Professor Alison Leary has tabled a Petition to Parliament regarding the risks to the public from nurses who have been struck off the NMC register but are still practising as nurses in the private sector.
She correctly identified deficiencies in the legislation – that was supposed to protect the title “nurse” and prevent anyone from using it without statutory registration. A position conceded by the Nursing & Midwifery Council – the regulator – itself.
Both Professor Leary and the NMC hope the Government will now change the law to prevent this clear and present danger from harming patients.
Readers of this blog will be more than familiar with this issue. This is exactly the concern I raised with the sister regulator of the NMC – the Health & Care Professions Council – in 2008, which resulted in two criminal prosecutions against me a few years later.
Both government and regulators denied there was a problem – and spent £450K of public money in legal fees in an attempt to cover it up with a private criminal prosecution over three years.
I sincerely hope Professor Leary doesn’t experience any professional recriminations as a result of her action – she won’t be prosecuted unless she takes the same action as I had to do – and even then, there are no grounds as the regulator has conceded. The legislation doesn’t protect to the title after all. It never did.
Before any effective treatment can be commenced, it is essential to first establish an accurate diagnosis to save the life of a severely ill patient. To do that, the doctor will apply years of knowledge and experience, then balance their judgement after a careful and objective examination of all the evidence.
In some cases, like septic shock, the only effective treatment may involve the loss of an organ or limb so the life can be saved and then, the onus on doctors to make that accurate diagnosis quickly is paramount, if the patient is to have a chance of survival.
Many of us experience these difficult circumstances in our lives – from both sides of the coin – but when it is our own life in the balance, all we can do is place our trust in those doctors – and have faith in our own resilience.
But by the time a cancer patient faces the surgeon’s knife, they will understand what is required to have a good outcome. The diagnosis and treatment plan will have been carefully explained and they can prepare themselves to make whatever sacrifices required to ensure survival. If they are fortunate, for sometimes the disease is so severe and threatening, there is little time to prepare.
Humanity is that acutely ill patient. Without warning, our busy life has been rudely interrupted by a critical health crisis that is rapidly progressing towards the gravest outcome – unless appropriate treatment is commenced without delay.
But as we lie in Intensive Care, watching our doctors’ dither and argue and fail to even recognise the most obvious symptoms of the illness, what hope do we have for our survival when such glaring incompetence and inexperience is revealed before us? Our predicament is made even worse with the knowledge that some of the doctors we are relying on are complicit in our demise by their neglect and mismanagement.
Should we resign ourselves to the inevitable tragedy – or do we seek a second opinion without delay?
The virus outbreak has provided much clarity. We have known for many years that our “economy” – our way of life – has been truly toxic for much of the planet and has destroyed many of the ecosystems and resources that are essential to maintain the diversity and environment we rely on to survive. Even with all the warnings, we have been unable or unwilling to change our ways.
Just like a chronic drug-addict whose unfortunate exposure to prescription opioids has created a potentially terminal illness, humanity has several urgent decisions to make before commencing life-saving treatment. Who do we trust? Which sacrifices must we make? What can we do to ensure a good recovery and prevent recurrence? What is the best treatment available?
On the question of trust, we can now see that our ‘doctors’ – with their extensive entourage – are no specialists, but snake-oil salesmen – and we would be foolish in the extreme to have any faith in their opinions.
In seeking to preserve the economy, politicians are not only prolonging and exacerbating the crisis, but risk our very survival by their actions. A complete change of direction is required yet it is increasingly obvious they are ignorant and incapable of doing so. Even at this late stage, we must summon the courage to dismiss them from any further responsibility in our affairs before they inflict the fatal blow.
We must remember this:
As a country with its own currency, the UK can never run out of money – but it can run out of people and the essentials to life – food and fuel – if the combined consequences of a pandemic disease with unknown potential and the evaporation of trust in the authorities are realised. By ignoring the desperate plight of millions of ordinary people, governments across the world are failing in their principle duty – to protect their citizens. Instead many have already been sacrificed on the altar of greed and power in the desire to save the status quo. This neglect can only lead to social collapse and disorder, which will greatly enhance the deadly progress of the virus and render recovery impossible for many generations to come.
That will be our final legacy if we fail to act decisively now.
We must first realise and accept that the virus has completely destroyed the global economy – and in doing so, it has done humanity and the planet a great favour. Within a few months all of the established fiscal frameworks have collapsed, forcing governments to issue new currency to meet increased spending costs amidst grave uncertainties and falling revenue. Growth and productivity have all but ceased and many businesses have already closed for good.
Our malign problem has been surgically and efficiently removed, but our dependency and addiction has left us weak and vulnerable following the operation and we face a critical time ahead on life-support. But as we recuperate, there is time to consider the clarity the outbreak has also provided in clearing the mists and myths obscuring the reality with money and government spending.
Last week (23r April 2020), Gertjan Vlieghe, an ‘external’ member of the Bank of England’s Monetary Policy Committee (MPC), gave a speech headed “Monetary Policy and the Bank of England’s Balance Sheet” in an attempt to explain the extraordinary sums of money that are appearing out of thin air. It’s a good effort, using the prevailing mists and myths from telling the story in everyday language – but really the game is well and truly up for these dishonest characters, who by their own admission, have been exploiting those mechanisms for the last half century.
Thankfully, we now have, a simple translation of the speech and its implications for governments and individuals in every country.
This is one example how HMG could structure a response where money is no problem:
All policies directed to maintain the two vital ingredients essential for our recovery; preservation of the individual and those services fundamental to our survival – the NHS, food and medicines and the basic utilities – power, fuel and communications. It is incumbent on the State to apply adequate fiscal support to both until the outbreak and its inevitable consequences are contained and absorbed. That process may be counted in years if not decades.
Thus, direct payment to the individual must be apportioned immediately. This can be achieved by making everyone an employee or student of the ‘State’, with every person receiving a regular monthly ‘salary’ in addition to other supporting measures.
No debt repayments of any kind – mortgages, rents, loans, taxes including VAT, will cease immediately.
No payments for utilities, communications, prescriptions.
A weekly free-of-charge package of groceries and household items.
Emergency grants and funding for all community activities assisting the response and for restoration and support of essential business and services.
This represents a critical investment in a workforce we will desperately need if we are to survive intact and in sufficient numbers to bring with us the expertise, skills and knowledge that will be essential in the years and decades ahead. We will need new skills and a radically different focus for business. This will take time, careful planning and consensus to formulate. The difficult, but crucial period of isolation provides a unique opportunity for everyone to participate towards that goal. But only if they have support.
To achieve this, the ‘State’ – using emergency powers – assumes responsibility for all utilities, telecommunications, mobile and Internet providers, insurance and other essential business such as food production and distribution, supermarkets and pharmacies. The commercial banks are nationalised and serve as a conduit for funding from government. All off-shore banking activities and financial markets under UK control, should be suspended immediately and access to existing deposits will be restricted.
Without this investment and reforms, our children will never know or benefit from anything we have learned and achieved in our lifetimes. Instead they will face the bleakest and most savage future imaginable.
If we are in in this together, it must be on equal terms – or not at all.
The net worth or earning capability of any individual is no longer important or representative of their true value. It never was. Is a footballer or media celebrity more important than a cleaner or carer? Do billionaires like Branson, Green and the Windsors deserve any better than you or your family?
It is simply not possible – and highly undesirable – to transition from one society to another under the heavy burden of unjust inequality and unrestrained greed. In time we will need to reconcile these discrepancies in a fair and sensible manner – but for the foreseeable duration, whilst our very survival is in the balance, we must all be on an equal footing financially – and in all other areas of support.
Nothing less will do.
History has taught us that every civilisation, at the point of collapse, has but the briefest of time to adjust to the new circumstances and threats. As yet, none have grasped the moment or faced the challenge with any realism and all have failed.
We have everything we need at our disposal to navigate through the troubled waters ahead, but we are being dragged down by the weight of a snarled anchor.
Just as humanity must dispense with the discredited snake-oil salesmen it is time to cut the chains from the deadweight below – those who the salesmen truly represent. There is much to be done – how we organise and support each other through the difficult times ahead.
How we recover and rebuild. How we restore, not only ourselves but also this place we call home. Unless we do this together, many of us will perish. Together, on equal terms, we may yet again flourish and learn to appreciate the true value of this life and each other. But everything needs to change.
Unfortunately, it won’t – at least not with any Westminster government and the British Establishment in charge of our affairs. As Vlieghe’s speech illustrates – even when Pandora’s Box has been opened, they still try and claim it’s nothing more than a meaningless trinket. They are the very worst of the snake-oil villains and will stop at nothing to preserve the status quo. They have yet to realise that is no longer possible. That dichotomy spells disaster.
On that basis, I appeal to those in Scotland in a position of authority to urgently consider the potential for Scotland, as an independent country with its own currency, to provide for its citizens a radically different fiscal stimulus, where the only limit on spending and progressive policies is our own imagination.
All of the suggestions outlined above can be achieved in a moment if the Scottish people and government have sovereignty over their own affairs. The time for decisive leadership is surely upon us. It is a matter of survival – nothing less.
When I was a young boy, my grandmother died from a simple act of medical negligence that was completely avoidable. No one had the knowledge to speak up at the time and we can never bring her back. I still miss her today. She instilled in me her great love of this beautiful country, its people, their history and traditions. “It has everything you could ever want”, she used to say. It does; we should hold onto it with everything we can. Especially the Blackmount Rowan.
On her mantelpiece was another tree – a porcelain ornament with an inscription below and another lesson:
“Tall oaks from small acorns grow.”
Now is the time to make that happen.
Also published at: https://weegingerdug.wordpress.com/2020/04/28/tall-oaks/
Photograph of the Ban Vane Oak reproduced with the kind permission of Mr Alan Walsh.
Monday the 9th November 2015 was an unremarkable day in world events. It was sunny and warm in Britain – 13C in London; the Russians were banned from athletics for doping offences; Seaworld was under pressure for its treatment of killer whales; a painting by the Italian artist, Modigliani became the second most expensive piece of art – reaching $170m at auction – and Justin Bieber released the single “Love Yourself” – which would earn him a Grammy Award the following year.
But on that same day, a respected scientific journal published a paper by a group of researchers from the Department of Epidemiology at the University of North Carolina about a recent discovery they had made whilst experimenting with a group of viruses, derived from samples of bat excrement.
Their paper examined the potential for a particular strain of coronavirus – similar to that which had created the SARS and MERS outbreaks – that one of the researchers had isolated from horseshoe bats in Shitou Cave near Yunnan, China – where they conducted intense sampling during different seasons over five consecutive years.
Dr Shi Zhengli—a virologist – who is often called China’s “bat woman” by her colleagues because of her virus-hunting expeditions in bat caves, was one of the authors. She was on secondment to the UNC during the research, which was co-funded by the US military bio-warfare division at Fort Detrick.
