Norovirus

Onto one of the biggest media stories that was reported on around Christmas time. Norovirus or the 'winter vomiting bug' was responsible for a large number of dramatic media headlines over the winter period with a BBC headline entitled "winter vomiting cases at 1.1 million", described by some as an outbreak, others as a superbug...but really? I for one don't know anyone who contracted norovirus this year yet the stats presented by the media corporations are very dramatic as if no-one is untouched by it?

The Health Protection Agency (HPA) (http://tinyurl.com/b9xw4gb) has up to date information on the number of laboratory cases reported of norovirus in England and Wales in each year from the year 2000 up to 2012 (but the 2012 data is at the moment provisional).

 

 

This graph, from the HPA website, shows the number of laboratory reports in each year (for precise figures see the URL above). Between 2000 and 2005 the levels fluctuated but rose steadily from 2005 to 2009 and then steeply in 2010. Since 2010 there have been large fluctuations in the number of reports and it will be interesting to see the levels in 2013.

 

In 2010 there was also a media storm about norovirus, once again being described as a pandemic and a superbug (this would presumably be down to the increase that can be observed in the graph above). The big issue in 2011 was to do with "norovirus being found in 76% of British oysters" (http://tinyurl.com/c5rb6ns).

Information at http://www.patient.co.uk/doctor/Norovirus.htm tells you all you need to know about norovirus but I will pick out the useful parts;

"Noroviruses (NVs) are a genus of the Caliciviridae family of viruses found in 'used' water. They are concentrated in shellfish, oysters and plankton."

"The numbers [of cases] seem to have risen since about 1993 and this may in part be spurious due to the introduction of a commercially available enzyme-linked immunosorbent assay (ELISA) test that made diagnosis much easier. However, it may also be due to the emergence of a new strain of NV which is even more virulent [infectious] than the original strain."

"Outbreaks tend to affect no more than about 50% within a community. Outbreaks tend to be within November to April when pressures on hospitals are at their greatest." This therefore indicates an issue with infection control within hospitals when there is great pressure/the capacities are high; such as the use of alcohol gels and the ability to isolate those with the virus.
  

"There is a risk of mortality especially in the frail, immunocompromised [where the immune system is unable to respond effectively] and at the extremes of age."

A headline reading "winter vomiting cases at 1.1 million" is definitely an alarming headline to read. But as we can see from the data in the above graph and the detailed values on the HPA website their cases are nowhere near the 1 million mark (only just reaching 10,000).

The 1.1 million value has therefore been quoted on the basis that "for each confirmed case, there are a further 288 unreported cases, as the vast majority of those affected do not seek healthcare services in response to their illness" (http://tinyurl.com/ae3a4xa). So based on the current 4,407 number of laboratory cases reported (as of yesterday rather than the BBC's report on the 2 January) the total number of cases is at 1,273,623 across England and Wales. So maybe the ground shaking figures on the BBC news website are relevant but still may not be completely accurate as 288 is only a rough guide to the levels of undiagnosed norovirus.

"John Harris, an expert in norovirus from the HPA said: “Norovirus activity always varies from year to year and although we might have expected cases to rise again now we have passed the New Year period this hasn’t been the case. We can’t read anything into this fall and don’t know how busy the rest of the season will be. The busiest months are normally from December to April, so further cases will occur but we can’t say if there will be further significant increases in the number of laboratory reports.

“There have been reports in the media of people with symptoms of norovirus attending their local hospital but we would urge people not to do this. If you think you may have the illness then it is important to stay away from any healthcare facility and care homes to avoid spreading it to people who may have underlying health conditions and already be vulnerable” (http://tinyurl.com/ae3a4xa).

But there is no need to worry, not as the NHS was  provided with "additional funding to help it cope with the added pressure that the winter brought" but also the statement from the Department of Health in England who "said 2.4% of beds were closed in the NHS due to norovirus symptoms compared with a peak of 2.9% last year." (http://www.bbc.co.uk/news/health-20889382)

Maybe we should just follow Charlie Brooker in his suggestion?
"If things go disastrously wrong, and you've shaken someone's revolting disease-sodden hand and you don't have immediate access to hot water and a sink, it's imperative to remember your hand is "evil" until you've had a chance to wash it. Don't eat with it, and don't pick your nose or rub your eye with it either or you will die. Keep it in a pocket. Or sit on it... Just don't use it. Now wash your hands." (http://tinyurl.com/bccsg7t) 

Medical Mash Up

BBC- NHS and US health system 'should share ideas' (http://www.bbc.co.uk/news/health-19913437)

Before reading the article you would think that it was a good suggestion to share ideas and learn from different mistakes made. However to compare the two nations proves difficult in the size of the population and also their distribution between built up and rural areas.

