NHS: A Sacred Cow Or A Dysfunctional Bureaucracy

Political failures and corporate greed have brought the NHS to its knees, and led to my mother’s death

While the rest of the country obsesses over Brexit and the election and our political leaders, Jezza and Boris, compete to win the award for making the title of most outrageously dishonest pledge to protect the NHS I am unusually quiet on matters of politics, because I am still getting over the loss of my lovely wife Teresa who died of respiratory failure,while  surrounded by highly trained medical professionals and millions of poundsworth of hi tech equipment.

Only last week a story featured on the BBC main news of a young man, Mark Stuart, who was admitted to the same hospital as Teresa routine surgery, and having bee prepped for his operation, was left untended after the surgery was deyated and left without food or water for FIVE DAYS, The story is no longer online at BBC News but a report can be read on the Lancashire Evening Telegraph website..

You will read how the efforts of Mark’s parents to get to the truth of what happened and how such a cock up could go unnoticed for FIVE DAYS have been delayed, obstructed and obfuscated by snivelling little parasites who have brown nosed their way to roles far beyond their lavel of competence in the dysfunctional centralised bureaucracy that runs the national Health Service.

My wife’s case is still under investigation so I cannot go into great detail, but in view of similarities with the case of Mark Stuart and others involving the same hospital let’s just say a pattern has emerged.

Another case which has aspects of the same pattern featured in the i Newspaper today and is reproduced below in this not for profit blog under fair use terms, for public information.

The time where we could accept cautious evolution has passed – our NHS today needs a revolution
from the i Newspaper

“I love you too much, you have a heart of gold. Look after your Papa.” These were the last lucid words my mother said to me as I hugged her tighter than I’d ever done in my life. A week later she was gone.

One year ago at 2:32pm on the 29th November, Dr Anisha Malhotra took her last breath. A GP that had dedicated over 25 years of her life to the NHS was ultimately failed by it.

Four weeks earlier my mother had been admitted with a temperature and excruciating back pain. She was diagnosed with discitis, which proved to be resistant to antibiotics. A secondary heart attack as a result of the stress on her already frail body was enough to tip her over the edge. But what happened in hospital, which eventually led to the premature death of a 68-year old lady in the most horrible of circumstances, and the profound emotional trauma of family members witnessing it, was entirely avoidable.

Lifestyle-related disease – a result of consuming too much ultra-processed food and inactivity – had left her overweight, resulting in hypertension and severe osteoarthritis. Years of popping ibuprofen like Smarties to deal with joint pain made her anaemic, and loss of appetite made it particularly difficult to get enough nourishment from her vegetarian diet. Weak bones from malnourishment and lack of activity brought her to hospital twice last year in the space of four months.

‘The system is struggling to provide even basic quality care to many patients.’

An overstretched system

Although remarkably strong in spirit she was extremely frail and weak by the time she was admitted to hospital for the final time. But rather than allow her to die with dignity, an overstretched system meant a missed heart attack was only noted by her medical team eleven days after it was reported.By then it was too late to save her. Excess intravenous fluids led to heart failure. It took several days of diuretics to make her comfortable and allow her to be taken off oxygen. But by then she’d slipped into a deep coma, never to wake up again.

There can be no doubt years of austerity and NHS underfunding have led to a shortage of nurses and doctors unable to keep up with increasing demand. But even if that were to be resolved overnight it would be at best no more than putting a sticking plaster on a severed artery, because the system is struggling to provide even basic quality care to many patients.

Lifestyle factors and ‘too much medicine’

The two major reasons for this are simply not being addressed: maldistribution of resources through “too much medicine”; and diet-related disease. Former medical director of NHS England, Sir Bruce Keogh, has previously stated that one in seven operations and treatments should never have been carried out on patients in hospital.

The Academy of Medical Royal Colleges waste report stated that “one doctor’s waste is another patient’s delay”. For my mother that meant waiting for two extra hours (because of understaffing) to be prescribed oxygen and diuretics whilst in crashing pulmonary oedema, an experience that can only be likened to drowning but remaining alive at the same time. And this is despite my father, a doctor, watching by her bedside totally helpless to relieve the suffering of his life partner of 45 years.