In essence, the paper established the potential for a reverse engineering a coronavirus called SHC014-CoV and increasing its lethality through a series of modifications to its structure. This process is called “gain of function”.
In 2012, a Dutch virologist, Ron Fouchier, published details of an experiment on the recent H5N1 strain of bird flu. This strain was extremely deadly, killing an estimated 60% of humans it infected – far beyond even the Spanish flu. Yet its inability to pass from human to human had so far prevented a pandemic. Fouchier wanted to find out whether (and how) H5N1 could naturally develop this ability. He passed the disease through a series of 10 ferrets, which are commonly used as a model for how influenza affects humans. By the time it passed to the final ferret, his strain of H5N1 had become directly transmissible between mammals.
The work caused fierce controversy. Much of this was focused on the information contained in his work. The US National Science Advisory Board for Biosecurity ruled that his paper had to be stripped of some of its technical details before publication, to limit the ability of bad actors to cause a pandemic. And the Dutch government claimed that the research broke EU law on exporting information useful for bioweapons. But it is not the possibility of misuse that concerns me here. Fouchier’s research provides a clear example of well-intentioned scientists enhancing the destructive capabilities of pathogens known to threaten global catastrophe.
But the USNSABB were silent when the researchers from UNC published their paper in 2015 and it remains online today. Just like Fouchier’s paper three years earlier – it provided a blueprint for ‘bad actors’ to initiate a pandemic – as noted by scientists a week after publication.
The abstract for the paper is instructive:
“The emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome (MERS)-CoV underscores the threat of cross-species transmission events leading to outbreaks in humans. Here we examine the disease potential of a SARS-like virus, SHC014-CoV, which is currently circulating in Chinese horseshoe bat populations. Using the SARS-CoV reverse genetics system, we generated and characterized a chimeric virus expressing the spike of bat coronavirus SHC014 in a mouse-adapted SARS-CoV backbone. The results indicate that group 2b viruses encoding the SHC014 spike in a wild-type backbone can efficiently use multiple orthologs of the SARS receptor human angiotensin converting enzyme II (ACE2), replicate efficiently in primary human airway cells and achieve in vitro titers equivalent to epidemic strains of SARS-CoV. Additionally, in vivo experiments demonstrate replication of the chimeric virus in mouse lung with notable pathogenesis. Evaluation of available SARS-based immune-therapeutic and prophylactic modalities revealed poor efficacy; both monoclonal antibody and vaccine approaches failed to neutralize and protect from infection with CoVs using the novel spike protein. On the basis of these findings, we synthetically re-derived an infectious full-length SHC014 recombinant virus and demonstrate robust viral replication both in vitro and in vivo. “
The paper describes how they achieved the dramatic gain of function by manipulating the genome sequence of a SHC014-CoV virus obtained from Fort Detrick, then combining various intermediary host pathways that enable cross-species transmission with enhanced adaptations, to increase its lethality.
These experiments – even in military laboratories – are extremely controversial. President Obama called a moratorium on gain of function experiments in 2014 – and the authors’ make comment to the risks in their summary.
“In addition to offering preparation against future emerging viruses, this approach must be considered in the context of the US government–mandated pause on gain-of-function (GOF) studies. On the basis of previous models of emergence, the creation of chimeric viruses such as SHC014-MA15 was not expected to increase pathogenicity, (however) relative to the Urbani spike–MA15 CoV, SHC014-MA15 shows a gain in pathogenesis.
On the basis of these findings, scientific review panels may deem similar studies building chimeric viruses based on circulating strains too risky to pursue, as increased pathogenicity in mammalian models cannot be excluded.“
But the information or blueprint was there for any ‘bad actors’ to exploit, should they so wish. However, there is also another, more reasonable and innocent explanation, if the virus eventually is determined to be of chimeric origin.
Dr Shi left UNC in September last year and returned to the Key Laboratory of Special Pathogens and Biosafety at the Wuhan Institute of Virology, which is located about 200m from the animal market, reported to be the source of the current outbreak. She now specialises in horseshoe bat coronavirus pathology and is a leading authority on gain potentiation in engineered methodology.
It is certainly a coincidence that the first victims of a mysterious fatal pneumonia were recorded in Wuhan in workers from a food market – a short distance away from a BSL-4 laboratory just a few weeks after Dr Shi returned from the USA. But this would have likely gone unnoticed, had it not been for the Department of Justice – who arrested another scientist – a Harvard University Professor in Chemical Biology, specialising in nanotechnology – and issued a press release in February this year.
Last week, the authors of the paper issued an update.
30 March 2020
Editors’ note, March 2020: We are aware that this article is being used as the basis for unverified theories that the novel coronavirus causing COVID-19 was engineered. There is no evidence that this is true; scientists believe that an animal is the most likely source of the coronavirus.
When scientists use the words “believe” and “most likely” in defending a hypothesis – particularly when they are themselves the focus of understandable speculation, it is surely time for a very transparent independent investigation – and full public disclosure.
Most countries operate clandestine biowarfare research facilities – the UK has Porton Down, USA has Fort Detrick- Mossad run several as do Russia and China. It really doesn’t matter if it were accidentally released by Chinese scientists working at Wuhan – or a deliberate release by China – or any of the other actors, who wanted to exploit the circumstances to punish China. What matters is that all these secret facilities – & all of the intelligence & security agencies with their nefarious agendas, are dismantled immediately and never resurrected.
Whatever the excuse or justification, we must never again allow the irresponsible and dangerous experimentation with any element – biological, chemical or nuclear – that can has such catastrophic consequences if misused or when mistakes are made.
Now is not the time, but after, when we start to rebuild, there will be a thorough examination of all the activities and experiments, conducted in secret, but in our name, by governments and their agencies – and we will learn from this and never, ever permit these circumstances to arise again.
“Dr. Anthony Fauci is an adviser to President Donald Trump and something of an American folk hero for his steady, calm leadership during the pandemic crisis. At least one poll shows that Americans trust Fauci more than Trump on the coronavirus pandemic—and few scientists are portrayed on TV by Brad Pitt.
But just last year, the National Institute for Allergy and Infectious Diseases, the organization led by Dr. Fauci, funded scientists at the Wuhan Institute of Virology and other institutions for work on gain-of-function research on bat coronaviruses.
In 2019, with the backing of NIAID, the National Institutes of Health committed $3.7 million over six years for research that included some gain-of-function work. The program followed another $3.7 million, 5-year project for collecting and studying bat coronaviruses, which ended in 2019, bringing the total to $7.4 million.
Many scientists have criticized gain of function research, which involves manipulating viruses in the lab to explore their potential for infecting humans, because it creates a risk of starting a pandemic from accidental release.
SARS-CoV-2 , the virus now causing a global pandemic, is believed to have originated in bats. U.S. intelligence, after originally asserting that the coronavirus had occurred naturally, conceded last month that the pandemic may have originated in a leak from the Wuhan lab. (At this point most scientists say it’s possible—but not likely—that the pandemic virus was engineered or manipulated.)
Dr. Fauci did not respond to Newsweek’s requests for comment. NIH responded with a statement that said in part: “Most emerging human viruses come from wildlife, and these represent a significant threat to public health and biosecurity in the US and globally, as demonstrated by the SARS epidemic of 2002-03, and the current COVID-19 pandemic…. scientific research indicates that there is no evidence that suggests the virus was created in a laboratory.”
The NIH research consisted of two parts. The first part began in 2014 and involved surveillance of bat coronaviruses, and had a budget of $3.7 million. The program funded Shi Zheng-Li, a virologist at the Wuhan lab, and other researchers to investigate and catalogue bat coronaviruses in the wild. This part of the project was completed in 2019.
A second phase of the project, beginning that year, included additional surveillance work but also gain-of-function research for the purpose of understanding how bat coronaviruses could mutate to attack humans. The project was run by EcoHealth Alliance, a non-profit research group, under the direction of President Peter Daszak, an expert on disease ecology. NIH canceled the project just this past Friday, April 24th, Politico reported. Daszak did not immediately respond to Newsweek requests for comment.
The project proposal states: “We will use S protein sequence data, infectious clone technology, in vitro and in vivo infection experiments and analysis of receptor binding to test the hypothesis that % divergence thresholds in S protein sequences predict spillover potential.”
In layman’s terms, “spillover potential” refers to the ability of a virus to jump from animals to humans, which requires that the virus be able to attach to receptors in the cells of humans. SARS-CoV-2, for instance, is adept at binding to the ACE2 receptor in human lungs and other organs.
According to Richard Ebright, an infectious disease expert at Rutgers University, the project description refers to experiments that would enhance the ability of bat coronavirus to infect human cells and laboratory animals using techniques of genetic engineering. In the wake of the pandemic, that is a noteworthy detail.
Ebright, along with many other scientists, has been a vocal opponent of gain-of-function research because of the risk it presents of creating a pandemic through accidental release from a lab.
Dr. Fauci is renowned for his work on the HIV/AIDS crisis in the 1990s. Born in Brooklyn, he graduated first in his class from Cornell University Medical College in 1966. As head of NIAID since 1984, he has served as an adviser to every U.S. president since Ronald Reagan.
A decade ago, during a controversy over gain-of-function research on bird-flu viruses, Dr. Fauci played an important role in promoting the work. He argued that the research was worth the risk it entailed because it enables scientists to make preparations, such as investigating possible anti-viral medications, that could be useful if and when a pandemic occurred.
The work in question was a type of gain-of-function research that involved taking wild viruses and passing them through live animals until they mutate into a form that could pose a pandemic threat. Scientists used it to take a virus that was poorly transmitted among humans and make it into one that was highly transmissible—a hallmark of a pandemic virus. This work was done by infecting a series of ferrets, allowing the virus to mutate until a ferret that hadn’t been deliberately infected contracted the disease.
The work entailed risks that worried even seasoned researchers. More than 200 scientists called for the work to be halted. The problem, they said, is that it increased the likelihood that a pandemic would occur through a laboratory accident.
Dr. Fauci defended the work. “[D]etermining the molecular Achilles’ heel of these viruses can allow scientists to identify novel antiviral drug targets that could be used to prevent infection in those at risk or to better treat those who become infected,” wrote Fauci and two co-authors in the Washington Post on December 30, 2011. “Decades of experience tells us that disseminating information gained through biomedical research to legitimate scientists and health officials provides a critical foundation for generating appropriate countermeasures and, ultimately, protecting the public health.”
Nevertheless, in 2014, under pressure from the Obama administration, the National of Institutes of Health instituted a moratorium on the work, suspending 21 studies.
Three years later, though—in December 2017—the NIH ended the moratorium and the second phase of the NIAID project, which included the gain-of-function research, began. The NIH established a framework for determining how the research would go forward: scientists have to get approval from a panel of experts, who would decide whether the risks were justified.
The reviews were indeed conducted—but in secret, for which the NIH has drawn criticism. In early 2019, after a reporter for Science magazine discovered that the NIH had approved two influenza research projects that used gain of function methods, scientists who oppose this kind of research excoriated the NIH in an editorial in the Washington Post.
