Grumpy Grampy from Tunbridge Wells
Jul. 23rd, 2009 01:09 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
peterbirksIt's not as if I can't think of anything to write about; it's just that all of the things that I do want to write about look as if they will make me seem to to "Outraged of Tunbridge Wells".
First it was this (UK) administration's disgraceful performance on Tuesday, when Ministries competed with themselves to put out absolutely horrific news just before (as in, a few minutes before) the minister went off on his or her 76-day summer break.
Unsurprisingly, first prize went to the Treasury, where figures that had been ready for weeks had had their release deliberately delayed because, well, they were just such poo that issuing them at any time would have been disastrous. For once the opposition had the field all to themselves -- Darling was off. Probably the worst number of a sequence of horrific numbers was the news that Government revenue fell £32bn in the financial year to March 31, and the Treasury expects the Government deficit to double to £175bn, or 12.4 percent of economic output, in the current year.
Looking at the bar charts showing the impact of the recession on the economy over the past 18 months, it makes 1990-91 look like a tea party. So, why don't things feel as bad? presumably it's because there has been some kind of functional shift in the structure of the economy, or perhaps the combination of low mortgage rates for those on trackers and the wild distributing of £200bn into the economy via Quantitative Easing has had a hidden effect.
Second part of Mr Grumpland was the news this morning that a hospital had sent a girl home with swine flu, only for it to turn out that she had meningitis. When a misunderstanding of risk and probability leads to unnecessary endangerment to life, I fear that I get annoyed.
Gemma Drury of Derbyshire was diagnosed with swine flu over the phone and by a doctor who visited her home, but she was subsequently admitted to Rotherham General Hospital in South Yorkshire with meningitis. She was diagnosed on her second visit to Chesterfield Royal Hospital in Derbyshire.
This in itself is worrying enough, but it was the explanation of the hospital that I found most disturbing. A spokesperson for the Chesterfield Royal Hospital NHS Trust said:
The problem here is the faulty logic used to justify the Trust's actions. Let's take the two sets of symptoms:
Symptom A (first hospital visit): Consistent with Swine Flu and meningitis. Patient taking tablets for swine flu
Symptom B (second hospital visit): Only consistent with meningitis.
So, the question has to be asked, how does the hospital's reaction to symptoms consistent with either swine flu or meningitis (or, I suppose, if you are the unluckiest person in the world, both) justify a diagnosis of swine flu? The answer, I assume, is that it was "more likely".
But here there is a serious matter of risk and reward. The risk if the patient has meningitis is immeasurably greater. And, here's the catch, the existence of swine flu in the UK does not lessen the probability of meningitis.
The system of diagnosis here seems to be that, if there is a slightly bad disease going around, then we will assume that it isn't that much worse disease that has similar symptoms.
+++++++++++++
IG Index released their figures this week and revealed that Foreign Exchange trading had been the huge growth area over the past year or so. This was interesting. When I opened my Finspreads account it was solely to trade FX, but apparently most trading in those days was on equities, or indices of equities. These days, FX is the biz.
The interesting thing here is what we might call the "Mrs Watanabe effect", that being, the impact that Japanese retail investors had on the Australian exchange rate a couple of years ago. With Japanese rates at zero, and healthy returns available in the Antipodes, the Watanabes by the million put their money into Australian investments. This had the effect of pushing the Australian dollar up (thus increasing the paper gain and feeding the Watanabe "invest abroad" frenzy).
The question is, how much is the trading of these retail gamblers with IG Index affecting the market? The instinctive response might be "not at all", but if there are a few hundred thousand retail players, then their combined actions would surely equal that of at least a medium-sized proprietary trader. Ahh, you might say, but the retail players won't all be going the same way at once! Indeed, indeed. But it would still be nice to know what's driving them? If, for example, they are all "follow the trend" players, then that would lead to greater swings than normal. If, on the other hand, they are "range traders" then that would cause shifts to be smaller than expected (or, rather, rebounds to happen earlier and earlier until you get a massive funadmental break-out).
