Outsourcing is cost-effective, but does it always deliver?

The SPIEGEL news magazine in Germany reports a case where large companies outdsourced their occupational health provision to a a private health centre. Thousands and thousands of patients with occupational health related needs were treated by staff in that clinic, their blood was drawn etc. Thing is tho, nobody in that health clinic had any medical or even health care qualifications. There were builders, welders and others who took a liking to providing health care instead of building and welding etc. The owner of the clinic had a whole fleet of luxury cars confiscated. No doubt the clinic at the time made a very cost effective offer to the companies that subsequently outsourced their occupational health delivery to them ... and that is all that seems to matter in this day and age.

Wonna know how it feels to be an illegal immigrant?

Really interesting story on the BBC News website. Someone clever has set up a fairly realistic theme park in Mexico, of all places, aiming to give tourists a feel for what it is like to be an illegal Mexican immigrant into the US of A (land of the free etc etc). Fascinating stuff. Read the first person account of the corporation's Mexican correspondent about being an 'iilegal immigrant' at Eco Alberto Park in the central Mexican state of Hidalgo. The park itself is owned and operated by a local indigenous community, the Hnahnu. It is suggested that part of the rationale for setting it up was to generate empathy for 'illegals'.

Free Kareem Soliman

Interfaith Coalition Condemns Jailing of Egyptian Student over Blogposts, Calls on Egyptian President Mubarak to Pardon Abdelkareem Soliman

February 22nd, 2007

FOR IMMEDIATE RELEASE
Free Kareem Coalition
+1-617-661-0053
free.kareem@gmail.com

Interfaith Coalition Condemns Jailing of Egyptian Student over Blogposts, Calls on Egyptian President Mubarak to Pardon Abdelkareem Soliman

CAIRO – The “Free Kareem Coalition,” an interfaith group of human rights activists from around the world, condemned the sentencing of Egyptian student Abdelkareem Soliman for expressing his opinion on his personal blog.

A judge in Egypt today sentenced Kareem to four years in prison for the alleged crimes of “defaming the President of Egypt” and “insulting Islam.”

Dalia Ziada, a blogger and activist involved with the Cairo-based Arabic Network for Human Rights Information, explained that Kareem’s conviction remains the first time an Egyptian blogger has been arrested for writing on his blog. “It sends a chilling message to bloggers of all persuasions in Egypt and across the Middle East. We are not free to express ourselves openly on our websites.”

Kareem criticized Egyptian authorities for failing to protect the rights of religious minorities and women, and expressed views about religious extremism in strong terms.

Bahraini blogger Esra’a Al-Shafei, who launched the website FreeKareem.org to coordinate the international solidarity campaign, noted the basic human rights violation. “I was offended by some of Kareem’s blog writings. But I cannot support his imprisonment merely because he said a few things that insult my identity. Freedom of expression and open exchange of ideas must be respected.”

In November, Kareem was detained after being interrogated by prosecutors. He was held for over two months without trial and has remained in solitary confinement without access to his lawyers.

Kareem’s conviction comes despite global rallies on Kareem’s behalf, including demonstrations outside Egyptian embassies in Washington, Rome, London, Paris, Stockholm, and New York. Over 2,000 people have sent letters to Egyptian authorities demanding Kareem’s release.

Opinion editorials in the Washington Post, International Herald Tribune, and Beirut Daily Star have all also called for Kareem’s release, along with a bi-partisan coalition of US Congressional leaders, European parliamentarians, and Costa Rican representatives.

“We call on the appeals courts in Egypt to listen to international condemnation and do the right thing,” stated organizer Mohammed Shouman. “Kareem’s right to free expression has been violated and his conviction should be overturned.”

In the meantime, activists fear Kareem’s life is in danger and hope for high-level intervention. “We hope President Hosni Mubarak will pardon Kareem and allow him to start a new life outside of Egypt,” noted Al-Shafei. “We won’t be silent until Kareem is safe.”

See www.FreeKareem.org for the latest updates.