“We have serious doubts about whether these experiments should be conducted at all,” wrote Tom Inglesby of Johns Hopkins University and Marc Lipsitch of Harvard. “[W]ith deliberations kept behind closed doors, none of us will have the opportunity to understand how the government arrived at these decisions or to judge the rigor and integrity of that process.”
Channel Four documentary 22/8/21 “Did Covid Leak from a Lab in China. (Click on play in youtube)
There’s a climb high up on Ben Nevis, where the crux move is over an overhang at the top of a vertical corner six hundred feet above the screes. There’s a small hold for the right hand two feet above the lip, but you have to reach it in one move – and that means letting go of both hands that are wedged into the crack underneath the two feet of granite you keep banging your head on.
Two feet out and two feet up and six hundred below. And you’re getting cramp in both legs that are spread as wide as possible so you can arch your back and peer nervously over the lip. Not a place for a selfie….
What’s required is a huge amount of courage, determination, strength – and most importantly, belief. Belief that the hold is there and you can make it. Belief that it will give you the momentum to keep going up the steep crack above for the next ten feet to the big ledge and salvation. Belief that you won’t fall off.
It’s called the Bat (coined by Robin Smith on account of Dougal Haston’s impersonation of the wee beastie each time he fell off during the first ascent in 1959) – and I regret to say I’ve never been able to lead it and never will. Not through any lack of belief – only ability and strength. And decrepitude!
But I still think about it from time to time.
Perhaps when the time is right…
THE BAT AND THE WICKED
By Robin Smith (1960)
You got to go with the times. I went by the Halfway Lochan over the shoulder of Ben Nevis and I got to the Hut about two in the morning. Dick was there before me; we had to talk in whispers because old men were sleeping in the other beds. Next day we went up Sassenach and Centurion to spy on the little secrets hidden between them. We came down in the dark, and so next day it was so late before we were back on the hill that the big heat of our wicked scheme was fizzling away.
Carn Dearg Buttress sits like a black haystack split up the front by two great lines. Centurion rises straight up the middle, 500ft. in a vast corner running out into slabs and over the traverse of Route II and 200ft. threading the roofs above. Sassenach is close to the clean-cut right edge of the cliff, 200ft. through a barrier of overhangs, 200ft. in an overhanging chimney and 500ft. in a wide broken slowly easing corner. At the bottom a great dripping overhang leans out over the 100ft of intervening ground. Above this, tiers of overlapping shelves like armour plating sweep out of the corner of Centurion diagonally up to the right to peter out against the monstrous bulge of the wall on the left of the Sassenach chimney. And hung in the middle of this bulging wall is the Corner, cutting through 100ft of the bulge. Dick and I lay and swithered on a flat stone. We wanted to find a way out of Centurion over the shelves and over the bulge into the Corner and up the Corner and straight on by a line of grooves running all the way over the top of the Buttress, only now it was after two in the afternoon.
But we thought we ought just to have a look, so we climbed the first pitch of Centurion, 50ft. to a ledge on the left. The first twisted shelf on the right was not at all for us, so we followed the corner a little farther and broke out rightwards over a slab on a wandering line of holds, and as the slab heeled over into the overlap below, a break in the overlap above led to the start of a higher shelf and we followed this till it tapered away to a jammed block poking into the monstrous bulge above. For a little while Dick had a theory that he felt unlike leading, but I put on all the running belays just before the hard bits so that he was in for the bigger swing away down over the bottom dripping overhang. We were so frightened that we shattered ourselves fiddling pebbles and jamming knots for runners. We swung down backwards in to an overlap and down to the right to a lower shelf and followed it over a fiendish step to crouch on a tiny triangular slab tucked under the bulge, and here we could just unfold enough to reach into a V-groove, cutting through the bottom of the bulge and letting us out on a slab on the right just left of the Sassenach chimney.
And so we had found a way over the shelves, but only to go into orbit round the bulging wall with still about 40ft. of bulge between us and the bottom of the Corner now up on the left. The way to go was very plain to see, a crooked little lichenous overhanging groove looking as happy as a hoodie crow. But it looked as though it was getting late and all the belays we could see were very lousy and we might get up the groove and then have to abseil and underneath were 200ft of overhangs and anyway we would be back in the morning. We could just see the top of the Corner leering down at us over the bulge as we slunk round the edge on the right to the foot of the Sassenach chimney. A great old-fashioned battle with fearful constrictions and rattling chockstones brought us out of the chimney into night, and from there we groped our way on our memory of the day before, leading through in 150ft run-outs and looking for belays and failing to find them and tying on to lumps of grass and little stones lying on the ledges. When we came over the top we made away to the left and down the bed of Number Five Gully to find the door of the Hut in the wee small hours.
We woke in the afternoon to the whine of the Death Wind fleeing down the Allt a’ Mhuillin. Fingery mists were creeping in at the five windows. Great grey spirals of rain were boring into the Buttress. We stuck our hands in our pockets and our heads between our shoulders and stomped off down the path under our rucksacks into the bright lights of the big city.
Well the summer went away and we all went to the Alps. (Dick had gone and failed his exams and was living in a hole until the re-sits, he was scrubbed.) The rest of the boys were extradited earlier than I was, sweeping north from the Channel with a pause in Wales in the Llanberis Pass at a daily rate of four apiece of climbs that Englishmen call xs (x is a variable, from exceptionally or extremely through very or hardily to merely or mildly severe). From there they never stopped until they came to Fort William, but the big black Ben was sitting in the clouds in the huff and bucketing rain and the rocks never dried until their holidays ended and I came home and only students and wasters were left on the hill.
Well I was the only climber Dougal could find and the only climber I could find was Dougal, so we swallowed a very mutual aversion to gain the greater end of a. sort of start over the rest of the field. Even so we had little time for the Ben. We could no more go for a weekend than anyone else, for as from the time that a fellow Cunningham showed us the rules we were drawn like iron filings to Jacksonville in the shadow of the Buachaille for the big-time inter-city pontoon school of a Saturday night. And then we had no transport and Dougal was living on the dole, and so to my disgust he would leave me on a Wednesday to hitch-hike back to Edinburgh in time to pick up his moneys on a Thursday. The first time we went away we had a bad Saturday night, we were late getting out on the Buachaille on Sunday and came down in the dark in a bit of rain. But the rain came to nothing, so we made our way to the Fort on Monday thinking of climbing to the Hut for the night; only there was something great showing at the pictures and then we went for chip suppers and then there were the birds and the juke-box and the slot machines and we ended up in a back-garden shed. But on Tuesday we got up in the morning, and since Dougal was going home next day we took nothing for the Hut, just our climbing gear like a bundle of stings and made a beeline for Carn Dearg Buttress.
This time we went over the shelves no bother at all, until we stood looking into the little green hoodie groove. It ran into a roof and from under the roof we would have to get out on the left on to what looked as though it might be a slab crossing to the bottom of the Corner. I was scheming to myself, now the groove will be terrible but nothing to the Corner and I will surely have to lead the crux, but Dougal shamed me with indifference and sent me round the edge on the right to find a decent belay under the Sassenach chimney. There it was very peaceful, I could see none of the tigering, only the red stripes down the side of Carn Mor Dearg running into the Allt a’ Mhuillin that was putting me to sleep if there hadn’t been odd faint snarls and scrabblings and little bits of rope once in a while tugging around the small of my back. But once Dougal was up he took in so much slack that I had to go and follow it myself. Half-way up he told me, you lean away out and loop a sling over the tip of a spike and do a can-can move to get a foot in the sling and reach for the sling with both hands as you lurch out of the groove and when you stop swinging climb up the sling until you can step back into the groove; and his sling had rolled off the spike as he left it, so I would have to put it on again. I came out at the top of the groove in a row of convulsions, which multiplied like a spastic as I took in the new perspective.
Dougal was belayed to pitons on the slab under the Corner. The slab and the left retaining wall went tapering down for 20ft till they merged and all heeled over into the general bulge. Above, the Corner balanced over Dougal like a blank open book with a rubber under the binding. The only big break in the bareness of the walls was a clean-cut black roof barring the width of the right wall. The crack went into the right wall, about six inches wide but tightly packed with bits of filling; and thus it rose in two leaps, 35ft. to the black roof, then out four horizontal feet and straight up 35ft. again; and then it widened for the last 30ft. as the right wall came swelling out in a bulge to meet the top of the great arc of the sky-line edge of the left wall. And if we could only get there then all the climb would surely be in the bag.
Well I had stolen the lead, only some time before I had been to a place called Harrison’s Rocks and some or other fellow out of London had made off with my PA’s. Now PA’s are the Achilles’ Heel of all the new men, they buckle your feet into claws and turn you into a tiger, but here I had only a flabby pair of kletterschuhe with nails sticking out on both sides of the soles, and so I worked on Dougal to change footwear at which he was not pleased because we stood on a steep slab with one little ledge for feet and a vision before us of retreating in our socks. We had two full-weight ropes. Dougal had one rope that was old before its time, it had once been 120ft long but it lost five feet during an experiment on the Currie Railway Walls. (This last word to sound like `Woz’.) A Glaswegian who was a friend had one day loaned us the other, and so it was even older, and he mentioned that it had been stretched a little, indeed it was 130ft. long, and so Dougal at the bottom had quickly tied on to an end of each rope which left me with 15ft on the one to get rid of round and round my middle to make the two ropes even. This was confusing, since I had a good dozen slings and karabiners round my neck and two bunches of pitons like bananas at my waist and a wooden wedge and a piton hammer swinging about and three or four spare karabiners and a big sling knotted into steps.
But I could still get my hands to the rocks, and I made slow progress as far as the black roof. I left about six feeble running belays on the way, mainly so that I would be able to breathe. And as there seemed little chance of runners above and little value in those below and nowhere to stand just under the roof and next to no chance of moving up for a while, I took a fat channel peg and drove it to the hilt into the corner crack as high under the roof as I could and fixed it as a runner and hung the knotted sling from it and stood with my right foot in the sling. Thus with my hands in the crack where it came out horizontally under the roof, I could plant my left foot fictitiously away out on the left wall and peer round over the roof into the Corner above. Deep dismay.
The crack looked very useless and the walls utterly bare and I shrunk under the roof into the sling. Shortly I leaned away out again to ponder a certain move and a little twist and then something else to get me 10ft. up. but what would I do then, and then the prepondering angle sent me scuttling back like a crab into shelter. In a while I got a grip and left the sling and heaved up half-way round the roof and sent a hand up the Corner exploring for a hold, but I thought, no no there is nothing at all, and I came down starting with a foot under the roof feverishly fishing for the sling. And there I hung like a brooding ape, maybe there’s a runner 10ft up or a secret keyhole for the fingers, but how are you ever to know for sitting primevally here, so for shame now where’s your boldness, see how good your piton is, and what’s in a peel, think of the Club, think of the glory, be a devil. I found a notch under the roof in which to jam the knot of a sling which made another runner, and I tried going up a few more times like a ball stopping bouncing until I realised I was going nowhere and trying nothing at all. So I jacked it in and left all the runners for Dougal and Dougal let out slack and I dribbled down to join him on the slab.
