Archive for the ‘Human rights / Surveillance state’ Category

National DNA database and psychiatric patients

Wednesday, September 8th, 2010

There’s a letter by me and Dr Lisa Conlan published yesterday in The Psychiatrist’s eLetters:

National DNA database and psychiatric patients

The advent of DNA analysis as a powerful tool for crime detection has led to the creation of England and Wales’s National DNA Database (NDNAD). This is one of the world’s largest databases of DNA information, storing profiles of nearly five million individuals (1). We write to raise a concern about the potential impact of this database on people with mental disorders.

The NDNAD has long been the subject of scrutiny and criticism with regards to how DNA profiles are collected and retained and from whom. This is because the current regulations on DNA profile collection mean that the NDNAD includes DNA profiles of a large number of people who have never been convicted of any crime. These DNA profiles are currently retained indefinitely. This practice, was challenged in the European Court of Human Rights who found England and Wales to be in breach of the European Convention of Human Rights. In light of this, both the current and previous UK governments have signalled their intention to enact reform but as yet there has been no change in legislation.

Some groups, including young black men, are known to be overrepresented on the database (2) and we are concerned that those with mental health problems, a vulnerable group of people, are similarly affected. This issue has been largely unexamined and there are no estimates for the number of people with mental disorders on the NDNAD. However in 2008, nine percent of mental health inpatients were admitted via the Criminal Justice system (3). Furthermore, studies of individuals in prison and on remand have concluded that mental disorder is extremely common in these populations with respective rates of 90% and 63% (4,5). It would be surprising if the population of the NDNAD were not to broadly reflect this state of affairs.

It is arguable that a person with mental health problems who has a profile on the NDNAD, despite being without criminal conviction, is not only disadvantaged but also criminalised. This is a potentially unhelpful outcome for the process of engagement and recovery. We have concerns about how some patients come to be on this database. Patients arrested as a direct result of their mental state may find themselves on the database despite being diverted into mental health services without charge. Given that police powers allow that reasonable force may be used to take a DNA sample without consent, a disturbed and oppositional patient may be injured in the process. There is also lack of any formal pathway for removal from the NDNAD, which is at present difficult to navigate.

The new UK Coalition Government has undertaken to adopt the current Scottish model whereby DNA profiles of those arrested but not convicted are retained for six years only. DNA profiles of those convicted will be kept indefinitely as before. This reform would go some way to addressing our concerns.

We would welcome a debate amongst clinicians on the issues surrounding mental health patients and the National DNA Database.


1.National Police Improvement Agency. National DNA Database Report 2007-2009 [document on the internet] National Police improvement agency; 2009 [cited 2 September 2010] Available here

2.Rt Hon Baroness Scotland of Asthal QC, Minister for Criminal Justice and Offender Management. Minutes of evidence 13 March 2007 (Q653) [document on internet] House of Commons [prepared 15 June 2007; cited 2 September 2010] Available here

3.Commission for Healthcare Audit and Inspection. Count Me In 2008 [document on the internet]. Commission for Healthcare Audit and Inspection; 2008. [cited 2 September 2010] Available here

4.Singleton, N., Meltzer, H. & Gatward, R. (1998) Psychiatric Morbidity among Prisoners in England and Wales (Office for National Statistics). London: Stationery Office.

5.Maden, A., Taylor, C. J. A., Brooke, D., et al (1995) Mental Disorder in Remand Prisoners. London: Home Office

Picture credit Wikipedia


This made is into the No2id newsletter 157

NHS Summary Care Record

Friday, March 12th, 2010

SCR logo

People living in London and four other strategic health authorities are currently receiving information in the post about the rollout of the NHS Summary Care Record (SCR) system.  SCR is part of the NHS Care Records System, a large UK government IT project which aims for more effective sharing of patient records between NHS services.  When the system is in full swing, NHS staff in Newcastle (say) will be able to access the medical records of someone requiring care whose residence and GP is in Penzance.  The SCR will initially contain records of such things as medications and allergies, but may eventually become more detailed and also allow access to specialists’ letters and scans.

