Parkinson would have protested
To Whitechapel for a commemoration of the 200th anniversary of the publication of An Essay on the Shaking Palsy, in which James Parkinson, surgeon apothecary of Hoxton, described the debilitating condition of tremor, rigidity and disordered movement that now bears his name.
The memorial day kicked off with a perambulation, taking in the Shoreditch church where Parkinson was christened, married and buried, the site of his family home and practice in Hoxton Square, and the St Leonard’s workhouse (still the base for local health services) where he was the first medical director.
Back at the London Hospital medical school (now incorporated in a consortium with Barts and Queen Mary University of London), the day continued with a series of talks from eminent neurologists largely devoted to celebrating the achievements of their predecessors and current colleagues.
The rather thin pretext for all this mutual back-slapping was that Parkinson, while he was apprenticed as an apothecary to his father, had attended the hospital as a menial “surgical dresser” for a mere six months.
It was left to Prof Andrew Lees, consultant at the National Hospital for Neurology at Queen Square, to concede that, after 200 years, Parkinson might have been disappointed at the lack of progress in finding effective treatments for his eponymous disease.
As Lees observed, it is more than half a century since the introduction of the drug levodopa, a development celebrated in Oliver Sacks’s famous 1973 book Awakenings (made into a film in 1990 starring Robert de Niro and Robin Williams). Yet levodopa is far from being universally effective and it has, like numerous drugs that have appeared in its wake, a long list of adverse effects.
One theme that has remained consistent since the days when physicians scorned humble apothecaries is the condescension of the world of hospital medicine towards practitioners of primary medical care.
The “commemorative booklet” for the James Parkinson Memorial Day contains detailed biographies of all the hospital consultants. Yet that of Chris Derrett – veteran east London GP, current president of the British Society for the History of Medicine and our guide on the historical walking tour – is conspicuously absent.
“Old Hubert”, the pseudonym under which Parkinson wrote radical democratic polemics, would have taken up his pen in protest.
A rise in spirits
Scotland is set to become the first country in the world to impose a minimum price on units of alcohol, a decision that has been widely celebrated by medical and political authorities across the world.
“A big policy designed to address a big problem,” says First Minster Nicola Sturgeon, bringing to mind HL Mencken’s famous observation that “for every complex human problem, there is a solution that is neat, simple and wrong”.
Supporters of the minimum price claim that this policy can save hundreds of lives from alcoholrelated illnesses, avoid thousands of hospital admissions and reduce the rate of crime associated with binge-drinking. But there are reasons to be sceptical whether raising the price of alcohol is the way to tackle this complex social problem.
The most obvious defect of the minimum pricing policy, according to Jamie Whyte, author of Quack Policy: Abusing Science in the Cause of Paternalism, is that it fails to take account of “substitution effects”. Raising the price of alcohol “will cause people to adopt intoxicating alternatives to regulated alcohol”, such as illicit “brewing, fermenting and distilling”, cannabis, legal highs, glue, even cocaine and heroin.
Apart from imposing punitive taxation on the poorest consumers, minimum pricing – like prohibition – may result in more drink and drug abuse, crime and ill health.
Alarm over apps
There has been some alarm among my GP colleagues over the emergence of a number of agencies providing services via mobile phone apps, offering “virtual consultations” and video calls on demand. These agencies accept that Uber-style medical apps are unsuitable for patients with “complex physical, psychological and social needs” and for those with learning disabilities, dementia or complex mental health conditions, also the pregnant, terminally ill, frail elderly or the drug dependent.
Such “Uber GP” apps also appear to be inappropriate for acutely ill babies and children, or for patients with poor English. In short, the majority of patients a GP sees day to day in their surgery are unlikely to find this approach useful.
On the other hand, the Uber GP seems ideal for the young and fit, for those who seek medical advice and reassurance in relation to minor symptoms and matters of diet and exercise, lifestyle and well-being.
We could seize this opportunity to effect a separation of a “national illness service” for people who need expert medical diagnosis and treatment, from a “recreational health service” for the worried well.
To avoid problems of cherrypicking low risk patients from the NHS and destabilising the financing of primary healthcare, recreational health services should operate entirely in the private sector. Patients should not be required to de-register from their GPS, who would continue to be available should they need serious medical attention.