The Telegraph Online website shows the population densities of the UK: http://tinyurl.com/cq5gh2o and the USA: http://tinyurl.com/9a2xdf4 with the USA clearly showing that it has large areas of very low population density compard to the UK which has a very high population density across the whole country.

Specifics that one could learn for the other include "NHS, which is in the middle of a £20bn savings drive in England, could learn from the transparency and analytical rigour provided by bodies such as the Congressional Budget Office in the US. And lessons learned from the NHS's rollout of universal electronic health care records could prove helpful to the US, which is much further behind on the issue."

"But both countries are under pressure to get more value out of health care spending and reduce growth in expenditure to sustainable levels and are consequently experimenting with new ways to encourage clinicians, patients and institutions to help achieve this." But maybe not copying another system is the way to do this, maybe ingenuity is needed?

BBC-Kaylee Davidson-Olley marks 25 years with new heart (http://www.bbc.co.uk/news/uk-england-tyne-19915904)

"She said: 'I cannot believe that I am fit and healthy 25 years after my transplant. This was only made possible because of the generosity of a family who made that important decision about organ donation, a decision that saved my life. Without that family discussing organ donation, I simply would not be here.'"

"In total, 112 babies aged under a year have received new hearts in the UK during the past 25 years."

And...one of the most inpirational stories I have seen in a while! http://www.bbc.co.uk/news/world-middle-east-19914444...incredible!
 

Tendinopathy

"Tendonitis is a term often used to describe an inflamed and painful tendon. However, tendon pain can also be caused by small tears in the surrounding tissue or the gradual deterioration of a tendon where it connects to the bone. This type of tendon pain is often referred to as 'tendinopathy'." (http://www.nhs.uk/conditions/Tendonitis/Pages/Introduction.aspx) where the term tendinopathy is used to describe "tendon injuries collectively" (as above). These injuries can include tendonitis, tenosynovitis and deterioration of the tendon.

Tendosynovitis is a condition where "the sheath surrounding the tendon, rather than the tendon itself, becomes inflamed" (http://tinyurl.com/97qozs9).

Specifically one of the types of tendonitis that can occur is "Achilles tendonitis (heel)" (http://tinyurl.com/97qozs9) and is "commonly caused by a sports injury" such as walking or running where you may be "wearing shoes that do not fit or support the foot properly" (http://tinyurl.com/97qozs9).

To minimise the damage that could be caused "you should stop doing the exercise or activity that caused your symptoms. Self-help techniques, such as rest, painkillers and ice packs, can often help relieve tendonitis. More persistent cases of tendonitis may need to be treated with physiotherapy, corticosteroid injections or shock wave therapy." (http://tinyurl.com/yjz3rjh)

And to ease the pain of tendonitis whilst doing sport if you already have it "you should warm up properly before you start to prepare your body for more vigorous activity and help avoid injury. It is also important you cool down and stretch after you finish." (http://tinyurl.com/yjz3rjh).

There is a short video and a lot more information on the NHS website http://tinyurl.com/yjz3rjh which also gives an informative animation of tendonitis and gives a good overview of inflammation and the difference between tendocynovitis and tendonitis.



 

Student Debt

Top news story on the BBC today was student debt who ran with the headline "Debt 'putting off' medical students, BMA warns" (http://www.bbc.co.uk/news/health-18128637).

Let me do the maths for you.
Every medical course at a British Universities will cost £9,000 per year for tuition fees by next year (September 2012). A medical course, for an undergraduate who has the correct A-levels and does not need to do a Foundation year, can last either 5 or 6 years depending on whether an intercalated degree is undertaken.

The NHS provide financial support whereby "from year five onwards, tuition fees will be paid by the NHS Student Bursary Scheme" (http://www.nhscareers.nhs.uk/details/default.aspx?id=557), so year five and year six of the degree will be paid for. Therefore in terms of tuition fees it will be £36,000 for the course. Of course the living costs at different universities varies so you could be looking at vast differences; for example London and Aberystwyth. Lets say a general £500-£600 per month which is £6000-£7200 per year.