The root of our healthcare crisis

This can and must not be taken as attack on the NHS itself. Instead, it’s an indictment on what is at the very root of our healthcare crisis: those vested interests that have brought it to the brink of collapse. The increasing burden of diet-related disease is at the heart of increasing demand on the NHS, yet there is absolutely nothing in the Conservative manifesto on policy changes to deal with the public health crisis.

It also does not address the tainted, industry-biased research which continues to cause significant harm to patients, with side effects of medications one of the leading causes of death. If 93 per cent of medical research is of questionable reliability and not relevant to patients it’s going to lead to bad outcomes, and that’s what we’ve got. But such lack of action is perhaps not surprising.

A BMJ investigation earlier this year highlighted that the Conservative party has received £4.3m from “free market” think tank, the IEA, that has opposed public health initiatives to tackle obesity, such as calorie labelling and advertising restrictions on unhealthy foods. This organisation has received funding from tobacco companies and the sugar and soft drinks industries.

 

‘It is now time all doctors also took some responsibility’

Following the cash-for-questions scandal in 1994, the then Prime Minister, Sir John Major, set up the Committee on Standards in Public Life. A subsequent report made it imperative that all those in public life, including MPs and Doctors whose primary duty is to serve the needs of the people, uphold the seven so-called “Nolan principles”: selflessness, objectivity, integrity, accountability, honesty, openness, and leadership.

The excesses and manipulations of industry that put personal greed and wealth before health would not be possible if it were not aided and abetted by regulators, politicians and powerful scientists.

It is now time all doctors also took some responsibility for and action against system failures that make their jobs unmanageable and, most importantly, deny patients timely and quality care. Corporate greed and systematic political failure have brought the NHS to its knees.

The system is broken and money alone cannot fix it. The time where we could accept cautious evolution has passed – our NHS today needs a revolution. No one should suffer like my mother, and no family should have to witness it.

Dr Aseem Malhotra is an NHS Consultant Cardiologist and Professor of Evidence Based Medicine

My mother’s vegetarian diet contributed to her early death. We should all learn from it

NHS cardiologist Dr Aseem Malhotra: my mother’s diet was full of ultra-processed foods and was ultimately to the detriment of her health

Two weeks ago, my father and I made a trip to Rishikesh in northern India to scatter my mother’s ashes in the River Ganges at an idyllic location at the foothills of the Himalayas. This was in keeping with her wishes as a devout Hindu that her spirit be released at a place she loved and previously visited on pilgrimage. Our family lost a greatly cherished mother and wife who went before her time, at only 68 years old.

I believe that what was finally written on her death certificate – severe sepsis and discitis with concomitant myocardial infarction (heart attack) – was entirely avoidable.

‘Growing up, I witnessed her regular consumption of starchy carbohydrates and ultra-processed snack foods of biscuits, crisps and chocolate. Our kitchen was flooded with these products’

i’s opinion newsletter: talking points from today

For most of her adult life, my mum was vegetarian and significantly overweight. Growing up, I witnessed her regular consumption of starchy carbohydrates and ultra-processed snack foods of biscuits, crisps and chocolate. Our kitchen was flooded with these products. I still have a vivid memory of her only meal on a weekly fast day consisting of a large chapatti and what can only be described as a mountain of table sugar. Her weight contributed to developing high blood pressure in her 40s and as a result, she suffered a brain haemorrhage in 2003.

Despite making a full recovery, taking up going to the gym and even learning to swim at the age of 50, the next 10 years resulted in a gradual deterioration in her mobility. Obesity related osteoarthritis led to slipped discs and severe degeneration of her spine, forcing her to take early retirement from General Practice.

Her vegetarian diet required her to take Vitamin B12 and iron supplementation. Protein deficiency led to sarcopenia (a decline in muscle mass) which limited her mobility even further. In the last six months of her life, she had two hospital admissions with agonising spontaneous sequential bilateral osteoporotic fractures of her pelvis. By the time she passed away, even high doses of morphine weren’t enough to completely ease the additional excruciating back pain from an infection in her spine.