Here I sat a while and blew, then I took my coat of mail and put it on Dougal and Dougal wanted his PA’s back and we untied to swop our end of rope so that Dougal could use my runners and I tied myself on to the stance while Dougal rotated into the tail end of the longer rope and the time went by. But Dougal caught it up a little by rushing up to the black roof while I pulleyed in the slack. And here we had a plan. Just above the lip of the roof, the crack opened into a pocket about an inch and a quarter wide. There should have been a chockstone in it, only there was not, and we could find none the right size to insert. If there had been trees on the Ben the way there are in Wales there would have been a tree growing out of the pocket, or at least down at the stance or close to hand so that we could have lopped off a branch and stuck it in the pocket. But here we had a wooden wedge tapering just to the right size and surely it once grew in a tree and so maybe it would not be very artificial to see if it could be made to stick in the pocket. Blows of the hammer did this thing, and Dougal clipped in a karabiner and threaded a sling and the two ropes and pulled up to stand in the sling so that he could reach well over the roof and look about at ease. And sure enough he could see a winking ledge, about 25ft. up on the right wall.
Now Dougal is a bit thick and very bold, he never stopped to think, he put bits of left arm and leg in the crack and the rest of him over the right wall and beat the rock ferociously and moved in staccato shuffles out of the sling and up the Corner. I shifted uneasily upon my slab which tapered into the overhangs. making eyes at my two little piton belays. As Dougal neared his ledge he was slowing down but flailing all the more, left fingers clawing at grass in the crack and right leg scything moss on the wall. I pulled down the sleeves of my jersey over my hands and took a great grip of the ropes. Then there came a sort of squawk as Dougal found that his ledge was not. He got a hand on it but it all sloped. Rattling sounds came from his throat or nails or something. In his last throes to bridge he threw his right foot at a straw away out on the right wall. Then his fingers went to butter. It began under control as the bit of news “I’m off,” but it must have been caught in the wind, for it grew like a wailing siren to a bloodcurdling scream as a black and bat-like shape came hurtling over the roof with legs splayed like webbed wings and hands hooked like a vampire. I flattened my ears and curled up rigid into a bristling ball, then I was lifted off my slab and rose five feet in the air until we met head to foot and buffered to a stop hanging from the runners at the roof. I could have sworn that his teeth were fangs and his eyes were big red orbs. We lowered ourselves to the slab, and there we sat in a swound while the shadows grew.
But indeed it was getting very late, and so I being a little less shattered heaved up on the ropes to retrieve the gear, leaving the wedge and the piton at the roof. We fixed a sling to one of the belay pitons and abseiled down the groove below with tails between our legs and a swing at the bottom to take us round to the foot of the Sassenach chimney. By now it was dusk and we thought it would be chaos in the chimney and just below it was very overhanging, but I knew a traversing line above the great roof of Sassenach leading to the clean-cut right edge of the cliff. My kletterschuhe kept slipping about and I was climbing like a stiff and I put in two or three tips of pitons for psychological runners before I made the 50ft. of progress to peer around the edge. But it looked a good 200ft to the shadowy screes at the bottom, and I scuffled back in half a panic out of the frying pan into the chimney. Then two English voices that were living in a tent came up the hill to ask if we were worried. We said we were laughing but what was the time, and they said it would soon be the middle of the night, and when we thought about the 700ft of Sassenach above and all the shambles round the side to get to our big boots sitting at the bottom of the cliff, we thought we would just slide to the end of the rope.
So I went back to the edge and round the right angle and down a bit of the wall on the far side to a ledge and a fat crack for a piton. By the time Dougal joined me we could only see a few dismal stars and sky-lines and a light in the English tent. Dougal vanished down a single rope while I belayed him on the other, and just as the belaying rope ran out I heard a long squelch and murky oaths. He seemed to be down and so I followed. Suddenly my feet shot away and I swung in under the great roof and spiralled down till I landed up to my knees in a black bog. We found our boots under Centurion and made off down the hill past the English tent to tell them we were living. When we hit the streets we followed our noses straight to our sleeping bags in the shed, leaving the city night, life alone.
The next Sunday we left a lot of enemies in Jacksonville and took a lift with the Mountain Rescue round to Fort William. They were saying they might be back to take us away as well. We had thick wads of notes but nothing to eat, and so we had to wait in the city to buy stores on Monday, and we got to the Hut so late that we thought we would house our energies to give us the chance of an early start in the morning. Even so we might have slept right through Tuesday but for the din of a mighty file of pilgrims winding up the Allt a’ Mhuillin making for Ben Nevis. We stumbled out rubbing our eyes and stood looking evil in the doorway, so that nobody called in, and then we ate and went out late in the day to the big black Buttress.
This time we went over the shelves and up the hoodie groove no bother at all. It was my turn to go into the Corner. By now I had a pair of PA’s. I climbed to the black roof and made three runners with a jammed knot, the piton and the wooden wedge and stood in a sling clipped to the wedge. Dougal’s ledge was fluttering above but it fooled nobody now. At full stretch I could reach two pebbles sitting in a thin bit of the crack and pinched them together to jam. Then I felt a lurch in my stomach like flying through an air pocket. When I looked at the wedge I could have sworn. it had moved. I seized a baby nylon sling and desperately threaded it round the pebbles. And then I was gracefully plucked from the rock to stop 20ft under the roof hanging from the piton and the jammed knot with the traitor wedge hanging from me and a sling round the pebbles sticking out of the Corner far above. I rushed back to the roof in a rage and made a strange manoeuvre to get round the roof and reach the sling and clip in a karabiner and various ropes, then trying not to think, I hauled up to sit in slings which seemed like a table of kings all to come down from the same two pebbles. I moved on hastily, but I felt neither strong nor bold, and so I took a piton and hammered it into the Corner about 20ft. above the roof. Happily I pulled up, and it leaped out with a squeal of delight and gave me no time to squeal at all before I found myself swinging about under the miserable roof again. The pebbles had held firm, but that meant I hung straight down from the lip of the roof and out from the Corner below so that Dougal had to lower me right to the bottom.
By now the night was creeping in. Peels were no longer upsetting, but Dougal was fed up with sitting on a slab and wanted to go down for a brew. But that was all very well, he was going home in the morning, and then coming back for a whole week with a host of terrible tigers when I would have to be sitting exams. So I was very sly and said we had to get the gear and climbed past the roof to the sling at the pebbles leaving all the gear in place. There I was so exhausted that I put in a piton, only it was very low, and I thought, so am I, peccavi, peccabo, and I put in another and rose indiscriminately until to my surprise I was past Dougal’s ledge and still on the rock in a place to rest beside a solid chockstone. Sweat was pouring out of me, frosting at my waist in the frozen mutterings flowing up the rope from Dougal. Overhead the right wall was swelling out like a bull-frog, but the cracks grew to a tight shallow chimney in which it was even blacker than the rest of the night. I squeezed in and pulled on a real hold, and a vast block slid down and sat on my head. Dougal tried to hide on his slab, I wobbled my head and the block rolled down my back, and then there was a deathly hush until it thundered on to the screes and made for the Hut like a fireball. I wriggled my last slings round chockstones and myself round the last of the bulges and I came out of the Corner fighting into the light of half a moon rising over the North-East Buttress. All around there were ledges and great good holds and bewildering easy angles, and I lashed myself to about six belays.
Dougal followed in the moonshade, in too great a hurry and too blinded and miserable to pass the time taking out the pitons, and so they are still there turning to rust, creeping up the cliff like poison ivy. Heated up by the time he passed me, Dougal went into a long groove out of the moon but not steep and brought me up to the left end of a terrace above the chimney of Sassenach. We could see the grooves we should have climbed in a long line above us, but only as thick black shadows against .the shiny bulges, and so we went right and grovelled up in the final corner of Sassenach where I knew the way to go. The wall on the left kept sticking out and stealing all the moonlight, but we took our belays right out on the clean-cut right edge of the cliff so that we could squat in the moon and peer at the fabulous sights. When we came over the top we hobbled down the screes on the left to get out of our PA’s into our boots and back to the Hut from as late a night as any, so late you could hardly call it a bed-night.
Some time next day Dougal beetled off and I slowly followed to face the examiners. The tigers all came for their week. On the first day Dougal and the elder Marshall climbed Sassenach until they were one pitch up from the Terrace above the chimney, and then they thought of going left and finished by the new line of grooves. Overnight the big black clouds rolled over and drummed out the summer and it rained all week and hardly stopped until it started to snow and we put away our PA’s and went for hill-walks waiting for the winter. They say the grooves were very nice and not very hard. All that was needed to make a whole new climb was one pitch from the terrace above the chimney, until we decided that the way we had been leaving the terrace as from the time that Dick found it when we first climbed Sassenach was not really part of Sassenach at all. By this means we put an end to this unscrupulous first ascent. The next team will climb it all no bother at all, except that they will complain that they couldn’t get their fingers into the holds filled up with pitons.
from THE SCOTTISH MOUNTAINEERING CLUB JOURNAL 1960
A few miles north of Bridge of Orchy, as the A82 skirts Loch Tulla and climbs steadily over the Blackmount towards Rannoch Moor and Glencoe, a lone rowan tree grows atop an enormous boulder, just a few yards from the road. It is an improbable place for a tree; its roots taking support and nourishment from the shallowest crack in a rock in the most inhospitable environment.
Yet every September, it produces an impressive harvest of berries and does so year after year, despite its exposure on a seemingly barren piece of rhyolite. In 1970, it was almost six feet high – as tall as my Dad – who climbed up the rock one day to cut a small branch to bring home to Lochgelly for our garden. Within a few years, it too was heavy with berries at the end of each summer.
Throughout my childhood, the rowan would invariably be cited in parental lessons about money. Unlike berries, money didn’t grow on trees – it had to be earned and saved before it could be spent – a mantra reinforced repeatedly over the years by my elders and politicians like Theresa May, who claimed ad nauseam, that government has no Magic Money Tree. It was her particular way of defending her policies of austerity.
It is not true.
On 8 October 2008, the then PM, Gordon Brown, announced his package to rescue the British banking system and immediately made available £400 billion to eight banks and building societies. Few asked, “Where’s the money coming from?” or, “How are we going to pay for it?” but the bankers and politicians knew the source and understood precisely how the Government was going to ‘pay’ for it.
The Government (or currency issuer) was the source – and it was ‘paid’ for by imputing numbers into a bank account. The money was not transferred from government deposits or by raising funds through bonds, gilts or taxes: it was created out of thin air by pressing a few keys on a computer. It is that simple.