Tuition: £36,000
Expenditure (Accommodation and Food):£36,000-£43,200 (6 years) OR £30,000-£36,000 (5 years)
Total Cost (in the region of) £75,600 (6 years) OR £69,000 (5 years)

From these figures (don't quote me on the expenditure figures because they depend entirely on location and the student lifestyle) we can see that it is indeed very expensive to attend medical school; but I wouldn't let it put you off and you will see why.

1. I was informed on a conference I attended that it costs around a £250,000 to put a student through medical school so the cost payed for tuition is not even 15% of the total cost of the degree.
2. If you want to become a doctor then surely there is nothing that will stop you doing what you most want to do in your life and inevitably is what you will spend the rest of your life doing.
3. When you pay back your student loan, even though it is a huge amount of money and you may be paying it back for a lot of your working life, they won't take so much away that you cannot live or sustain yourself. They also don't start taking money out of your pay until you reach a threshold of £21,000 and if you don't end up paying it off it is wiped at the age of 68.

But if your not convinced and you don't think it is right to be paying so much then there are other options. You could study abroad where the fees are less, for example Holland or other European countries but be aware that the British student loan companies do not provide loans for students studying abroad. But if you don't fancy that then you can do a different course such as a Biomedical degree that you can do Medicine afterwards/not at all. But also be aware that student loan companies do not provide loans for your second degree.

Genetic Disorders and Prenatal Testing

There are hundreds of genetic disorders that have been diagnosed and have also been linked to specific mutations in the DNA. There are some common genetic disorders that occur more frequently than others; for example because "people in an ethnic group often share certain versions of their genes, which have been passed down from common ancestors; therefore if one of these shared genes contains a disease-causing mutation, a particular genetic disorder may be more frequently seen in the group" (http://ghr.nlm.nih.gov/handbook/inheritance/ethnicgroup). This can be seen in genetic disorders such as "sickle cell anaemia, which is more common in people of African, African-American, or Mediterranean heritage" (http://ghr.nlm.nih.gov/handbook/inheritance/ethnicgroup). There are also other common disorders such as cystic fibrosis, Down's syndrome, haemophilia and colour blindness.

I will do short introductions on what down 's syndrome, haemophilia and cystic fibrosis are, and then discuss the ethical sides of  the diagnostic testing that is available to pregnant women and also the ethics of abortion.

Down's Syndrome: "someone with Down's syndrome has an extra copy of chromosome 21 in the cells of their body. This is known as trisomy 21 (trisomy means there are three copies of a chromosome - in this case, chromosome 21). Because there is an extra chromosome 21, there is extra genetic material in the body" (http://www.patient.co.uk/health/Pre-natal-Screening-and-Diagnosis-of-Down''s-Syndrome.htm). It also explains on that website the typical features of down's syndrome, but also explains that "anyone can have a baby with Down's syndrome but a woman's risk increases as she gets older" (same website).

Cystic Fibrosis: occurs in places where mucus is produced and is caused by a mutation in the CFTR gene, which codes for the CFTR protein. The CFTR protein performs in a complicated mechanism that regulates the movement of chloride ions, sodium ions and water movement in and out of the mucus. When the mucus becomes too sticky for the cilia (hairs on epithelial cells) to move the mucus to where it needs to be (i.e. in the bronchus up to the mouth) the water needs to be drawn into the mucus to make it less viscous but when the CFTR is no longer present the chloride ions cannot get into the mucus to draw the water in via osmosis. This leads to blockages and damage to the lungs, reproductive system and other mucus dependent areas of the body. Sadly, because of the bacterium getting caught in the mucus, it is then dragged down into the lungs and destroys the alveoli and bronchioles, reducing the surface area and eventually suffocating the sufferer. For a more detailed explanation see http://www.patient.co.uk/health/Cystic-Fibrosis.htm which explains the effects on the other parts of the body as well, very interesting genetic disorder.

Haemophilia: (2 types; A and B, which only vary due to "problems with different clotting factors) is a genetic (inherited) condition that affects the blood’s ability to clot, normally, if you cut yourself, proteins called clotting factors combine with blood cells called platelets to make the blood sticky. This makes the bleeding stop eventually. However, in haemophilia, there are not as many clotting factors in the blood as there should be. Therefore, someone with the condition will bleed for a longer time than usual" (http://www.nhs.uk/conditions/Haemophilia/Pages/Introduction.aspx). This means that people with haemophilia can be subjected to a greater volume of blood loss (both internal and external) than should normally occur which can be dangerous for the person with the disorder. It is also interesting that it "almost always occurs in males" (http://www.nhs.uk/conditions/Haemophilia/Pages/Introduction.aspx).