Here is a petition demanding his immediate release.

End to doctors' self-policing in the UK

There's some good news to report today. Doctors will lose the right to police themselves, at least if the UK government has its way. That probably is a good idea. For justice to be done it needs also to be seen to be done. A profession that essentially polices itself is about as credible an arbiter in conflicts between patients and doctors as an insurance industry having a policing body made up of insurance sales persons. Being a professional means to serve the public good. In return for us as society conceding a great deal of professional autonomy to doctors we expect a substantial degree of accountability in return. This objective was never met under the current regime. Change has long been overdue.

Budget airlines and 'harsh' landings

I don't know about you, but I am almost certain you've flown at one point or other with Ryanair, Easyjet or any number of other budget airlines if you live in Europe. We don't expect any service from them really, and they usually manage to meet this sort of expectation. What we do expect, of course, is that they bring us from A to B reasonably safely - at least we expect them to be as safe as any full-service legacy carrier. After all, our savings are meant to indicate that we're happy to be treated pretty terribly as opposed to getting killed in an accident driven by these airlines' cost cutting exercises.

Now, I wonder, whether there's a pattern here. Ryanair (and I got to be honest, after flying with them for a few times, I just can't get myself to use them ever again) is currently being investigated in the Republic of Ireland for its allegedly dangerous landing approaches. The claim has been made that rather than doing a second round if they come in badly, the airline's pilots will set the planes down anyway to avoid punishment from the airline's management. It goes without saying that the airline thinks the pilots are wrong. In my experience with Ryanair at least, truly nasty landings are standard operating procedure. I was on planes that literally fell out of the sky onto the tarmac and swerved all over the runway just to come to a stop before running out of space. The pilots seemed to go deliberately left to right to left just to increase the length of the runway. Pretty scary stuff. I decided that probably the life-time savings made by using Ryanair are not worth the nerve wrecking experience of its landing related gambles. - Mind you, I made a similar experience on a BA flight just this Monday, but at least it happens rarely on legacy carriers. That's a start.

In Indonesia (see picture above left) meanwhile, a plane was set down sufficiently harshly by a local by a local budget carrier's pilot to break apart on impact. Mind boggling.

So, other than the obvious question of whether or not we should be flying as much as too many of us do (myself definitely included here, so I am not pointing my finger at you!), I also wonder whether budget carriers in their ever-more desperate attempts at efficiency savings gamble with our and their staff lives. After all, as the old saying goes, if it looks too good to be true, it probably isn't true. Quite possibly budget carriers' prices are a case in point.

KLM's airline 'food', and Dutch anti-terrorism airport security

Yeah, I know, you will say 'big deal', 'not particularly interesting posting', but check out this photo of KLM's vegetarian breakfast in its economy class (commonly known also as torture class). The airline brags to its customers about great improvements it made to its inflight meals. Well, check out this dry role wrapped around two soggy slices of veggies. Even the poor stewardess on my flight from San Francisco to Glasgow thought of this offering as 'gross'... I couldn't agree more.

While I am at it, I'm sure you will know that most airports are busily fighting terrorists. Their primary focus in this regard is, as you'd expect, the duty free perfumes that we might wish to take on planes. Schiphol airport in Amsterdam has brought this by and large idiotic activity to even greater lows. So, here goes my true story: I bought in San Francisco's international airport perfume (you know, the stuff you better bring home if you want to live). It was carefully sealed in an airtight bag by airport security to ensure I couldn't secretly replace it with a nuclear bomb. Being safely (sic!) inside airport security I thought changing planes in Amsterdam would not be a major big deal. After all, so I thought, I had passed security already. Well, far from that, having arrived from the US of A in Amsterdam people busily scanned my back-pack again and found (no, not the nuclear device, but) the perfume bottle. 100 ml of deeply suspicious looking perfume-like material sealed in an undoubtedly fake sealed airport security bag from San Francisco. They quickly opened the dangerous package and discovered ... guess what..., there's perfume in there. Well, rules being rules, they happily confiscated the perfume and asked me to move on with my life. When I pointed out to them that the same bottle bought from a duty free agent in Amsterdam's airport and sealed by them could be taken on-board, they agreed. Of course, it would then probably be confiscated again by some other poor sucker in another airport on the look-out for terrorist perfume. While I appreciate the need to generate local sales... c'mon folks, surely duty free shops at Amsterdam's Schiphol airport can't be that desperate.