Controversy about this centralised system has been rumbling on for some time and before you read further I must declare my hand: I have opted out.

No record system is perfect.  Whenever you meet with any NHS healthcare professional a record will be made of your interaction and, in these days of team working and shift work, this could be seen by a fairly large number of people.  Equally if you are a patient on a ward, patient notes are most often not kept under lock and key and are therefore accessible to any nosey parker who happens to walk by.  Patient records are currently kept locally, for example within a particular NHS trust, and are shared within NHS organisations on a ‘need to know’ basis.  Most specialists who see a patient will write and inform their GP.

As with other large database projects – of which this country now has legion – the advantages of sharing information must be balanced with the possible pitfalls.  The SCR’s benefits are most obvious for forgetful people who have a serious medical condition or allergy and are visiting friends out of town.  This is a relatively small number of people and for the rest of us the benefits appear to be marginal.  The rollout of the SCR raises serious questions around the issues of privacy, legality, effectiveness, and cost.


In order for medical care to function effectively it is clearly absolutely essential that patients feel that their records are kept confidential.  In line with this the leaflet “Changes to your health records” states that ‘anyone who has access to your records… must be directly involved in caring for you’.  However this Connecting for Health document (broken link) concedes that access will also be possible, without a patient being informed, ‘in the public interest’, ‘by statute’ or by court order.

The wide access necessary for the SCR to be effective massively increases potential for snooping.  This is something of which Gordon Brown and Alex Salmond may already be aware.  In order to police access to the SCR all NHS staff will be issued with a chip and pin card and retrieval of any record will leave an audit trail.  But this does not address unauthorized access through logged in but unattended terminals, a common occurrence, or the accidental accessing of an incorrect patient’s record as a result of partial patient identifying details.  Audit trail or not, it is hard to imagine that such a vast database can be effectively policed.

Central to the concept of privacy is deciding to whom your personal details should be displayed.  Inclusion in the SCR is currently ‘opt-out’.  Unless you make your wishes known, as I did, your patient records will become part of the SCR by default.  This use of ‘presumed consent’ presupposes that individuals are aware of the SCR’s existence; yet in pilot areas many people were not.  The recent mailings do not include an opt-out form, and opting out appears to be being made deliberately difficult.  GPs are for instance unable to order opt-out forms in bulk.

The BMA has called on the department of health to suspend the SCR rollout as patients are not receiving the information they need to decide if they wish to be included on the SCR.  London GPs have also been unenthusiastic.


The SCR is vulnerable to legal challenge.  In a 2009 report by the Joseph Rowntree Reform Trust the SCR was awarded an ‘amber light’ indicating ‘the system demonstrates significant worrying failings and may fall foul of a legal challenge’.  European law requires that systems which store sensitive personal information such as medical records either have the free and informed consent of the data subject, or be based on specific legal provisions that are sufficiently narrow to make their effect foreseeable.  Such provisions must also be proportionate and necessary in a democratic society.  The SCR would appear to fall short of these stipulations.

There are doubts about whether it will be possible for people to have themselves removed from the SCR.  The DoH has been quoted as saying that it will be impossible, on the basis of medico-legal considerations and cost, to remove someone’s record once it has been entered.


I am unaware of any evidence that the SCR will dramatically improve care.  For some people, making relevant medical information available to emergency medical staff may be very beneficial and for a few possibly life saving.  However for the vast majority of us it will be of little or no use.

In 2005 Amanda Campbell, died from septicaemia despite having been assessed by eight doctors.  During a Today programme interview Dr Eccles, medical director for Connecting for Health, mentioned her case as an example of where centralized records would have been of benefit.  Whilst centralized records might have been useful this account suggests that her avoidable death was at least as much a result of the substandard medical care that she received, something outside the remit of a centralized records database.  The SCR does not work abroad or even work across the whole of the UK, as Scotland has a different system.  And relying on a single system means that errors can be propagated;  I would not recommend that anyone leave their medical alert bracelet at home.


Originally expected to cost £2.3 billion over three years, in June 2006 the total cost of the NHS National Programme for IT was estimated by the National Audit Office to be £12.4bn over 10 years.