De La Rue, the printers, did not go into overdrive – nor was there hyperinflation – and the bankers were naturally delighted that the consequences of their greed and dishonesty were rewarded by the UK Government’s very own Magic Money Tree. One day, they were broke and facing penury; next morning they were celebrating with champagne, pay rises and bonuses. Quelle surprise !
‘Quantitative Easing’ was just the Bank of England buying bonds, shares and other assets in exchange for deposits made by the central bank in the commercial banking sector, by crediting their reserve accounts through a digital transaction. The purpose was to create excess reserves that could be loaned to chase a positive rate of return, which in turn would provide greater liquidity and stability. All well and good, but the ‘money’ was no more than an accounting adjustment in the respective accounts to reflect the asset exchange.
The secrecy of the global banking system and the deliberate lack of transparency in government fiscal reporting conceal the true nature of these financial exchanges and capital creation. However, due to a small group of economists and academics, a new economic paradigm has evolved that provides a greater understanding of these financial mechanisms and how they may be harnessed by governments to fund their operations and policy objectives.
Modern Monetary Theory (MMT) outlines the principles for a progressive, sustainable society which has no funding constraints. It is, in effect, the Magic Money Tree – and if used responsibly, could transform society across the planet.
At this point in history, our civilisation faces enormous challenges. Pollution of our atmosphere and oceans threaten our very existence, primarily as a result of uncontrolled population growth and all the attendant waste that humanity produces. The impact of pollutants on the climate and weather systems is well known, but the deterioration in air quality in particular poses a far more immediate and deadly threat than extreme weather and rising sea levels.
We will all have to change the way we live if humanity is to survive – and that level of readjustment, together with all the environmental restoration that is urgently required, cannot be funded sustainably (or desirably) by borrowing from the banks and markets. But for currency issuing countries like the UK, that isn’t a problem.
MMT is best explained as a macroeconomic framework that says monetarily sovereign countries like the U.S., U.K., Japan, Russia and Canada are not operationally constrained by revenues when it comes to government spending. In other words, such governments do not need taxes or borrowing for spending since they can print as much as they need and are the monopoly issuers of the currency.
MMT challenges conventional beliefs about the way government interacts with the economy, the nature of money, the use of taxes and the importance of budget deficits. These beliefs, in part reinforced by our well-intentioned parents and grandparents, are really no longer accurate, useful or necessary.
You may ask if that is the case, why do we have such horrific levels of poverty and homelessness in the UK? Why the cuts to public services and infrastructure if government spending is not constrained by revenues? Why do we have Universal Credit instead of a universal income? Why is Holyrood’s budget restricted? How could Gordon Brown magic up £400,000,000,000 from thin air and gift it to the wealthiest in society whilst child poverty reminiscent of Victorian times rose during his tenure of No10?
Why – if not to preserve the status quo? I suppose those responsible for these policy decisions have their reasons but at least they can count on being suitably rewarded for their loyalty once their time in office comes to an end. But at what cost to the rest of us?
Scotland, therefore, can do something quite remarkable should it choose independence. It already retains the rights to issue the Scottish pound and can legally establish its own currency issuer or central bank, through which its government can credit the commercial banks’ reserves to provide sufficient money for the economy and all its policy objectives without reliance on raising taxes, issuing bonds or borrowing from the private sector and markets.
“Too wee, too poor and too stupid”, really is no longer applicable (if it ever was). Everything Scotland needs to be an economically sustainable, progressive sovereign country is within its grasp – providing it adopts and exploits the MMT paradigm to create its currency reserves then applies transparency and good housekeeping principles to all of its transactions.
Is there a risk? The reality is that governments across the world have been using their own Magic Money Tree to create any amount of cash for many years. The USA printed billions of dollars and shipped them out in crates to Iraq and Afghanistan to fund day-to-day military and security operations during the ‘war on terror’. The money wasn’t taken from the American people through taxation; if it is recorded anywhere; it is merely as an accounting entry on a Federal Reserve ledger.
Japan embarked on a course of fiscal stimulus, money creation and increased government spending following the asset collapse and economic crash of 1992. It runs a substantial deficit and will continue to do so but that does not constrain or limit its spending in any way whatsoever. Its economy is stable and its citizens enjoy a high standard of living, despite the enormous impact of the tsunami and the ongoing operation to recover and isolate the nuclear corium from the Fukushima power plant.
And the UK – which has gifted some £535,000,000,000 to the commercial banks since 2008. Where did it all go? Can it all be accounted for? How much ended up off-shore in secretive banking networks? I would not like to guess but it also raises the question that if the UK Government utilised these arrangements to create over half a trillion pounds for the banks, has it done so to fund other commitments and expenditure? And what might they be for?
One of the founding proponents of MMT, Professor Bill Mitchell gave a lecture at the Labour Party Conference on the 23 September this year where he outlined the potential for sovereign nations to adequately fund the Green New Deal. I am certain a Scottish audience would be extremely receptive to his suggestions.
Scotland’s reputation for building a progressive and inclusive society was gained in no small part through the wisdom of its famous sons and daughters during the Enlightenment. In ‘The Wealth of Nations’, Adam Smith observed:
“What improves the circumstances of the greater part can never be regarded as an inconvenience to the whole. No society can surely be flourishing and happy [when] the far greater part of the members are poor and miserable.”
Smith could never imagine a Magic Money Tree when he wrote his book in Kirkcaldy during 1775 and would probably be incredulous at the suggestion. Yet today, a few miles along the coast in North Queensferry, sits a Fifer of lesser repute who certainly knows otherwise.
Scotland has an incredible opportunity to take a completely different path with the ability to fund itself fully without impoverishing its citizens – indeed, quite the opposite. Its Magic Money Tree is in Holyrood, not atop a boulder on the Blackmount but its harvest could be just as productive and as beautiful as the rowan.
Use it responsibly. Use it now. Before it is too late.
It will be obvious to all, that our system of governance has failed and whatever the outcome of the General Election tomorrow, none of the proposed policies from any of the established political parties will address the significant challenges facing the people within these islands at this point in history.
To understand why, go back to basis.
We are the latest and possibly last civilisation to populate this planet. We are characterised by our creativity and ingenuity, exemplified in many areas – arts, music, industry and technology – and achieved much, even in our lifetimes, that our forefathers could never dream of.
But it has come at an enormous cost. The focus on environmental issues is welcome, but climate change is only part of the problem; there are far more imminent threats to our survival than severe weather and rising sea levels – as catastrophic as that may eventually prove.
From space, this place we call home is spectacularly beautiful; the deep hues of the oceans and brilliant white of clouds – all under the very thin blue line of our atmosphere. There’s nothing else like it out there in the void, but there is plenty evidence that some of our closer neighbours had something similar to Earth once upon a time – but not now. They are spectacular too – but only in their desolation and emptiness. And absence of life.
A fluid and a gas. Water and air. The basis of all life on this planet. Yet in just two centuries, human activity has contaminated and polluted both of these essential substances to such a degree that we now imperil the future prospects of not only humanity itself, but most living species that we have been so fortunate to share this place with.
The only thing we had to do was to look after it and preserve the delicate balance in nature that provides us with everything so that future generations could experience the same as ourselves; to wonder at the incredible miracle that we exist at all and to marvel at the abundance, wealth and beauty around us. We should be overjoyed every day and be having the most ridiculous amount of fun – and sharing these experiences with each other, wherever we happen to find ourselves.
The decline in air quality is accelerating with the destruction of the rainforests and global wildfires rapidly contributing to the increasing volume of toxic gasses, particularly CO2 in the air we breathe. It doesn’t evaporate out into space, it remains in the atmosphere. Two centuries ago, we numbered a billion people. A century later, the population had grown to 1.8 billion. Now we are approaching 7 billion. All consuming, all polluting.
That’s a lot of cars, trucks, factories, houses, airplanes and any other number of sources pumping out vast quantities of gas that is poisonous and will suffocate us – not in decades to come, but much sooner. We are all aware of the recent deaths in Delhi and other cities. Saturation of our atmosphere with gas that is incompatible with life is simply stupid and must cease immediately, however inconvenient that may be. We need clean air again. Anything that impairs that goal must stop.
The pollution in our seas and fresh water supplies is also grave. Aside from the plastics and toxic chemicals we’ve dumped in the oceans, we now face the horrific prospect that the highly radioactive corium from the three nuclear reactors at Fukushima may never be recovered and will continue emitting high levels of isotopes directly into the Pacific. The corium will also require constant cooling for decades to come – and Japan is rapidly running out of space to store the contaminated waste already. Eight years have been wasted through corruption and cover-up. We are rapidly running out if time.
Our waste is rapidly destroying the entire marine habitat. Large areas of the oceans are now devoid of oxygen from the build up of algae that follows agri-chem discharges. Witness the beaching’s and decline in migratory fish stocks. If we kill the seas, we die too.
Even our fresh water is unclean. Britain has some of the highest levels of antibiotics in its waterways – from the way we farm our livestock. Resistance to infection from the conventional misuse of these drugs is already well established. That we add to the problem from food production methodology is insane and may well be a contributory factor in the exponential rise in sepsis cases in the last few years.
For these reasons, the restoration of Earth’s environment should be our principle objective. But Britain cannot achieve this alone. No country can, whilst we all remain shackled to the present economic model. We urgently need to change the way we live, but none of the politicians anywhere in the world can offer a solution. How can it be done? How can we afford it?
How can we not?
To appreciate the challenge we all face, go back to basics again and consider human nature and our own behaviour. Think of the chronic smoker who’s had a leg amputated and told they will lose the other – if not their life – within a year, unless they quit. Few will manage it. Most will head outside in their wheelchair desperate for another smoke. We know it’s stupid, but that’s just addiction. We all suffer from it to one degree or another. Drugs and alcohol are even more difficult to quit because of the pleasurable feelings.
But substance addiction is relatively harmless – except to the individuals and those around them – when compared to the consequences and impact of our greatest addiction. Money. Our one invention that was supposed to benefit all humanity has been corrupted in every sense. The obscene wealth inequality and resulting poverty is commonplace in every country, destabilising societies across the globe. Money and wealth has become the sole prerogative of humanity for so long that it has obscured everything else
If we aspire to achieve only monetary wealth, then it is not only the financial elites who perpetuate the status quo; it is all of us. We have to break the cycle. We have to beat this addiction. Everyone. But money will also be vital to our recovery, if we ever chose a different road.
That choice will not be offered by any political party. Our governments are part of the problem – they are committed to the geopolitical and neoliberal economic model that endangers us all, not least because of the personal and financial rewards their subservience provides. Their motives, ideologies and tribalism are no longer fit for purpose – and it should be abundantly clear by now that trust and honesty are qualities long disappeared from political and public life.
** UPDATED 9.1.20 **
Since writing the foregoing, Australia burns.
The following is taken from Bill Mitchell’s excellent blog. Click on text for full article.