So then, here is my take-home message: if you live in the UK and you happen to think that Schiphol compared to London Heathrow is the lesser of two evils... think again!

On a more cheerful note, the Royal Bank of Scotland (see various postings below) wasn't heard of ever since and I have complained to my local branch manageress. The issue is now being investigated. I will keep you posted.

Dumping Homeless Patients in the Streets - LA Presbyterian Hospital Care in Action

First an update on the incompetence of Royal Bank of Scotland staff (see postings below for background). Bottom line: The bank was never heard of again. Scandalous is too polite a word to describe what I think about this outfit.

Anyway, on to Los Angeles. The Hollywood Presbyterian Medical Center dumped a homeless paraplegic patient it had cared for on the streets of a particularly crime ridden neighbourhood. The patient was reportedly found crawling on the streets, with a soiled gown, a broken colostomy bag, and a plastic bag with his belongings clenched between his teeth. This story reminds me a bit of similar reports I heard with regard to private hospitals while I lived in South Africa. - No comment required, no doubt...

And more from the US of A

While I write this I am watching a TV programme, appropriately on Rupert Murdoch's Fox TV. There's a middle-aged woman with finger nails about 10 cm long or so. She's video taped aliens and tells us that they're watching us and that they're unhappy about how we treat mother earth. There's viewers calling in asking for advice from her. Fascinating... -

Anyway, talking about aliens and messages from beyond, today on my way to the corner of Powell and Market (still no word from the Royal Bank of Scotland - see last two postings for background), I saw a car with stickers I kinda liked. You know, stuff like 'Impeach Bush', 'no more lies', that sort of thing. While I briefy rejoiced in having found a like-minded soul, I noticed another sticker on the car, with an image like the one to the top-left. So, probably not a like-minded soul after all.

More from the US of A

For what it's worth, the Royal Bank of S (see posting below) was never heard of again, and I am quietly preparing for another day at the corner of Market and Powell. At least I know which credit card to cancel the day I get back to Scotland. - Bunch of jokers.

So, while I have plenty of time to watch TV in-between begging stints necessitated by incompetent Royal Bank of Scotland staff, I thought I might as well keep you posted on the oddities of US political life. And yes, you guessed it, other than the Obama vs Clinton question (ie Blackish vs Womanish - two possible firsts for the US presidency), sex is high on the agenda. The US being the conservative country that it is, has long been preoccupied by sex (a fixation only matched by older guys working for the Catholic Church - you can spot them wearing funnily colourful robes, and usually talking non-stop about sex [mind you, something they claim they don't have]) . US gay campaigners' primary policy issue is access to 'gay marriage'. Typical, if there's a law saying only straight folks may burn their hands on glowing/hot oven plates, only gay folks would start a campaign to achieve the same right. I am AGAINST gay marriage. What exactly is progressive about extending access to a failed institution to gay people? It is - at best - intellectually dishonest for anyone (usually at very young age) to promise to someone they know only a little to stick together with him or her until 'death parts' them. Close to half of all marriages fail, and there is an even larger number of unhappy marriages, yet gay folks busily campaign for a 'right' to more of just that. I think the civil partnership idea put into action in the UK and many other countries is the most sensible way of going about this. If two (why not more?) people want to give each other particular rights of access to each other's assets, visitation privileges in case of illness and such things, the state should support those decisions in some form or other. Marriage is fundamentally a religious exercise and should be eliminated from the state's statute books altogether. If you want to get married, grab your local priest and take it from there. The state has no proper business in this thing called marriage.