Database State – a super report (if you happen to think this sort of thing is interesting) about the failings of UK Government IT projects

Henry Porter on the SCR writing in the Guardian’s Liberty Central


Addedum 26 April 2010

Over 1000 people have read this post since I published it.  If it changed your mind, or even if it didn’t, I’d really like to know your story.  Please leave a comment below.

Letter to

Wednesday, January 20th, 2010


Here is a letter I wrote to


On 7 December I wrote an opinion for this site about the launch of identity cards in Manchester. I received one comment, from Joan Burton, who wrote: “It’s a cliche but a true one – if you’ve done nothing wrong you have nothing to fear.”

One of the problems about the current UK government’s overarching surveillance project has been a lack of debate, both publically and in parliament, so I welcome any engagement with these issues.  I have heard the above sentiment voiced before and I address it here to provide clarification and, I hope on Ms Burton’s part, reevaluation.

Public protection from criminal activities is a key responsibility of the state but this should not allow the state whatever means it wishes in the pursuit of this goal.  Governments need to keep in mind that their populations predominantly comprise law abiding citizens whose rights and wishes should be balanced against any reasonable requirements the state may have to pursue its duties.  The ‘done nothing wrong/nothing to fear’ paradigm ignores any need for balancing public and private needs to the extent there is nothing that cannot be justified by its invocation.  It would, for instance, endorse the enforcement of the fitting of positioning devices to everyone living in or entering the UK, something that might drastically reduce crime but at the expense of massive state intrusion.

Thinking this way ignores the need to evaluate state surveillance projects and dismisses those who object as oversensitive to individuals’ rights, or failing to see the threat that we face.  The point I wished to make about ID cards is that not only are they intrusive, but they fail to meet any of their objectives, even though these objectives have changed over the years.  Now, more than ever, the UK Government must be careful with its taxpayers money and, civil liberties issues aside, that project of the expense of that of the ID cards is now being promoted as first and foremost a convenient way to prove identity at the post office is of concern in itself.

Finally within ‘done nothing wrong/nothing to fear’ thinking there is a tacit assumption that governments are inherently benign and have the interests of their populations at heart.  Whilst this may be broadly so for the UK it is foolish to think that this is a universal attribute of governments or that adverse change is not possible.  It is a sad fact that the majority of acts of violence committed in the modern world have been visited by those in governmental power against those who are out of power.  Indeed the word ‘terrorism’ actually dates from the French revolution and refers to the use of terror by governments against their own populations (1).  One estimate holds that during the 20th century governments killed 7.3% of their populations.  ID cards have  been documented as having been assets in mass killings both recent and historical and continue to be used to target vulnerable populations.

Yours etc.,
Dr. Stephen Ginn MD,


See also in recent news:
British police arrest man under terror legislation for internet joke – Independent 18 January 2010
(2018 update – sadly is no more.  I can’t find the estimate for the % of their populations that governments killed during the 20th Century alas, but search around and you’ll find something along the same line).

Britain introduces identity cards in Manchester

Wednesday, December 9th, 2009

On Monday, November 30, the Manchester Identity and Passport service opened its doors and began issuing the first identity cards to British subjects since 1952. (1)

Although the cards themselves are bad enough, they are perhaps the most benign aspect of the whole enterprise, the true meat of which is the National Identity Register’(2), a centralised database in which details of all those who carry the card will be held. Fifty items per individual of personal data are to be stored (3) on this database and these will include fingerprints and facial scans, with provision for further data to be added at a later date.

Although plans to make the cards themselves compulsory were dropped anyone wishing to avoid being present on the National Identity Register will, from 2011, find themselves listed if they apply for a passport. If the government is successful in rolling out identity cards across the country then this will represent a massive accumulation of personal data and an unacceptable intrusion into the private lives of UK subjects.

Yet despite its scope, since the scheme’s inception the government has failed to make a case for its introduction. The latest attempt came from Meg Hiller, the minister for identity, who, when appearing (4) on BBC Radio 4’s Today programme, suggested that a major benefits for the people of Manchester from identity cards would be that they would be able to collect parcels from post offices with greater ease and that young people would now no longer need a passport to prove their age whilst gaining entry to a nightclub.