Thirty-five years ago, during the summer of 1984, my grandmother, Agnes MacDonald became unwell and after several hospital visits for blood transfusions, she passed away at the start of October aged 68 years. She died from acute myeloid leukaemia (AML) – an aggressive cancer of the bone marrow that results in a fatal abnormality of the white blood cells.
However, the true cause of death was a negligent mistake by the NHS. Over a decade before, she undergone a hysterectomy for ovarian cancer and been prescribed a course of cyclophosphamide – an immunosuppressant used in cancer care. The recommended course was 12-18 months, however a simple administrative error meant that course completion dates were not recorded or flagged and she remained on the drug for the next twelve years, unbeknown to her consultant and GP.
The overexposure to cyclophosphamide destroyed her bone marrow and was the cause of the AML – however, this was not reported to the family at the time and would have remained undiscovered, had it not been for another mistake by a hospital medical records department a few years later.
I’d only been qualified for a year when she died and worked at the same hospital as her consultant. When a patient sharing the same name of Agnes MacDonald came in for treatment one afternoon a few years later, the notes in the bundle of records I’d been sent were my grandmother’s; therein lay the truth of the matter.
It was clear from the consultant’s final entries and letter to the GP, that the cause of death was overexposure to the drug. But there was no explanation why this had happened, any admission of negligence or suggestions to prevent any similar cases happening again in the future.
At the time, there were few options to pursue enquiries regarding NHS treatment and care of relatives. Complaints managers or liaison services for patients didn’t exist back then and medical negligence litigation was extremely rare, not that any of these would have been a consideration anyway. Not in our family at least.
My grandmother’s view would have been quite simple. Everyone makes mistakes, the important thing is to learn and not cover them up for fear of punishment. That only compounds the problem. She had always been thankful and gracious with all the doctors and nurses that had looked after her over the years – and any notion of a complaint or legal action for negligence would not be something she would have wished for in any circumstance. But I still needed some answers.
I wrote about these events in an earlier essay, but it was not until relatively recently that I realised just how much of an impression they had made – and why the lessons they offered at the time are equally important today as they were back then.
Whistleblowing was unheard of in 1984 – unless you were familiar with the adventures of Winston Smith – and in the NHS particularly, the idea that an employee would seek to publicise through the media, mistakes made in patient care, would primarily be regarded as a betrayal and breach of trust of colleagues; a powerful inhibitor in any consideration. In practical terms, it may also prove counter-productive – negative publicity, loss of trust and respect, blame and punishment – rarely act as a prelude to a satisfactory outcome.
But that was thirty-five years ago and in the interim, the NHS has been politicised and weaponised by successive governments and an increasing number of external agencies with powerful vested interests. Professional bodies, private hospitals & commerce – such as the pharmaceutical industry, medical regulators and the legal profession – each one pursuing a different agenda – are all part of today’s working environment in the NHS.
Ostensibly, these agencies should compliment and enhance the function and performance within the NHS – and improve patient outcomes. In many aspects they do just that. But they also complicate and threaten professional responsibilities for health professionals within the NHS who raise concerns regarding risks to the general public.
When dangerous practice is created by the function or actions of one of these agencies, the risk to the health professional raising concerns becomes substantial. Sadly, over the last two decades, we have witnessed the persecution and victimisation of many individuals in the NHS – and other sectors – who have had their careers ended and reputations tarnished when their concerns implicate the very agencies and institutions whose principal responsibility is to ‘protect the public’.
Raj Mattu, David Drew, Narinder Kapur and Shamila Chowdry all had the misfortune of losing their careers after raising concerns about patient safety in the NHS. The conduct of the agencies involved in persecution of Dr Mattu and Dr Drew led directly to the Public Inquiry headed by Sir Robert Francis, whose condemnation of the conduct by the NHS Trusts and regulators involved in the cover-up of the scandal at Mid Staffs, compelled the Health Secretary, Jeremy Hunt, to make a formal apology in Parliament on 11 February 2015 in response to the publication of the Francis Report.
“Sir Robert confirmed the need for further change in his report today. He said he heard again and again of horrific stories of people’s lives being destroyed because they tried to do the right thing for patients: people losing their jobs; being financially ruined; brought to the brink of suicide; and family lives being shattered. Eminent and respected clinicians had their reputations maligned.
There are stories of fear, bullying, ostracisation, marginalisation as well as psychological and physical harm. There are reports of a culture of “delay, defend and deny” with “prolonged rants” directed at people branded “snitches, troublemakers and backstabbers” and then blacklisted from future employment in the NHS as the system closed ranks.
But the whole House will be profoundly shocked at the nature and extent of what has been revealed today. The only way we will build an NHS with the highest standards is if doctors and nurses who have given their lives to patient care always feel listened to if they speak out about patient care. The message must go out today that we are calling time on bullying, intimidation and victimisation, which has no place in our NHS.”
Jeremy Hunt 11/2/2015
Whilst he was making this statement, I was standing in the dock at Hammersmith Magistrate’s Court being prosecuted for the second time by a health regulator. Hunt was aware of the case – my MP had written several times by then – but the Health Secretary remained silent and refused to intervene. Even after it became known that one of the UK’s worst paedophiles had exploited the loopholes in the legislation and had been practising as an unregistered podiatrist for over a decade until his arrest and conviction in 2016 – Jeremy Hunt refused to acknowledge the regulatory failings at the HPC.
Blatant hypocrisy from a Health Secretary who presided over a regime at the Department of Health that created its own ‘hostile environment’ in the NHS and Social Care with its continued persecution of whistleblowers. Dr Chris Day, the nurses at Gossport and Shrewsbury continue to have their lives blighted by malicious and sustained victimisation by the Department and its partners in the regulatory and legal agencies.
Earlier this month, Norman Lamb MP tabled a debate in the Commons regarding whistleblowing and highlighted the experience of Chris Day.
In recent months, medical and health regulators issued their own guidance on whistleblowing for their registrants. This included the Health Professions Council (HPC) and the Nursing and Midwifery Council (NMC), who jointly regulate over a million health professionals in the UK.
Readers of this blog will recall my own experience at the hands of the HPC after I raised concerns about public safety caused by deficiencies in their primary legislation regarding “protected titles”. Following two criminal prosecutions and fifteen separate hearings over four years – with legal costs for the HPC exceeding £300,000 – I am sadly unsurprised by Norman Lamb’s remarks in Parliament.
I suspect in due course, he will share a similar sentiment when he reads the following.
I am now in a position to advise readers that the legal proceeding have now concluded in my case with this regulator. In January last year, I submitted an application to the Criminal Cases Review Commission after my conviction was upheld by a perverse judgement at Preston Crown Court in June 2016.
The application to the CCRC was based on evidence that the HPC and Department of Health, wilfully and knowingly conspired to conceal the actual provisions governing use of title, thus compelling individuals to register with them when the legislation gave no such authority in law. The HPC – and NMC – fraudulently misrepresented the conditions for registration when they became statutory regulators in 2004 – and their failure to properly disclose the provisions formed the basis of my application to the Commission.
When submitting this in January 2018, I asked the CCRC to obtain the transcript of evidence heard at my Crown Appeal – together with the prosecution and defence papers. The Judge had contradicted herself a number of times in her summary judgement – whilst the prosecuting counsel for the HPC had misled the court regarding disclosure during my evidence. I provided new evidence that the regulator had deliberately concealed essential information from the professions, public and myself as a defendant in a criminal prosecution that had only one purpose: To silence an individual whose persistent defiance threatened to expose yet another scandal in the agencies associated with the NHS.
The CCRC agreed to obtain this material and estimated a conclusion by May 2018. In February 2019, they issued their provisional review – and upheld and reinforced the Appeal Judge’s findings. It was quickly apparent that the Commission had not examined the transcript evidence from the hearing – a fact confirmed in an email exchange on the day the review was received.
When I made my application to the CCRC last January, I asked whether the Commission would have access to the court transcripts of my hearings – particularly the Crown appeal. I was assured they would be available for consideration, if required.
From the Commission’s response, I suspect the transcript of the appeal was not considered. Can you confirm that is the case, please?
Hello Mr Russell,
I can confirm that you are correct – the Commission did not obtain a full transcript of the appeal proceedings, but instead relied upon the detailed judgment of the court that you provided to us in support of your application.
I invited the CCRC to reconsider their decision and set out why their decision and that of the Appeal Court was fatally flawed. I asked them once again to obtain the transcript of the hearing and consider this in context with my submissions.
In May, I received a final decision from the CCRC not to refer the case to the Court of Appeal. They refused to obtain and consider the Appeal hearing transcript and then compounded matters by offering their own interpretation of the legislation, directly contradicting the findings of all the courts during this bizarre case. It was perhaps, given all that had gone before, a fitting conclusion – but not one, I suspect, the CCRC will be especially comfortable with in the very near future.
For transparency, I have uploaded the application and all other papers referred to here:
I had really hoped that there would at last, be a satisfactory outcome in this sorry saga – not least to provide some reassurance all the other health professionals who may, in future, be faced with a similar dilemma that I had a decade ago. Regrettably, I am unable to do that, but what I can do it to offer some advice for all registrant health professionals, doctors, nurses and dentists – who might consider voicing a concern regarding safeguarding but is worried about the implications and impact it may have, professionally and personally.
Document everything; every meeting, conversation and all correspondence.
Be honest, objective, accurate and truthful at all times. Don’t exaggerate any claims. Be concise.
If your initial concerns are rejected or ignored, think carefully whether you wish to pursue the matter further. Consider what other interests might be affected by your claim and how that may impact in future action against you.
Do not trust anyone in authority. Do not trust the institutions you expect to be honest, transparent and forthright – as if we didn’t know that by now.
Do not expect any assistance from your professional body or any other agency you are affiliated with, particularly when they are implicated in the safeguarding issue you raise.
Do expect to lose your livelihood, future career, reputation, home, savings and pension. Your relationships, with loved ones and friends, health, sanity, self-respect and dignity will also suffer detrimentally. At some stage, suicide will seem an attractive solution.
Anticipate little satisfaction from political quarters. Pursuing whistleblowing concerns directly with government Ministers through constituency MPs is a complete waste of time and energy. Particularly when they are in the governing party.
Do not assume any support from the media, unless your claim is sensational and can be summarised in just one sentence. The vast majority of journalists and editors in the media – and their readers – don’t understand complex cases where victimisation, cover-ups and NDAs all form part of the game.
Confide only with close friends and seek the assistance and guidance of others who have experienced similar matters.
Provide an account of your experience with documented evidence for the public and your colleagues to consider.
Be resolute, determined and most of all, believe in yourself, particularly when all seems lost.
As the political chaos with Brexit engulfs Parliament and the country, I watch with a mixture of horror and disdain at the choices facing us for the future Prime Minister. On the one hand we have a fantasist buffoon who can barely string a sentence without contradicting himself – and on the other, a consummate liar; a Machiavellian character who has inflicted immeasurable damage on the NHS and many of the dedicated professionals who work in that sector. A Hobson’s Choice, if ever.