What's interesting about the US debate that's currently on the TV is the take some gay activists have on a recent Washington Supreme Court ruling. The court argued in its majority opinion that the state has an interest in upholding the institution of marriage (and limiting access to it to straight folks) because of its procreative character. Well, leaving aside for a moment that it wasn't love that was foremost on the judges minds but baby production, a gay activist is now campaigning to limit marriage to only those couples that actually have produced children. The thing is that it's not only many gay folks who are reproductively challenged but also 1 out of 4 married couples. So, the gay guy, attempting to show the idiocy of the majority opinion, argues that these marriages should be disssolved. Well, good on him and good luck to his cause (not that it's one I would support, but surely his argument is ingenious).

Well, there's a few other funny stories in the national headlines, but this should do it for now. Gotta get back to my begging corner at Market/Powell.

Some bad news from the Royal Bank of Scotland

I am currently in California. Haven't been to San Francisco for a very long time. I love this town.

Well, on to the Royal Bank of Scotland. Guess what, my credit card was declined just yesterday. This happened after I went out of my way to call the bank prior to going here so they'd not use unusual transactions overseas as a reason to shut down the card. Its call centre staff thanked me for being so considerate. I also transferred extra cash from my cheque into my credit card account to ensure I don't run out of money while in the USA. Well, yesterday my card didn't buy me a five quid brunch in the hotel bar. I sort of have to concede that I cursed (quietly) what I thought were incompetent hotel staffers. I tried then to ring my bank to find out why my card was declined. Goes without saying that I had to call at 4:30 am local time so as to catch someone working in the UK based call centre. Of course, the hotel had since cut my outside phone line, seeing that my card wasn't valid. So, the toll free call to my bank had to be made from my mobile and cost me probably a small fortune. After spending probably 5 minutes in a (likely) expensive (for me) queue I got thru to a call centre operator. It quickly became clear what happened. I am a victim of a suitably incompetent call centre agent. When I called to top up my credit card balance (with a transfer from my cheque account) the call centre staffer decided instead to move a large chunk of money from my credit card into my cheque account. The result is that I travelled to the USA with a carefuly drained (and, in fact, overdrawn) credit card account. I'm sure the bank has since busily levied charges for my overdrawn credit card... guess it's a typical case of let the buyer beware.

The bank is currently trying to fix the problem (at least on the phone its staffer acknowledged straightaway that it's their fault), but it could be a couple of days till my card would be back in credit.

Begging is fairly common in this country, so if you see me today on the corner of Powell and Market street, spare me a dime while I wait for the Royal Bank of Scotland to fix its mistake. One has to eat after all ...

Udo Schuklenk is testing

... there's something about African Heads of State

... well, some of em anyway. I'm sure you will remember the South African President's ruminations about HIV being not the cause of AIDS, and it all being a nasty conspiracy of white supremacists aimed at denigrating black men. Anyway, Thabo Mbeki has since been engaged in a bitter race towards the ultimate goal, namely the title of 'Nuttiest President on the African Continent'. His most recent efforts in that regard are not focused anylonger on AIDS, he has moved on to suggesting crime isn't that serious a problem in South Africa (population: about 40 million, annual number of murders: 18,000). Another serious contender for the covetted title was for awhile his that-time Deputy President Jacob Zuma. Zuma thought nothing of having unsafe sex with a woman he knew to be HIV infected. Incidentally that woman was not one of his wives (plural, odd, I know) and claimed to have been raped by Zuma. Zuma decided to take serious efforts at post exposure prophylaxis in form of ... guess what ... a shower. Yep, Zuma thought if he washed himself properly his chances of contracting HIV would be reduced. Truly challenging to determine whether Mbeki is ahead or whether Zuma is currently the frontrunner.

My apologies, I have to concede that I kind of digress. I really wanted to tell you about another serious African presidential contender for the title of 'Nuttiest President on the African Continent'. I'm talking about the Gambian President Yahya Jammeh. He claims (yep, proudly on the record) that he is capable of curing AIDS within three days. I understand he was offered a place in various local psychiatric hospitals but he declined, obviously worried that he might have to share a room some time down the road with Thabo Mbeki, or (scary thought) Manto Tshabalala-Msimang, Mbeki's Minister for Health Prevention.

