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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in oncology after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Friday, 15 March 2013

Look after the pennies and the alcohol will take care of itself

I'm pre-nights.  I've spent 3 out of my 5 days off at some sort of work related teaching/course etc.  I'm a little bit cranky secondary to this.


I just wanted to have a wee chat about this whole minimum price for alcohol issue that is rather a hot topic in the UK.Read more here...

Genuine confusion from me about why this is so controversial.

I feel before I start, I should lay out my own drinking habits.  I tend not to drink much alcohol, or anything, during the week.  If I went out for a meal, I'd probably share a bottle of wine with someone.  If I go to the pub, I'd have a pint and a half maybe.  I'm no Saint, particularly back in my student days, and occasionally now if I have a really awful day, but I'm generally not that bothered by alcohol.  If prohibition was back tomorrow, it'd be no biggie.

So the main statements against minimum pricing for alcohol seem to circle on an attack on personal liberties and the feeling that this won't make any difference anyway.

On the former - I find this... surprising.  Apparently moderate drinkers will be punished - really?  Under the proposals, the cheapest a bottle of wine would be is still less than a fiver.  I think most discerning drinkers would say that's still unbelievably cheap for 12 units of alcohol.  As one of said moderate drinkers, I do not feel this infringes my personal freedom.

What I see is very much the end that Sarah Woollaston is on about - the bit where people come into hospital and have had their entire lives ruined by alcohol.  In my current work environment, this can be as pancreatitis, bleeding ulcers in the stomach, liver failure... but it can also be an 'aside' part of their health problems, where they have family or employment problems as a result of alcohol.  Withdrawal effects can also be severe and life threatening.  Many have argued that increasing the cost of alcohol won't make a difference and that people will still drink.  I'd argue two things for this.  First, we cannot predict that it will stop people drinking; but surely if there's a chance it will reduce it, that's a start and worth trying.  Second, at the very least, there will be more money to provide the drugs and services people need as a result of excessive drinking.  It also frustrates me that excessive drinking is seen as a 'bad choice' made by trouble makers.  Addiction is an illness that can affect anyone from any background, and as a society we have a responsibility to supporting these people as we would those with any other illness.

I always get a bit depressed when people bemoan a change that might benefit the minority in society.  If this change was going to financially penalise people in a more active way - i.e. more money out of someone's pay cheque or increasing council tax - I would understand.  As it is, I stand to 'lose' as much as anyone in society, and yes, perhaps I'd think twice about that pint at the end of the week.  But for me, that is a price well worth paying. 

Wednesday, 13 March 2013

Where did all the drugs go?

My annual leave could not have come a moment too soon.  There is only so much energy and motivation in the tank of one junior doctor, and although winter seems to have made yet ANOTHER appearance, training is still going well - the advantage of living somewhere really pretty is that  even when the legs and lungs start hurting on a run, chances are there's something nice to look at while you're expiring! Yet to jump in a swimming pool, but in my defence, the run happens first!

Of course I'm suppose to be doing a bit more of THIS - i.e. reading and writing, which I am currently enjoying in the rather delightful surroundings of an Oxford cafe or three.  I am nerding out to my heart's content over many a tasty cup of coffee.  I'm on nights this weekend so the freedom is shortlived, and yet another celebration is down the pan (sorry, sister, I'll hopefully make your birthday next year!). 

In reality I am doing a lot of THIS - pondering, pen in hand, and trying to get a bit of R and R, something that does not come naturally to me at all. 

As a total aside, I realise my blog has deviated somewhat from its original purpose of my chit-chat about random things going on in medicine from the perspective of one lowly junior doctor type person, and a discussion I had this weekend made me think about this a bit more carefully.  My brother-in-law was asking me about the lack of negative drug reporting and how do drugs come to be available to us anyway?  On the latter - this is essentially what I am reading about in the current module of my studies, but in a nutshell, it's a long, arduous process lined with failure at every step.  Less than 10% of all drugs that start the clinical trial process make it out the other side, and that's the ones that even reach said process.  That amounts to a seriously expensive drop out rate, and a cost which is mopped up by any successful drugs that do pop out.  Think about how much our world has changed since the human genome project - so many possible targets for drugs to reach!  The question is, which ones and how?  Pharma hasn't got that one quite sussed yet, and it's something that everyone's trying to solve - the FDA talk about a 'Critical Path' that should take drugs safely through this process - whether this works remains to be seen.

As for the former, I think I've posted this before but Ben Goldacre's talk on the lack of negative result publishing is well worth another mention.  It's a real problem that pharma-land and the publishers have yet to address.  I'll let Dr G do the talking....

Right.  FDA report reading, here I come....