Medical LIfe

Until Belle de Jour disclosed her day job yesterday, I had never heard of the Bristol Initiative for Research of Child Health (BIRCH). The author of 'The Intimate Diary of a London Call Girl', who kept the world guessing about her identity for six years, outed herself as Brooke Magnanti (PhD, informatics, epidemiology and forensic science) at the Bristol-based organisation, and a picture of her sitting demurely on a bench – hands in lap, knees together – next to two colleagues appears on its website.

I was initially sceptical as to whether it was a genuine scientific unit, with its ungrammatical title – shouldn't that "of" be an "into"? Its area of research – environmental pollutants – is also one that tends to attract conspiracy theorists and fantasists.

Then I read the paragraph about Margaret Saunders, its director. "Dr Saunders is a well known expert in applying for and securing EU Framework funding," it said – adding that she had recently "undertaken the role of Co-ordinator (PLUTOCRACY)."

Ah, I thought, a typical research outfit, devoted to finding inventive ways to fund its activities, in all its entrepreneurial glory. Just like Belle de Jour, in fact.

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One of the first things doctors learn in medical school is that the cure can be worse than the disease. "First, do no harm," intoned Hippocrates, a couple of thousand years ago. So what are we to make of the Government's crackdown on anti-psychotic prescribing to people with dementia, announced last week?

It is always easier to withdraw something than to replace it with an alternative. So the order to cease use of the "liquid cosh" – the cocktail of powerful drugs used far too widely in care homes to sedate residents who might otherwise exhibit "challenging" behaviour – is simple to meet. Something like 144,000 elderly people are estimated to be receiving these drugs inappropriately and the independent review by Professor Sube Bannerjee, published last week and accepted by the Government, said their prescriptions should be phased out within three years.

But what then? If these patients are not drugged, and they should not be, they will require managing in other ways – with extra nursing from trained carers who have access to psychological therapies and specialist support. The independent review estimated a relatively modest £68 million was needed in England, but ministers declined to allocate an extra penny.

I have a relative, rejected by two homes because of her behaviour, who is now cared for in a third only with the help of a drug cocktail, without which, according to her immediate family, she would be unmanageable. She suffers mood swings, is periodically disoriented and can be abusive to staff. If her drugs are withdrawn, and nothing put in their place, who will care for her?

I foresee a growing band of "hard to manage" dementia patients, shunted from pillar to post in the care system, in search of a home prepared to take them in. The Government's anti-drugging strategy is badly needed. But to implement it without the funding necessary to provide an effective and humane alternative is political opportunism of the most cynical kind.

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