I shall be watching the charts to see if I can glean any clues about this significant alteration in the "players at the game".
__________
First it was this (UK) administration's disgraceful performance on Tuesday, when Ministries competed with themselves to put out absolutely horrific news just before (as in, a few minutes before) the minister went off on his or her 76-day summer break.
Unsurprisingly, first prize went to the Treasury, where figures that had been ready for weeks had had their release deliberately delayed because, well, they were just such poo that issuing them at any time would have been disastrous. For once the opposition had the field all to themselves -- Darling was off. Probably the worst number of a sequence of horrific numbers was the news that Government revenue fell £32bn in the financial year to March 31, and the Treasury expects the Government deficit to double to £175bn, or 12.4 percent of economic output, in the current year.
Looking at the bar charts showing the impact of the recession on the economy over the past 18 months, it makes 1990-91 look like a tea party. So, why don't things feel as bad? presumably it's because there has been some kind of functional shift in the structure of the economy, or perhaps the combination of low mortgage rates for those on trackers and the wild distributing of £200bn into the economy via Quantitative Easing has had a hidden effect.
Second part of Mr Grumpland was the news this morning that a hospital had sent a girl home with swine flu, only for it to turn out that she had meningitis. When a misunderstanding of risk and probability leads to unnecessary endangerment to life, I fear that I get annoyed.
Gemma Drury of Derbyshire was diagnosed with swine flu over the phone and by a doctor who visited her home, but she was subsequently admitted to Rotherham General Hospital in South Yorkshire with meningitis. She was diagnosed on her second visit to Chesterfield Royal Hospital in Derbyshire.
This in itself is worrying enough, but it was the explanation of the hospital that I found most disturbing. A spokesperson for the Chesterfield Royal Hospital NHS Trust said:
"At her initial visit to our emergency department, Gemma reported flu-like symptoms and had been taking antivirals prescribed for suspected swine flu.
"On examination her symptoms were indicative of this and she received treatment. She responded well and was discharged with advice.
"On return Gemma's condition had deteriorated with symptoms pointing to meningitis.
"She was immediately diagnosed and treatment commenced straight away, after which she was admitted to critical care."
The problem here is the faulty logic used to justify the Trust's actions. Let's take the two sets of symptoms:
Symptom A (first hospital visit): Consistent with Swine Flu and meningitis. Patient taking tablets for swine flu
Symptom B (second hospital visit): Only consistent with meningitis.
So, the question has to be asked, how does the hospital's reaction to symptoms consistent with either swine flu or meningitis (or, I suppose, if you are the unluckiest person in the world, both) justify a diagnosis of swine flu? The answer, I assume, is that it was "more likely".
But here there is a serious matter of risk and reward. The risk if the patient has meningitis is immeasurably greater. And, here's the catch, the existence of swine flu in the UK does not lessen the probability of meningitis.
The system of diagnosis here seems to be that, if there is a slightly bad disease going around, then we will assume that it isn't that much worse disease that has similar symptoms.
+++++++++++++
IG Index released their figures this week and revealed that Foreign Exchange trading had been the huge growth area over the past year or so. This was interesting. When I opened my Finspreads account it was solely to trade FX, but apparently most trading in those days was on equities, or indices of equities. These days, FX is the biz.
The interesting thing here is what we might call the "Mrs Watanabe effect", that being, the impact that Japanese retail investors had on the Australian exchange rate a couple of years ago. With Japanese rates at zero, and healthy returns available in the Antipodes, the Watanabes by the million put their money into Australian investments. This had the effect of pushing the Australian dollar up (thus increasing the paper gain and feeding the Watanabe "invest abroad" frenzy).