These are extremely modest improvements to modern life for a project that the Government has forecast will cost £5.6 (5) and the LSE £10.2-19.6 (6) billion to run for ten years. Other justifications for the scheme have included the prevention of terrorism, identity theft and benefit fraud but none of these stands up to scrutiny.

Former home secretary Charles Clarke admitted (7) that identity cards would not have prevented the 2005 London attacks, and reliance on a single nominally secure form of identification could actually make identity theft more straightforward. The only clear agenda satisfied is the current Labour paradigm whereby any problem that might conceivably be solved by a massive and costly database should be so. As well as a nascent identity card scheme, the UK also has the world’s largest DNA database and ContactPoint holds details of every child in the UK under the age of 18.

With the current national deficit nothing short of astronomic (8) there was hope that the identity card scheme would be quietly dropped. It is unnecessary and costly and threatens the civil liberties of UK subjects. It has also been so beset by setbacks (9) that were it a private sector project it undoubtedly have been canned some time ago. Indeed, if the next administration is led by any party other than Labour it will be – the Conservative and Liberal Democrat parties have both said they will scrap it. But our floundering government would rather push ahead with this costly, invasive and useless idea than consider the taxpayer, never mind come to their senses and start to trust the public.
(1) For two different views on Manchester’s first day see: ID cards now available. Count me out, Dave Page, the Guardian, November 30, 2009 and Angela Epstein, the UK’s first ID card holder, Angela Epstein, Jewish Chronicle, December 3, 2009
(2) Overseas identity card schemes do have an accompanying database and are not comparable
(3) As specified by the Identity Card Act, 2006 See:
(4) Today programme, BBC, Monday 16th November
(5) ID card scheme ‘to cost £5.6bn’, BBC News, November 8, 2007
(6) See: The LSE Identity Project Report (PDF), London School of Economics and Political Science, 2005
(7) ID cards ‘wouldn’t stop attacks’, BBC News, July 8, 2005
(8) Bank bailout cost hits £850 bln, Kistin Ridley, Reuters, December 4, 2009
(9) See ID cards: Seven years of missed deadlines and U-turns, Nick Heath,, December 2, 2009 (now unavailable)


nb: this article first published on where someone commented:

‘It’s a cliche but a true one – if you’ve done nothing wrong you have nothing to fear’

Before you settle into this state of mind, ask yourself this question – what is not justified by this line of reasoning?  Then listen to this song.   Fundamental on Amazon

Open letter of protest – Update

Monday, October 26th, 2009


In February of this year I posted this open letter of protest on this website.  This is a campaign by 725 physicians (including myself) from 43 countries to compel the World Medical Association (WMA) to examine the medical ethical track record of the Israeli Medical Association, one of its member associations, in relation to its adherence to the Declaration of Tokyo, a key WMA code. This declaration mandates doctors not only to refuse any involvement in the practice of torture, but to speak out and confront it whenever encountered.

Unfortunately there is reputable evidence of the collusion of doctors with torture in Israel.  Our letter to the WMA Council in May set out some of this evidence and also queried the probity of IMA President Yoram Blachar’s position as WMA President as a result of his inaction in addressing this matter.

We continue to press the WMA Council for a response.  Dr Blachar however has responded on his own account by instructing solicitor Mark Stephens of Finer, Stephens & Innocent to issue the campaign convener, Dr Derek Summerfield, with a threat of a libel action – directed to him personally.  This would appear to be an attempt to muzzle this issue of high public interest and principle, as regrettably English defamation laws are weighted heavily in favour of the plaintiff and libel actions here are costly to fight.

What is particularly puzzling is that despite writing to Dr Summerfield, solicitor Mark Stephens would appear to be constitutionally placed to be sympathetic towards our campaign’s wish to be heard.  Perusal of the website of Index on Censorship, who campaign for freedom of expression, indicates that he is a trustee of their organisation.