There are a number of  tests that can be carried out to ascertain whether your child will have a genetic disorder; "prenatal testing provides information about your baby's health before he or she is born and, based on screening test results, your doctor might suggest diagnostic tests. Diagnostic tests confirm or rule out health problems in you or your baby" (http://www.nlm.nih.gov/medlineplus/prenataltesting.html).

1) Amniocentesis: carried out at 15-17 weeks of pregnancy where a needle is inserted into the amniotic fluid to collect cells that have fallen off the embryo which are then tested for known genetic disorders. It is "usually only offered to women when there is a significant risk that their baby will develop a serious condition or abnormality. This is because the procedure is quite invasive and has a small associated risks of miscarriage; estimated to be 1 in 100" (http://www.nhs.uk/conditions/Amniocentesis/Pages/Introduction.aspx).

2) Chorionic Villus Sampling: this is where placental tissue is removed (around 8-12 weeks) via "transabdominal CVS-a needle is inserted through the abdomen, or, transcervical CVS – a tube is inserted through the cervix (the neck of the womb)" (http://www.nhs.uk/conditions/Chorionic-Villus-sampling/Pages/Introduction.aspx). "The risk of CVS causing complications, such as miscarriage or birth defects in the baby, is higher if it is carried out before week 10 of the pregnancy" (as above).

So what are the implications of getting results from these tests? Well, if the results are negative then the family will probably decide to continue with the pregnancy as intended, but what if they come back positive?

1) The couple will receive guidance from their GP and will be given access to a whole host of people who can help them to make their decision and prepare for the child or to have an abortion, but either way, it will be an informed decision, that is best for everyone involved.
2) An argument that is often used is from those who believe in life beginning at conception, so they would say that an abortion is not the correct option, since that child now has a life ahead of him.
3) Others would say that life begins at birth and that the child is not conscious in the womb, so would argue against number three, but both arguing about human rights and when they are granted.
4) It also depends on the severity of the genetic disorder because if it is haemophilia then there is a good chance that the child will have a long life ahead of him that he can prosper in. But with cystic fibrosis it is very difficult for the child because of the treatments they must undergo regularly and also the suffering that they go through.

Please feel free to add to the list by leaving a comment and starting a discussion!

Hip Surgery and Prescriptions

Odd combination but I haven't done a post for a while, so I thought I would do a couple of topics together.

Earlier in the year it was reported that thousands of pounds were lost to the NHS due to prescriptions every year i.e. in Wales where prescriptions are free (as in Scotland and Northern Ireland) it was reported that "people in Wales received an average of 22 items on prescription last year, costing the NHS £594m" (http://www.bbc.co.uk/news/uk-wales-politics-14738797).

But the news is that the cost of the prescriptions have risen in England (while the other UK nations stay free). I'm not going to list figures because that would be boring and that's not what matters here really, it's still a fairly low price to pay; but yes, the price has has gone up and that may be an issue for some people i.e. those who have long term conditions who need constant prescriptions. Maybe there should be funding schemes set up to help these people, but then again there is so much funding being lost these days it would be hard to see that happen.

The question is, why can't England have free prescriptions like the rest of the United Kingdom? Well; "The government says abolishing prescription charges in England would leave the NHS £450m short each year" (http://www.bbc.co.uk/news/health-17576096), which is a fair argument but they aren't dealing with the losses they are making in Wales (as illustrated earlier). There were a number of opinions expressed in the comments on the BBC website. Some were for the rises but others were unhappy with the rises and thought that it was 'unfair' (a very common term used in the report). What I suggest is that we be thankful for the NHS and what they do for us for free and we just accept these extra payments. If you are in a critical condition and on the brink of death they will perform life saving surgery without asking any questions, how about that for healthcare. I've been to other countries and seen their standards of healthcare where they can barely put up all the people in a hospital who need treatment. What are people suggesting? That we go private? Then things will be ten times more expensive because healthcare will no longer be good practice, it will be a business, charging people to live because they know that people want one thing; and they will pay anything to keep their lives. Honestly, what do people think is the alternative to what services we have?!