The question is, how much is the trading of these retail gamblers with IG Index affecting the market? The instinctive response might be "not at all", but if there are a few hundred thousand retail players, then their combined actions would surely equal that of at least a medium-sized proprietary trader. Ahh, you might say, but the retail players won't all be going the same way at once! Indeed, indeed. But it would still be nice to know what's driving them? If, for example, they are all "follow the trend" players, then that would lead to greater swings than normal. If, on the other hand, they are "range traders" then that would cause shifts to be smaller than expected (or, rather, rebounds to happen earlier and earlier until you get a massive funadmental break-out).
I shall be watching the charts to see if I can glean any clues about this significant alteration in the "players at the game".
__________
Meningitis
Date: 2009-07-23 02:18 pm (UTC)John W
Re: Meningitis
Date: 2009-07-23 03:00 pm (UTC)If this kind of thing has been happening for years, then god help us.
PJ
Meningitis
Date: 2009-07-23 05:39 pm (UTC)no subject
Date: 2009-07-24 01:25 pm (UTC)Finite risk aversion
Date: 2009-07-24 04:18 pm (UTC)The phrase "Finite resources" is a ridiculous axiomatic inversion. It has nothing whatsoever to do with whether medical staff (in general, or in particular) can make a diagnosis. It is therefore verbal fluff.
"Surely, given the pressures on the NHS...?" is effectively an ad hominem argument, taken to the extreme of an ad systemis.
Your "Logical thing," therefore, depends upon two assumptions; assumptions which you have clearly stated ex post facto in order to make your case, but which additionally have no bearing whatsoever on the logic, or otherwise, of your proposition.
Let's take this the other way around, shall we? I'll abide by the logic of your conclusion.
(a) I hobble into the doctor and ask for a throat swab. "I'll just put the face-mask on ... you don't mind if it's Spidey, do you? It keeps the kids in the waiting room happy." Turns out I've got an ingrown toe-nail. "Here's a spidey-encoded prescription for Tamiflu. Make sure you don't take it to Doctor Oc!" My feet still hurt.
(b) I sneeze and snork my way into the doctor and ask for a throat swab. I have normal summer flu. (Whatever that is; I've never had it.) Turns out I need a dose of Tamiflu, because there are thirty million of the fuckers out there, and nobody has bothered to produce a palliative to my summer flu. Which is all right, because only a few thousand die of it every year.
(c) I hobble in to the doctor on my one good foot. I'm sneezing and snorking all over the place, because I've got summer flu. Here's the difference: I bring my eleven year old daughter in, because she's showing symptoms of meningitis.
The doctor says, "There's a lot of it going about. I'm not sure whether or not you have swine flu or summer flu or that you're just a malingering little bastard who wants to get off work. Clearly, in the current circumstances, the implied odds are that both you and your daughter have swine flu. Hey, I might even get my photo in the local paper if you both die, looking properly serious and concerned!"
Result: Two doses of tamiflu, and one dead little girl.
I am a little concerned that medical staff in general may not be particularly apt in the interpretation of statistics. (There are some frightening studies that suggest this.)
I am also a little concerned that the prognosis for someone with meningitis appears to be, typically, adversely affected by the original diagnosis and a subsequent lack of follow-ups. I mean, it's lot like lupus erythematosus. There has to be at least one or more indicators that indicate a possible reason to check back after six hours or so. I assume this is Birks' original point.
Basically, your argument is indefensible tosh.
Re: Finite risk aversion
Date: 2009-07-24 04:24 pm (UTC)And while in this box, I'd also add that I bow to John W's opinions on the question. He might be a mere dentist, but he certainly knows more than me on any medical matter I can think of (apart from that nagging ache in my back teeth. I think that's sexual. I'd need a psychiatrist for that.)
Meningitis
Date: 2009-07-24 07:07 pm (UTC)I have personal experince of the difficulties of diagnosing meningitis.