I’ve never considered myself a whistleblower before – just a podiatrist who raised a safeguarding concern through the appropriate channels – and discovered, to my cost, a quagmire of dishonesty, deceit and corruption. Never again. As another matter has exquisitely reinforced, no-one is listening.
The Health Professions Council spent over £300K prosecuting me to cover-up their dishonesty and fraudulent misrepresentation. I was fined £200. My costs including loss of earnings now amount to over £700K. I am now unemployed and in receipt of Universal Credit which provides me with a generous £3.85 per month to live on.
The pendulum always swings back, Mr Hunt. This time it carries more weight than you can ever imagine.
Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death. In other words, it’s your body’s overactive and toxic response to an infection.
It is the third largest cause of death in the UK and kills more people than bowel, breast and prostate cancer combined.
Some people are at higher risk of developing sepsis because they are at higher risk of contracting an infection. These include the very young, the very old, those with chronic illnesses, and those with a weakened or impaired immune system.
But it can affect anyone at any age, even those in good health – and recovery can be a long and difficult journey for those fortunate to survive.
In severe cases of septic shock, the most common cause of death is multi-organ failure due to a loss of blood pressure. To combat this, a range of drugs called vasopressors are administered. These have the effect of constricting the blood vessels in the arms and legs, redirecting the flow to the major organs. Approximately 40% of critical care patients with septicaemia require vasopressor administration. Unfortunately, this necessary regime has serious complications with life changing consequences for many patients.
The primary complication is a condition called disseminated intravascular coagulation (DIC), which occurs when trapped blood in the constricted arteries in the arms and legs, coagulates (or clots) and blocks the vessel. When the drug regime is discontinued and the blood flow returns to the limbs, these clots impair the re-vascularisation and gangrene occurs. Many of these patients then undergo limb salvage and amputation, often in multiple limbs – with mid-calf and above-wrist level amputations not uncommon.
Currently there is no NHS treatment for DIC induced ischaemic and gangrenous limbs other than salvage surgery.
In 1999, Tom and Nicola Ray were newly married and expecting their second child when, almost overnight, their lives were thrown into turmoil. Tom developed sepsis following a dental procedure and within a day of onset, he slipped into a coma. He was 38 years old.
When he woke up five months later, Tom discovered he had undergone quadruple amputations to both hands and feet, with additional facial amputations as a result of sepsis. He couldn’t remember who he was and didn’t recognise his family. During his coma, Nicola gave birth to their second child, but their difficulties were far from over.
Tom and Nicola lost the business they were running together and had to sell their house and move out. There followed several years of reconstructive surgery..
“I had to go through several years of extremely painful facial reconstruction operations to get a cosmetic nose and to make me look not so ugly. But the surgeon at the London Hospital gave up in the end – he is the best in the world but he said there was nothing more they could do about my face. I never understood why but apparently it was too difficult.”
Last year, an extremely moving film detailing Tom’s journey to recovery was released at the Edinburgh Film Festival. It should be seen by everyone.
When Scottish businesswoman Corinne Hutton from Lochwinnoch, fell ill at age 43 in June 2013 after suffering acute pneumonia and sepsis, surgeons were forced to amputate both her hands and her legs below the knee. Prior to her illness, Corinne was a busy small business owner, devoted Mum and regular fitness fanatic, setting herself challenges like running marathons, cycle rides and climbing expeditions to raise money for worthy causes. Earlier this year, Corrine underwent a double hand transplant and is presently recuperating, but like Tom and Nicola, she has since devoted herself to raising awareness of sepsis and its devastating complications and helping those who have lost limbs. Brave and amazing people all.
Five months ago, I wrote about the experience of a friend, Alan Bowell, from Blackpool who contracted sepsis last September and was gravely ill on admission to hospital. Alan had recently started taking medication for Crohn’s Disease – an immunosuppressant called Azathioprine – and was nine days into the course when he became disorientated and shivering uncontrollably.
He wasn’t made aware that immunosuppressant therapy can be a contributory factor in sepsis cases – and consequently, remained ignorant of the clinical signs and symptoms of the disease. Alan thought he was coming down with the flu and didn’t seek any medical help until the following morning when his condition deteriorated significantly. His last memory before he fell unconscious was being helped into the ambulance at home.
Ten days later, when he regained consciousness he discovered gangrene was already established in both feet and the fingers of his right hand and the prognosis was poor. Alan had undergone a colon resection a few days after admission and had a stoma fitted, but a surgeon advised he would require further operations to the gangrenous limbs, before a stoma reversal could be considered.
In cases of vascular insufficiency, with accompanying tissue necrosis and gangrene, a demarcation line is often found encircling the affected limb. This represents the boundary between the truly viable and dead or dying tissue. In limb salvage the level of amputation is determined by the demarcation line to ensure healing takes place.
Three weeks after regaining consciousness, the demarcation line in both Alan’s legs was mid-calf and in his right arm, just above the wrist.
From the previous post you will have read that Alan started a course of hyperbaric oxygen treatment when he was discharged home the following week. I wasn’t aware that he was ill until six weeks after he was admitted – and a month after he regained consciousness. When I visited him on 24 October, I was shocked by his appearance. We’d played guitar together late August and enjoyed a meal and drink. He was in great form.
Within just two months he looked dreadful, lost over two stones and dwarfed in the standard issue NHS high backed chair. It took a bit of time to adjust – just thinking about what he had gone through and what he was now facing. I’m not sure if I was in that position – the very real prospect of losing hands and feet – if I could even face it for a day. But here he was. Knackered, confused, frightened, angry but very determined. At that point, I’m not that sure I understood why.
As he told me what he knew had happened – falling ill, coma, abdominal surgery with bowel resection and stoma – and gangrenous fingers and toes (with established demarcation), I remembered something vaguely similar in the past and mentioned it to Alan.
When the ward doctor called in, we asked him about the possibility of starting hyperbaric oxygen treatment, but he hadn’t heard of it. Nor had any of Alan’s other doctors he was to subsequently see. The vascular and plastic surgeon he was referred to told us there was no evidence that HBOT helped limbs affected by vasopressor administration, but nor did they think it would do any harm.
So, the following week, when he was discharged from hospital, Alan started a seven-day course of HBOT at ‘A Breath for Life’ near Lancaster. After the first one-hour session, he reported feeling ‘tingling and pins and needles’ in both feet and his right hand. By the end of the course the demarcation lines in all three limbs had disappeared and pulses were present again in both feet.
Over the following three months, some recovery of necrotic and gangrenous tissue was established and new skin has since formed. Alan finally underwent salvage surgery in March this year to remove the putrefied tissue of his right forefoot, the apex of three toes on the left – and the tips of two fingers on his right hand.
He is making a good recovery and is hoping the stoma reversal will be scheduled in the very near future. Two weeks ago, he played his first gig since last August and it was a privilege to watch him perform.
I’m not a sepsis or vascular specialist, simply a podiatrist that recalled a similar case a few decades ago and assumed – wrongly, as it turned out – that pressurised oxygen treatment was already playing an important role to play in restoring circulation to limbs affected by vasopressor administration in sepsis management.
To discover that this is not the case in the NHS was astonishing. It certainly worked with Alan, which we are all grateful for – although I can’t help wonder how much more of his limbs could have been saved had the HBOT been started much earlier. Time is the critical factor – once the tissues and blood vessels degrade past a certain point, they are unrecoverable.
But when one considers just how many other patients are facing a similar prospect and prognosis currently, it seems inconceivable that they should be left with no other option than the surgeon’s knife.
Until very recently, I had no idea how HBOT worked in these cases. When I searched for articles online, I discovered no published articles reporting or supporting its use in preventing limb loss in sepsis recovery patients.
However, there were numerous articles on limb loss from vasopressor induced ischaemia following septic shock – and these explain the mechanisms that cause the loss of blood supply and tissue necrosis. The blockage of arteries by clots of coagulated blood – DIC – resonated with me when I read the first article. It is the same mechanism of injury that occurs in severe frostbite – and I’ve known a few people over the years climbers and patients that have lost fingers, toes and limbs from prolonged exposure to the cold.
When searching for DIC in frostbite gangrene – I found several prominent articles citing the use of HBOT for the treatment of frostbite, which explained in detail how pressurised oxygen helped re- vascularise limbs affected by cold induced DIC – even with established high level demarcation and gangrene.
It appears that the mechanism of injury – the coagulated clots in the blood vessels that impair the return of the blood flow – and subsequent tissue death – are the same in severe frostbite and those recovering sepsis patients. In the former, it is extreme cold that closes down the circulation – in the latter it is the drugs used to combat the loss of BP and multi-organ failure in severe septic shock management.
Subsequent searches on different medical and scientific databases have revealed numerous articles citing the use of HBOT for frostbite – many as the ‘gold standard’. Pressure chambers are now installed in most scientific stations in the Artic and Antarctic – as well as various sites in the Himalaya – specifically for that purpose.
Scientists and medics from Norway, Denmark, Russia and Canada use the HBOT chambers in the Artic – and all reports/papers demonstrate favourable outcomes and a considerable reduction in limb/tissue loss.
Recent papers cite a combined regime of HBOT, thrombolytics and manual physiotherapy/massage initiated as soon as possible following injury provide the best outcomes. If this works for frostbite, it may prove beneficial in sepsis care to prevent limb loss.
As Alan remarked, “It seemed like a good positive thing – and what did I have to lose, except the obvious?”
So, although I am no longer in practice, I thought it might be a good idea to report it to someone, especially as it seemed no-one in the NHS had even heard of HBOT, never mind its use for these patients. In January, I wrote to my MP and asked him to notify somebody in the Department of Health and two months later they replied saying following a recent review, HBOT was only now commissioned for decompression sickness in diving injuries and before they’d consider it further, they’d need a detailed proposal from a relevant specialist.
There are no HBOT facilities in the NHS and most of the private/charitable centres use multi-person chambers we are all familiar with. However, single use units for intensive care are used in many other countries. They are inexpensive and simple to operate and take up no more space than a hospital bed.
I’ve since written 98 emails to various people I think might be vaguely interested – the editors and presenters of news programs every time sepsis is mentioned, which is fairly regular these days. Same with newspaper health and medical correspondents who write regularly about tragic cases like Tom and Corinne – and other sepsis patients. To Ministers, shadow Ministers and other politicians – and even places like the Sepsis Trust and other charities.
Unfortunately, I have yet to receive an acknowledgement never mind a response from any one. You’d think I would know better by now….
I’m publishing this now in the hope it gets shared through social media, text or word of mouth – so that those of you who may one day find yourself in a similar predicament and told, like Alan, that nothing that can be done – might now be able to offer a suggestion to the medical team that could be very worthwhile.
You will encounter scepticism if not opposition; the majority of NHS doctors will search internet and find no evidence – and that’s what forms their opinion today – but if you are the victim or relative or friend, please persist and cite this post and the attached articles as evidence.