What I see in my job as an NHS cardiologist

Such cases are not unusual for me to see as a cardiologist working in the NHS. The majority of those admitted with heart attack are not obese but have a condition known as metabolic syndrome  (photo: Pixabay)

Such cases are not unusual for me to see as a cardiologist working in the NHS. The majority of those admitted with heart attack are not obese but have a condition known as metabolic syndrome  (photo: Pixabay)

Although, as in my mum’s case, it is widely acknowledged that obesity is associated with the development of chronic disease, a not well-known phenomenon of being “overfat” (defined as excess body fat that can impair health and contribute to chronic disease) is now estimated to affect 70 to 80 per cent of the Indian adults and 41 per cent of children.

A large percentage of overfat individuals will have a normal Body Mass Index, with up to 50 per cent having excess body fat linked to risk factors for disease.

I recently learned an uncle of mine who has been a “slim” physically active vegetarian all his life, and never smoked, had a triple coronary bypass for three occluded heart arteries aged only 69. This was less than a year after being diagnosed with type 2 diabetes and high blood pressure. When I spoke to him, he admitted for the last twenty years his diet was high in flour based and sugary foods, but he believed because he wasn’t overweight he was perfectly healthy.

The diabetes capital of the world

Such cases are not unusual for me to see as a cardiologist working in the NHS. The majority of those admitted with heart attack are not obese but have a condition known as metabolic syndrome with one of the major components being increased waist circumference. The significant limitation of BMI (calculated by dividing one’s weight in kg by height in metres squared) is that is that it fails to take into account age, ethnicity, bone structure, fat distribution and muscle mass.

‘It’s instructive to note that India, with more vegetarians and vegans than the rest of the world combined, is the “diabetes capital of the world”‘

In developed countries such as the USA, New Zealand, Greece, and Iceland the prevalence of having excess body fat has reached over 90 per cent. In the UK, it’s estimated that 86 per cent of the adult men and 77 per cent of women are overfat. Excess body fat, which acts as a substrate for chronic inflammation and insulin resistance, is now implicated in the development of type 2 diabetes, high blood pressure, cardiovascular disease, arthritis, osteoporosis, cancer and Alzheimer’s.

It’s instructive to note that India, with more vegetarians and vegans than the rest of the world combined, is the “diabetes capital of the world”. The city of Chandigarh has the highest prevalence of type 2 diabetes in the country and the state of which it is capital, Punjab, has 75 per cent of the population as vegetarian. In the subcontinent, the last 50 years have specifically seen significant increases in consumption of processed wheat, sugar and vegetable oils (which have overtaken animal fats as a percentage of calories).

Majority of vegetarians not following a healthy diet

(One can have a very healthy vegetarian diet but the majority of vegetarians in the world are clearly not following this (Getty Images)

(One can have a very healthy vegetarian diet but the majority of vegetarians in the world are clearly not following this (Getty Images)

The Indian Dietetic Association recently put out a statement claiming 84 per cent of vegetarians in the country are protein deficient versus 65 per cent of meat eaters. As one of New Zealand’s most eminent dietitian’s Dr Caryn Zinn told me: “Calorie for calorie, meat is more proteinaceous and nutrient dense than vegetables. Of course, one can have a very healthy vegetarian diet but the majority of vegetarians in the world are clearly not following this.”

A large observational study conducted in Australia in 2016 concluded that contrary to popular belief, once other lifestyle factors were accounted for, vegetarians do not live longer than non-vegetarians in the developed world. Similarly, a large Austrian study published in the prestigious medical journal PLOS 1 found that despite having a lower BMI and less alcohol consumption, “a vegetarian diet is associated with poorer health (higher incidences of cancer, allergies and mental health disorders) a higher need for health care and a poorer quality of life.”

‘The point about saturated fat is: the evidence is now looking pretty good, but the guidance hasn’t shifted’

The totality of evidence does not find an association with the consumption of unprocessed red meat and reduced life expectancy. The association of the dietary saturated fat and heart disease found in high amounts in animal products has also been debunked in a paper I coauthored with two eminent cardiologists.