Moral Minds - On Yawning and Empathy

I read this most fascinating book by Mark Hauser. He argues that we as a species have developed a universal moral instinct guiding our ethical decision making. Here's a snippet from the book - sort of my end of the week type quote:
'In my discussion of empathy in humans, I mentioned the interesting observation that people who are more empathetic are more susceptible to yawning. Yawning is generally contagious. But it is really contagious if you have a big heart, unable to turn off your compassion for others. Based on this correlation between yawning and empathy, the psychologist James Anderson wondered whether other animals might also be susceptible to contagious yawning. 39 Captive chimpanzees watched videos of other chimpanzees yawning and doing other things. Though inconsistent across individuals, some individuals consistently yawned back. We can't say that the yawners are empathetic while the non-yawners are not. What we can say is that given the observation that contagious yawning is a signature of empathy in humans, it is possible that the same holds true for chimpanzees and other species. This possibility, as well as other observations of caring in animals, sets up a more specific look for empathy.'

Lucky day for bioethicists: Another Jehova's Witnesses story for our clinical ethics teaching

Reports today's issue of the Canadian broadsheet GLOBE AND MAIL that the authorities in one of the country's provinces have taken control over the medical care of a couple's newborns. In this case, of their sextuplets two newborns died in the meantime, the other four need regular blood transfusions to stay alive. The kids are unfortunate enough to have parents who happen to be Jehova's Witnesses. Not unexpectedly Jehova has told his witnesses that their kids may not receive blood transfusions etc etc - really the usual ridiculousness that religions dump without warning on the uninitiated and unprepared observer. So, these parents are quite happy to see them die rather than receive life saving blood transfusions. Dad reportedly left the hospital when the life preserving transfusions took place as he didn't feel good about sticking around while his newborns were being 'violated'. Of course, if he wasn't be a member of an organised religion (meaning there's plenty more where he came from), the courts would have him on neglect and probably child abuse charges. Given that he believes so very strongly, it seems somehow his 'conscience' based decision deserves some respect instead of derision.

The main point (ie the take-home message) is this: As an adult, competent person you're entitled to decline life preserving means such as blood transfusions. There is no way, however, that you're entitled to make such a decision on behalf of your kids. You are entitled to harm yourself, you are not entitled to harm others (including your kids). That you belief otherwise is besides the point, clinical judgment must win the day, and thankfully it does in most countries.

Funny though that news media continue reporting such cases. I assume this is done so us bioethicists get our hands on more teaching materials ... and for that we ought to be grateful to them!

Beware: AIDS microbicide makes you more vulnerable to HIV infection

An HIV prevention trial was halted in various Southern African countries and in India. The BBC reports that the investigators discovered that instead of reducing the risk of HIV infection the microbicide in question actually increased the risk. In other words, more participants (it being a microbicide, all women, of course) became infected in the active agent arm then in the placebo controlled arm of the trial.

There are several interesting questions with regard to this trial, none of which was flagged in the BBC news report:

1. The women who participated in the trial, by definition were HIV negative when they enrolled. They became infected (almost certainly due to unsafe sex) during the trial. The question is whether these infections constitute a trial related injury that ought to be subject to compensation. Many of them might well have had a therapeutic misconception, that is they might have thought that the stuff they got in the clinic gave them some (a lot - complete?) protection against HIV.
   
2. Indeed, one wonders whether these women will be provided with access to HAART when this could be clinically beneficial to them.
3. Sexy as the idea of an HIV microbicide is, none of the trials undertaken so far have led anywhere. As a non-expert I wonder whether this is a dead-end type concept that is never going to work. You might say, reasonably so, that only further research will tell. The trouble is that we will only find out when women become infected during a trial. That's arguably a pretty high price to pay, even if the women were volunteers and even if they gave truly informed first person consent.