Hopefully someone else will join up the dots very soon. Of the 200,000 plus survivors of sepsis every year in the UK, a not insignificant number of people will require salvage surgery and amputations as a direct result of the drugs given to save their lives. It really shouldn’t be one or the other.
This may well prove to be a low-cost, simple, safe and evidenced solution for a tragic, horrific condition that the NHS is simply ignoring and leaving to deteriorate without intervention.
Please share if you think it useful or appropriate, thank you.
A 65-year-old man develops systemic peripheral gangrene (SPG) following hospitalisation for acute septicaemia and pneumonia. On admission, it was established that he was ten days into a course of Azathioprine, an immunosuppressant used in the management of Crohns Disease. Ischaemic changes to all limbs were noted one day after admission, consistent with disseminated intravascular coagulation (DIC).
He is kept in an induced coma for ten days, but on recovery, discovers necrotic and gangrenous changes to all hands and feet. At an initial a surgical consult, he is advised that it is likely he will require both feet and hands to be removed. He remains in hospital under observation for a further three weeks, at which point, the demarcation line is mid calf and above wrist in the respective limbs. A further surgical consult confirms bilateral BK and above wrist amputations, but surgery is delayed until he makes a full recovery from the sepsis.
At the conclusion of the seven-day course, re-vascularisation of all limbs was achieved and over the following month, there was rapid sloughing and granulation to many areas of gangrenous and necrotic skin.
Three months after discharge, there remains dry gangrene to the right forefoot, and the end of the three middle toes on the left foot. The terminal phalanx of two fingers on the right hand are also unrecoverable. His surgical prognosis, is however, substantially improved, with only the right foot requiring salvage beyond the toes.
There isn’t any published literature that details the use of HBOT for SPG following acute systemic infection like sepsis or meningitis, but I recall being told of a similar case over four decades ago following an abdominal puncture wound to a diver during sub-sea installations in the North Sea. Subsequently he developed septicaemia with resulting ischaemia and SPG in all limbs.
He remained in decompression during his treatment and rapidly made a full recovery with no limb or even tissue loss.
Over the last four decades, the use of HBOT in a variety of medical conditions is becoming more widespread, particularly with ischaemic conditions such as cerebral palsy, strokes, diabetic and neurovascular foot and leg ulcers, where increased blood flow and oxygen perfusion can improve outcomes significantly.
Whilst I appreciate that n=1 is no basis to claim vascular recovery can be achieved in all cases of SPG by commencing a course of HBOT at the earliest opportunity, it is surely worthy of consideration.
Limb loss following septicaemia and meningitis is a life changing experience for the survivors – and a huge cost to the NHS in continuing care.
The gentleman referred to in this post was not a patient, but a friend of mine – a very good blues guitarist from Blackpool, who thankfully will be able to play again sometime soon – and drive himself to gigs. For others, the road is much more daunting.
So, to any vascular or sepsis specialists out there with responsibility for managing someone with SPG following septicaemia or meningitis, it may be worthwhile considering HBOT as a preferred option for limb recovery in these tragic cases.
Dad was born in the mining village of Cardenden on 15th October 1937, the first of two children to Jack and Mary Russell His father was a miner at the local pit and it’s reasonable to assume that Dad’s early childhood was not one characterised by luxury, not least because of the hardships that were to follow during and after the second world war, which started a month before his second birthday.
He spent many days during his formative years with his maternal grandfather, who introduced him to the art of fly-fishing, but only after he had learnt to tie his own flies and to cast properly, which he practised on the football pitch at the side of the River Ore. He knew of all the good pools on the river – and on the Fitty, down the ‘Meedies’ and every other bit of water in Fife – treasured information passed down from generations – something he put to good use.
I was with him many years later, in a reversible role, when he hooked an enormous brown trout at the ‘meetings’ – where the Fitty joins the Ore at Glencraig and it took nearly ten minutes to land. It was a monster, almost 5lbs, dark brown with big hooked jaw and I was too scared to go near it. I was only nine or ten at the time, but I remember him telling me about the pool and that his granddad once told him about the fish that were to be had under the branches of the trees on the opposite bank.
He was a creature of habit and kept to a fairly rigorous routine, something that was evident from an early age. His little sister, Irene, remembers Dad taking her to the village cinema where they used to sit in the same two seats every week. Woe betide anyone having the temerity (or stupidity) to sit in them before they arrived. There would be no reasoning with him. Thrawn wasn’t the word for it!
As a teenager, Dad attended Auchterderran High, where his prowess on the sport’s field outshone his academic achievements by a margin. That is not to say he was lacking in the classroom – far from it – but it was his athleticism and skills on the football field that were to combine into something truly remarkable. He made his first appearance for Dundonald Bluebell – the local Junior team – when he just turned fifteen and soon gained a reputation for being a fearsome tackler with a great turn of speed on the wing.
It was 1953. In March, he was selected to play for East of Scotland -v- Sunderland in the senior schools competition at his favourite position of right back. The inside right for Sunderland was Robert Charlton, better known, of course, as Bobby – and the pair were to meet again a few months later at Filbert Street in Leicester in the Schools Home Internationals. Bobby went on to be one of football’s greatest ever players – and whose goals will live on in the memory of everyone that ever loves the game, far beyond Manchester. But he didn’t score in either match back then. “I didnae let him” was the only boast I ever recall Dad making.
Dad played against Wales the following week and the young Scots went on to win 2:1 – then went on for trials with Liverpool and Hearts but a change in circumstances at home following his parents’ divorce took him in a different direction. A career in football then didn’t provide the security in the game today. Bobby (Charlton) trained as an electrician and Tom Finney (who was a patient of mine many years later) as a plumber – something to fall back on if they didn’t make it or were injured. As the new breadwinner at home, Dad didn’t have this latitude – so he gave up football and instead started a sales job in the Cooperative Shoe Shop in neighbouring Lochgelly, where a young girl by the name of Anna MacDonald worked in the ladies section. They were soon an ‘item’ in today’s parlance and one that was to endure.
The following year saw Dad enlist in the army as part of his National Service, which he served with 2 Para in the Middle East – first in Egypt during the Suez Crisis and then in Palestine. During his ‘square bashing’ at Aldershot, he was ‘volunteered’ as the Foot Orderly for his troop – an essential role to combat the crippling damage inflicted on squaddies feet during route marches from the army issue boots.
Blisters were soon his forte. It was, in hindsight, an unlikely apprenticeship and the start of another journey – one that would last for many years and lead him into a career, where he would continue to provide relief and comfort to many others that sought his skills and care.
In September 1960, John and Anna were married at St Andrews Church in Lochgelly and the following year, he opened his first chiropody surgery in the Main Street next to the Cross. I made my appearance a few months later and was a regular visitor in the practice by all accounts and some of my earliest memories are of Dad sitting in front of an old lady’s feet, the black Bakelite telephone with the two buttons and an overpowering smell of Dettol and TCP.
In 1966 the local Council introduced a chiropody scheme for old folk and Dad was asked to join the team, which was headed by Jim Ivers, a chiropodist from Northern Ireland. The following year, the NHS took over the service and Dad started work at the newly built Rosewell Clinic in Lochore and closed the Main Street surgery. But he kept his private practice running in the evenings, doing home visits most days after work and on Saturday mornings too. His services were always in great demand. Football would have been a gamble, but chiropody provided Dad with everything he needed and ever wanted – security, respect and the satisfaction of doing a good job.
We were all fortunate as a result. In April 1965, Mum arrived back from Kirkcaldy one afternoon carrying a tightly wrapped bundle with a shock of blonde curls at one end and suddenly I had a wee sister to entertain and play with for a year before I started school. A few months after Susan was born, we moved from a shared rented cottage in David Street to a brand new council house in Stewart Crescent, where we grew up and where Mum and Dad would spend the rest of their lives.
Our childhood was idyllic – a strange thing to say all things considered. Lochgelly was different back then – a working-class mining village for sure, but proud, ambitious and hopeful too. Dad’s job provided us with not only the staples, but also many of the luxuries he could only dream of as a child – holidays all over Scotland and everything we needed at home. His first car was a Hillman Minx followed by a run of Austin Maxi’s, which he loved. This was mostly down to the fact they could accommodate everything Mum would take on holiday with us – which was most of the house bar the furniture.
Oban was a favourite destination and became a regular haunt twice a year during the summer and autumn holidays. Dad had a patient that owned the caravan site in Benderloch and we spent many enjoyable weeks there. During the really hot summer in 1976, Dad took a notion to climbing Ben Cruachan after a day trip to the hydro scheme at Loch Awe. A few days later, we were sitting on the summit looking down on Loch Etive under clear blue skies.
It was a special day – the first of many in the mountains for both of us. The next few years would tick off many Munro’s all over the Highlands and what started as a holiday adventure, soon became a regular weekend feature.
Dad joined Lochgelly Bowling Club in 1960 and with both Mum’s parents they soon became regular names on trophies and club championships. He played at Lochgelly for 48 years until Mum’s death in 2008 and was regularly selected to play for the county team over the years. But he was modest and an intensely private man too. He didn’t like a fuss and certainly didn’t crave the limelight.
I only found out about his football history when I was a teenager and went rooting one Saturday afternoon in the attic and opened an old suitcase I hadn’t seen before. The first thing I saw was his Scottish Cap – then a pair of leather-studded football boots and horsehair shinguards – and not for the last time thought, “who is this man that’s called, Dad?”
When I played football for the school team, he would come to every game and stand quietly on the touchline and only make comment afterwards, if at all, but when he did, it seemed to make sense. But I had no idea. He was a season ticket holder at Dunfermline for a few years and used to take me to the home games on the supporter’s bus. It was the era of Willie Callaghan, Alex Edwards, Jock Stein – we watched many great games at East End Park and internationals at Hampden and he’d dissect the game on the way back home in the car or on the bus and I just used to sit and smile. What the heck did he know about football, after all?
That’s just how he was. After nearly two decades at Rosewell Clinic, Dad was promoted to District Chiropodist in Dunfermline where he worked in Carnegie Clinic managing the chiropody team in West Fife, until his retirement from the NHS in 1997. He kept his private practice running for another decade though and continued to ‘do the feet’ of many in Lochgelly, including some that first visited him in the Main Street shop almost half a century before.
With Anna, Dad found his perfect partner – they really were a beautiful couple in so many ways – and they complimented each other in every respect. It was an enduring romance but like all good relationships, the ending was always going to be hard to bear. When Mum was diagnosed with MND in 2007, Dad found it hugely difficult to accept, which is not in the least surprising. When she passed a year later, a big part of Dad left too – and that set the scene for the remainder of his journey.
Dad liked Soor Plooms and Barley Sugars. He whistled tunes that sounded like the Clangers and clucked his tongue like Skippy the Kangaroo. He loved music though, especially The Corries and he was a life-long Nationalist, long before it became fashionable. A brilliant smile and an avid reader throughout his life. His favourite story was Geordie – about the young boy who won a Gold Medal at the Commonwealth Games in New York.