Taking much of this evidence into consideration after two days of debate and discussion at the international science and politics of nutrition conference jointly hosted by medical reinsurance company Swiss Re and the BMJ in June last year, the editor in chief of the journal Dr Fiona Godlee remarked: “The point about saturated fat is: the evidence is now looking pretty good, but the guidance hasn’t shifted […] there doesn’t seem to have been an enormous ‘mea culpa’ from the scientific community that we got it so wrong. That does surprise me.”

A focus on starch, sugar and salt reduction instead

(Pexels) Population-wide strategies to curb obesity should now discard fat and saturated fat and focus on starch, sugar and salt reduction instead.

(Pexels) Population-wide strategies to curb obesity should now discard fat and saturated fat and focus on starch, sugar and salt reduction instead.

Dariush Mozaffarian, Dean of the Freedman School of Nutrition Science And Policy at Tufts University, Massachusetts, told me at the event in Zurich that population-wide strategies to curb obesity should now discard fat and saturated fat and focus on starch, sugar and salt reduction instead.

Ultra-processed food now makes up more than half of the British diet and is strongly linked to weight gain and even cancer. Ultra-processed is broadly defined as industrial formulations (any packaged food) with five or more ingredients. And when broken down into food groups, 77 per cent comes from sugary products and drinks, starchy foods and breakfast cereals, and ultra-processed fruit and vegetables. 19 per cent comes from ultra-processed meat, fish, eggs and dairy, and two per cent from “fats” and two per cent from salty snacks.

‘There’s been much media hype recently suggesting that adopting a meat or animal product free diet is best for human and planetary health, but this is not evidence-based’

There’s been much media hype recently suggesting that adopting a meat or animal product free diet is best for human and planetary health, but this is not evidence-based.

An independent report from the US Department of Agriculture predicts complete removal of animals from the food supply would only reduce total US greenhouse gases by 2.6 per cent but simultaneously increase dietary energy consumption from a plant only system and worsen nutritional deficiencies.

Not less meat, but better meat

Red meat happens to be one of the best sources of zinc and Vitamin B12 (Photo: Miguel Mendez/AFP/Getty Images)

Red meat happens to be one of the best sources of zinc and Vitamin B12 (Photo: Miguel Mendez/AFP/Getty Images)

 

“We don’t need less meat but better meat in the food supply,” said Dietitian and organic farmer Diana Rodgers. She recently wrote a devastating critique of the “nutritionally deficient” Eat Lancet report which recommends we consume less than half an ounce of red meat per day, the equivalent of one eight of a steak.

 

Red meat happens to be one of the best sources of zinc and Vitamin B12, a supplement of which needs to be taken by up to 92 per cent of vegans. “Well-managed cattle can also be one of our best tools at mitigating climate change,” Rodgers added, citing a study that shows how methane-emitting cattle can actually be a carbon sink, when looking at the full life cycle. “It’s not the cow, it’s the how.”

 

‘The biggest beneficiaries could very well be the ultra-processed “meat and dairy free” food industry, the vitamin and supplement industry and a predictable rise in the overfat epidemic and associated chronic diseases would be a cash cow for Big Pharma’

So whilst population health continues to suffer, the biggest beneficiaries could very well be the ultra-processed “meat and dairy free” food industry, the vitamin and supplement industry, and a predictable rise in the overfat epidemic and associated chronic diseases would be a cash cow for Big Pharma.

My mother dedicated most of her adult life to working as a GP in the NHS and was one of the most kind and compassionate people I have ever had the privilege of knowing. She wholeheartedly supported my public health advocacy work as it was in line with her philosophy as a Hindu to put Dharma (duty) to the community as paramount.

Sadly, her devout religious faith to avoid consuming animal products, combined with a high starch, high sugar diet, was ultimately to the detriment of her health. I very much hope that her premature and painful death was not in vain and we can learn that much of these ills are preventable.

Dr Aseem Malhotra is an NHS Consultant Cardiologist and Professor of Evidence Based Medicine. He is donating his fee for this article to Children in Need. 

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Labour planned to privatise 40% of NHS as hypocrite Corbyn takes aim at Johnson
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