My eldest daughter went to the doctors with my wife 4 years ago and told the GP that she had all of the symptoms listed on the Meningitis awareness notice in his waiting room. He told her she had flu and sent her home. She was in agony that night and we called an ambulance. The hospital diagnosed meningitis, shot her full of antibiotics and I'm pleased to say she has fully recovered. If we had waited any longer to call an ambulance, we would have been too late
My relationship with the GP, who I have known for 20 years, hasn't recovered.
Brian
Re: Meningitis
Date: 2009-07-24 09:48 pm (UTC)I'll admit, the symptoms of meningitis are strikingly similar to those of flu (let alone swine flu). Quite frankly, they're strikingly similar to the results of going on the Circle Line Rush (alcoholic version).
I think the point here is that a properly conscientious GP would do two things when confronted by a child who manifests these symptoms:
(1) Recognise that it's unlikely that an eleven year old has just spent five hours running around the Circle Line and drinking half a pint at every stop. These days, it might be worth asking. Or then again not.
(2) Assume the eleven year old has (swine or otherwise) flu -- because it's "more common" -- but offer advice on how to monitor the condition in case it's meningitis -- because flu is "less deadly." Incidentally, look out for signs of septicaemia.
I remain convinced that doctors in the UK shovel people out of the door, based upon a purely statistical and non-medical analysis of the symptoms. I am also convinced that follow-up procedures in the NHS are completely screwed.
I am also truly glad that it all turned out OK for your daughter, Brian.
Re: Meningitis
Date: 2009-07-26 08:56 am (UTC)I'm glad that it turned out well, and this tale certainly brings a human element to the "but, with finite resources" argument.
One interesting point raise here is that, if you can fulfil all of the criteria listed on the "meningitis awareness" card, and you tell your doctor, and the doctor then still dismisses it as flu, or a cold, or swine flu, then, from the medical profession's point of view, why bother to have the meningitis awareness card?. I mean, what kind of shit convoluted logic (and I'm sure that the medical profession has one to hand) will it use to justify having a notice in its waiting room, which the doctor will then ignore if the patient "qualifies"?
Re: Meningitis
Date: 2009-07-26 02:25 pm (UTC)That's the bit that beats me too mate!
Another strange aspect of the thing was that it turned out to be the "Hadj" variation, which is apparantly very, very rare in the UK.
Brian
Re: Meningitis
Date: 2009-07-26 07:55 pm (UTC)Beats me, too. Since I can't begin to offer a logical explanation, I'll try my favourite alternative of going sideways at a hundred miles an hour...
Whilst nursing a psychotic drug-addled girlfriend (the details are not important), I ended up in a "half-way clinic" (whatever one of those might be) in Northern California.
Unless you feel a spiritual connection with white-washed adobe, there's not much to do in a place like that. So, while the semi-literate quack was busy showing my girlfriend his collection of African masks, I looked around. And what did I find? A plaque on the wall. Not a summary of medical achievements, oh no. Just a simple, touchy-feely, EST-style plaque. It read:
"Have you been diagnosed with mental problems? Don't worry! Many of the smartest people ever born had mental problems. Here are just a few of them ..."
It proceeded to name around thirty or so famous people. This being California, rather than, say, Kentucky, Pinocchio wasn't one of them. Isaac Newton was, though; as were van Gogh, Virginia Woolf, Sylvia Plath, Ernest Hemingway, Kurt Cobain ..." Well, you get the picture. I was entranced. Roughly sixty to seventy per cent of these people had committed suicide. And this was meant to be a feel-good poster? In a purpose-built clinic for people with unspecified mental disorders?
But to Birks' main point. There is no correlation whatsoever between the ability of a doctor and the tat pinned up on the walls. The one is (hopefully) innate, and the other is a mere product of advertisement by large pharmaceutical companies, or these days by cretinous civil servants. I can hardly blame the former for totally ignoring the latter. I just wish they'd make sure they understood the possible ramifications of their initial diagnosis, that's all.
Still glad it worked out for your daughter, in any case. Be on your guard in future.
meningitis and teeth
Date: 2009-07-27 08:03 am (UTC)