In terms of the hip surgery story, it is much like the PIP breast implant story; "surgeons have been warned to stop using a particular type of metal-on-metal hip implant because it has an 'unacceptably' high failure rate" (http://www.bbc.co.uk/news/health-17590832). The BBC reported that over a 4 year period "10.7%" had to be replaced which is almost 29 out of the "270" who have been given the "Mitch TRC and Accolade" hip replacements. There is a lot of investment and research put into things like hip replacements and other structures that are put into the body. This is because it has to be accepted by the body and also try to act as if it is natural/meant to be there; for example making sure the bones can move with it in place or making sure the metal doesn't rust in the body.

One way of performing hip replacement surgery is to do 'anterior approach' which is said to be better because "rehabilitation is simplified and accelerated, dislocation risk is reduced, leg length is more accurately controlled, and the incision is small" (http://www.hipandpelvis.com/patient_education/totalhip/intro.html). It was interesting to find that (written in a report in 2007) it wasn't the preferable choice of hip surgery in the USA because apparently "there are several reasons: lack of familiarity, traditional teaching, and lack of the necessary instrumentation and equipment" (as above). However the techniques may have improved since the report was written.

Although this is a very long surgical video (almost 2 hours) detailing the whole procedure, if you flick through it you can see the basic outline of how the anterior approach surgery is carried out with a small incision.

To finish, back to the H5N1 story which is raging on in America at the moment; news is out that a "US panel has approved the publication of two controversial H5N1 bird flu studies, after they were revised" (http://www.bbc.co.uk/news/world-us-canada-17569494). There was controversy over whether to release the publications in case bioterrorists got hold of them. But the "panel said the publications no longer revealed details that could lead to abuse by terrorists" (link as above).

Smoking; Cigarette 2 pence rise?

News on the BBC today says that "health campaigners are asking for more substantial rises in cigarette duty in this month's Budget" (http://www.bbc.co.uk/news/health-17237159). The campaigners from "91 organisations" want the price to rise by "2 pence per cigarette" (http://www.bbc.co.uk/news/health-17237159). Statistics from the NHS 'smoke free' website say that a "20-a-day smoker will spend more than £900 over the next 6-months" (http://smokefree.nhs.uk/). If the cost was to be raised by 5% (as being campaigned for) then that figure would rise by £45 over 6 months or £90 over a whole year, which is a significant increase for those who may be struggling to pay for it at current prices.
Is this the best way of stopping people smoking? A 5% rise in the cost ofeach cigarette is a big increase if you are smoking one/two/three packets per day and would definitely build up over the years. "Prof John Britton, director of the UKCTCS (UK Centre for Tobacco Control Studies), said hitting smokers in the pocket was the best way to get them to stop" (http://www.bbc.co.uk/news/health-17237159). By raising the costs of smoking it will hopefully force the people who are on the brink of quitting the ideal way of getting out, with regards to the rises of £45 over 6 months and £90 over the whole year (as an average), this could force people to give up.

There are fears that the smuggling rates of tobacco would go up if the prices of cigarettes goes up. But this doesn't seem to be a very good argument against raising the cost of smoking and the "chief executive of ASH (Action on Smoking and Health) said; 'as ever the industry is clutching at straws with its ill-founded arguments'" (http://www.bbc.co.uk/news/health-17237159).

I would argue; based on the BBC's viewpoint and the known effects of smoking that it would be beneficial to increase tax on smoking which would hopefully persuade some people to give up smoking or to get on a stop smoking course such as the NHS 'smoke free'. I disagree with Mr Simon Clark's statement for Forest "(Freedom Organisation for the Right to Enjoy Smoking Tobacco)" (www.forestonline.org/) who says that "ideally we'd like to see a reduction in duty” (http://tinyurl.com/6s7h26x). The issue here is that this would encourage more people to smoke, and may increase the likelihood of younger people smoking if it was cheaper or more easily accessible. Although levels of smoking have decreased in children and adults over the last 20 years as shown in the tables on thiese two websites (http://ash.org.uk/files/documents/ASH_108.pdf) and (http://ash.org.uk/files/documents/ASH_106.pdf).

A quote from Sir Ronald Harwood says; "tobacco is not an illegal substance yet the government is persecuting a minority. I think that's a disgrace in a social democracy" (http://www.forestonline.org/). I can see where he is coming from because if the government raises the price above what people can pay then they are effectively taking it away from people and that doesn't seem very democratic since it is their choice if they want to smoke and the government would be taking away that choice. 

