or who don't adhere to norms of behaviour or law. We can identify them by their role rather than their name. Let's consider not putting  photographs of them on news. 

This applies to criminals too. Lets focus on the victims of crime, not the criminals. Naming & shaming doesn't seem to have worked. Some very objectionable people thrive on it. So lets try another way. Cut off the oxygen of publicity & see what happens. Media attention just seems to sustain controversial figures & extremist groups. 

Packaging

I never know where a blog post will go when I write it. This may well turn into a rant.

I am so fed up with everyday packaging I can't open. Everything - tins, cardboard boxes, plastic film covered food containers, blister packs. I have a drawer in my kitchen with 2 gizmos to help me open tins & 4 to help open jars. There is nothing to help peel the film back from plastic food containers or to prize open cardboard packaging. The problem with both of those is the glue. It's too strong. So I end up jabbing at it with a sharp knife.

In all honesty I will admit that my hands are not as strong or flexible as they were. But I really can't believe that it is beyond the wit of man to use a glue which allows people to open the package. As for opening child proof medication - I had to ask someone to do it for me with one bottle. 

The problem seems to be that manufacturers design packaging to solve business problems like theft, damage & tampering, rather than ease of use. Heat sealed plastic edges & rigid cardboard are cheap & fast to run on automated machinery compared to user friendly designs. Products often have to survive long distance shipping. 

We all want to be sure that what we buy is tamper proof, especially food. So I do understand this from the industry point of view. But not all packaged food is impossible to open without a knife, some is relatively easy, so  glue that seals but doesn't frustrate must be available. Why isn't it universally used? 

There are several cook your own food from fresh companies now. I tried one that has 3 small packs of the flavouring / seasoning & you supply your own fresh ingredients. I thought the recipes were very good. But opening the seasoning packs was a nightmare. They are small & round & difficult to hold while tearing off the film lids. Impossible to open without a knife because the glue is really strong. Lethal. I love the fact that these companies encourage cooking with fresh ingredients, but I stopped my subscription because of the packaging.

Packs of cake with instructions to "open here" with a tiny tab, but the glue is so strong you can't. On the other hand cereal boxes that have the same thing but open easily. Getting into blister packs of toothbrush heads. It's all about the glue strength.

We have just accepted that assembly lines churning out heat sealed, plastic to plastic, is the optimum method of transporting & buying food. Well it isn't. I remember a time when most food was not packaged at all. I remember fruit & veg shops, butchers & fishmongers. I remember when biscuits were displayed loose in big tins & you took how many you wanted & put them in a paper bag. Broken biscuits were sold off cheaply, not included in the packaged ones as now. 

Why on earth is fruit & veg packaged at all? I don't need 4 apples or pears in a tray wrapped in plastic. I don't need potatoes in a plastic bag. All of this has happened insidiously over time perhaps because we no longer eat food we have produced locally, in season. The "convenience" is to fit in with an industry that we actually don't really need & which produces mountains of waste.

I won't buy grapes when they are transported from Peru or Africa. I only eat grapes when they are in season in Europe. I won't eat French beans when they have been transported for thousands of miles. They grow really well in the UK & are seasonal. I'm tired of fruit that has been deep frozen, travelled miles, looks perfect & goes off really quickly, or is rotten inside or uneatable because it is so hard.

We have been conned by the food industry.

   

Legislation, Monitoring & Enforcement

I am a touch embarrassed to admit that when I was a teacher & a headteacher I did threaten to punish a whole class if a perpetrator did not admit to wrongdoing. I probably did carry the threat out & withdrew privileges or kept a class in. 

Israel has retaliated against Hebron in the West Bank by laying siege to the city, forcing residents out of their homes & then demolishing them after Palestinian gunmen killed 2 Israeli soldiers. The aim, according to Smotrich Israel's finance minister, is to “create deterrence and exact a price”. In other words an "eye for an eye & a tooth for a tooth" - the Law of Retaliation. 

You have to decide whether you think that is an acceptable response.

Without the rule of law we do not have a functioning society. Without a functioning society there is chaos. Law needs to be properly policed & monitored & perpetrators need to be punished or made to pay in some way. I think most reasonable & intelligent people would accept that is in their best interests.

In France demonstrators with genuine reasons to protest have been hijacked by extremists bent on disruption & anarchy. 70,000 police officers have been deployed to prevent further violence and looting. New GL-304 grenades were used against protesters, with at least two causing serious injuries, and two others involved in dangerous incidents. Is this acceptable enforcement against legitimate public protest? Or is it blanket law enforcement that isn't properly targeted against actual perpetrators?

You have to decide. 

It seems to me that there is no point in any legislation if it is not properly monitored. A good example is the UK water industry after privatisation. It can be argued that Ofwat was actually in collusion with the privatised companies. There is  widespread public, political, and academic criticism for regulatory failure, weak oversight, and allowing companies to engage in heavy debt-loading, massive dividend payouts, and environmental pollution. 

We need all three legal arms for a successfully operating society. I don't believe we have that in the UK or the wider world today & the "chickens are coming home to roost".