Hospital: Weekend Death Rates

I picked up on news today that patients are more likely to die if they are admitted on a weekend compared to a weekday. This has come after a study was carried out in "the Journal of the Royal Society of Medicine" (http://www.bbc.co.uk/news/health-16868428).

Let's look at the stats (all from http://www.bbc.co.uk/news/health-16868428);
1. Research was carried out by UCL (University College London), UEA (University of East Anglia) and Birmingham University.
2. It covered more than 14 million hospital admissions and 187,300 patients who died within 30 days of being admitted (during 2009/2010).
3. For every 100 deaths on a Wednesday there were 116 on a Sunday.
4. The results were consistent with data from 254 not-for-profit hospitals in the United States, which they also analysed.

So the obvious issue here is that more patients are dying on the weekend than in the weekday. This is maybe because of the lack of senior medical staff/consultants working on the weekend; as suggested by Professor Domenico Pagano on the BBC website. The lack of senior staff could have a major impact because of the experience that they offer in emergency situations; experience that can only come with time for junior doctors.

Another issue is what action to take now that this study has been carried out. What really needs to happen is that there needs to be more experienced doctors in the hospitals or close enough to the hospitals to be there in an emergency rather than on call (not very practical though). If there are more consultants consistently in the hospitals over the whole week, then the death rate should theoretically be lowered, based on the idea that experienced staff around means less deaths (but not no deaths).

It would be interesting to get some statistics on the mortality rates against the number of consultants and junior doctors working on the wards to see if there is a correlation between mortality rate and the experience of the staff on duty.

Should Doctors Strike?

Although it’s a dull story, it is an important ethical issue in the medical world on the basis of whether doctors should ever strike or withdraw their services.

Both Unite, “which represents 100,000 NHS members” (http://www.bbc.co.uk/news/business-16790168) and The British Medical Association (BMA), “the professional medical association and trade
union for doctors and medical students” (www.bma.org.uk) have rejected the new pension reform set out by the government. “Unions point out that, overall, public workers must pay more and work longer” (http://www.bbc.co.uk/news/business-16790168) but the government have said that it is the “final deal on the table, and that it is fair” (http://www.bbc.co.uk/news/business-16790168).

So, what actually is the bare outline of the new pension scheme?
The people in the health service who will be spared from the pension reform are, the "530,000 NHS staff earning between £15,000 and £26,557" and "those less than 10 years away from retirement" (http://www.bbc.co.uk/news/business-16259238).

But those who earn more than £26,557 will be expected to pay more towards their pension; as reported on the BMA website, "currently doctors pay 6.5%, 7.5% or 8.5% depending on what they earn" but "by April 2014 individuals who are currently paying 8.5% will have to pay 14.5%" (http://tinyurl.com/6umt56a). On top of the increase in rates that doctors will have to pay towards their pension, they will also have to "work to the age of 68 to be able to draw a full pension" (http://tinyurl.com/6umt56a), up from 60 on the 'old' pension scheme.

Some surveys were carried out by the BMA which showed that "8 out of 10 association members thought the NHS pension scheme proposals were unacceptable" (http://tinyurl.com/78rsmqm). The new scheme has lead to doctors "saying for the first time in a generation, they would be prepared to take industrial action" (http://tinyurl.com/78rsmqm).

In this story there are a number of talking points;
Firstly, the fact that the amount that a doctor will have to pay towards his pension will rise, as illustrated in the statistics above, which means that they are therefore not getting paid as much from the government at the end of their careers by the government, but are funding a lot more of their pensions themselves.

Secondly, raising the age of retirement means that the average doctor will spend around 44 years in the medical service (assuming they graduated at 24 years of age and then started their foundation years immediately after graduation). That is a staggering length of time to sustain the high demands of time, learning and commitment that is necessary for a doctor.

Thirdly, the ethical issues of strike action by doctors. This is surely the most important talking point that has resulted from the governments new plans on pension reform. Doctors have said that they would be willing to take industrial action against the new reforms. But what could that mean for the patients, and is a dispute over pensions a justifiable reason to withdraw their services from the public domain. This argument was summed upon the BMA website; "the BMA will now draw up detailed plans on taking industrial action, with all attempts being made to minimise any risk of harm to patients" (http://tinyurl.com/78rsmqm). So it shows that they are being cautious in the matter...

It would be great to hear your points of view on this matter by posting a comment underneath or even sparking a good discussion based on what you think should happen or what is best for the community.