Doctors demand Yoram Blachar resign as ethics chief over Israeli torture Guardian 21 June 2009

ContactPoint – money in exactly the wrong place

Monday, August 17th, 2009

I’m learning guitar.  Recently I went to visit Alex, my tutor, and briefly overlapped with the student who was before me; he’s a pleasant young man of perhaps 10 years old.  Also in the room was his father.  He looked a bit glum.  I assumed that this man was simply there, somewhat begrudgingly, to collect his son but Alex said that he routinely sits in for the duration of his son’s lessons.  Apparently this is common practice amongst parents these days.

The parents of Alex’s students aren’t prepared to give him the benefit of the doubt and assume that he’s not a paedophile.   I was surprised by this initially, but then when I thought about it some more I was surprised that I had been surprised, because the risk of an abuser taking advantage of one’s child is now one that is  impossible to take too seriously – for individual parents and government alike – and trumps all other considerations.

Modern psychiatric and psychoanalytical thinking has played a part in this.  As ‘talking therapy’ has become increasingly popular so has the notion that the events and relationships of childhood are causative of subsequent problems.  Such a vulnerable period will require careful marshalling and the exercising of a high index of suspicion.  But as the vast majority of people are decent, the consequence is that young people will be wary of those in whom they should place trust and potential role models will be discouraged from entering professions where their probity will be doubted; primary school teachers are for instance now staffed predominantly by women.  More prosaically, many more children will die from car crashes on the school run than would ever have been abducted.

This is not to say that there haven’t been some children who have suffered horribly and we have learnt about the failures of services charged with protecting vulnerable children through inquiries into what went wrong.  The most recent of these were those of Victoria Climbié and Baby P.  In both cases the authorities involved failed to act at crucial times and poor communication was exposed.  Lord Laming’s report into the circumstances surrounding Victoria Climbié’s death stated that ‘the extent of the failure to protect Victoria was lamentable’. There had been ‘no fewer than 12 key occasions when the relevant services had the opportunity to successfully intervene in the life of Victoria’.

Something else Laming said is very instructive:

‘Tragically, it [a successful intervention in into Victoria’s life] required nothing more than basic good practice being put into operation. This never happened.’

Encouraging good basic practice is not something at which politicians excel, as they favour grander gestures.  Under the policy heading of ‘Every Child Matters’ the Government has embarked on a mission to change the approach to child protection in the UK.  It’s strikingly similar to the way they’ve sought to tackle the threat posed by terrorists: expensive, technically complex, intrusive, restrictive, superficially impressive, and ultimately of dubious value.

Just like Alex, everyone is under suspicion and even those with the most fleeting access to children.  From November 2010 every adult who works with children will have to be registered with the Independent Safeguarding Authority (ISA).  This includes teachers and paediatricians, but also casual volunteers, including any authors who may wish to visit a school to read their work.  Last month Philip Pullman, author of the His Dark Materials Trilogy, said he would refuse to undergo these checks as he found them insulting.

“…we are teaching children, that the world is a dark and nasty place were everybody wants to murder and rape them.  It assumes that the default position of one human being to another is predatory rather than kindness.  It says to the very few people who are inclined to rape and murder children that they are no worse than anybody else, because they would do it too if they could.”

Worse, the ContactPoint Database will be a record of the details of the all the children in the UK under age of 18.  It stands accused of being vulnerable to inappropriate access, and violating the principle of privacy in a free society.  Its operation suggests that when it comes to access to personal information, the UK is two-tier as information about the children of ‘celebrities’ and MPs can be ‘shielded’.  The price tag is £224million, which although put into shade by the billions already spent on the national identity scheme, is still a staggering amount of money.

Such databases and reorganisations do nothing to help parents decide on the appropriate level of supervision for their children or encourage a more sensible risk assessment.  The events that these databases have been installed to prevent are so rare that their utility can never be established.  Child abuse is commonest in failing families whose problems are caused, at least in part, by social inequality, an altogether tougher nut to crack and one to which the UK government has generally paid no more than lip service.  London social work teams suffer from high staff turn over and are often demoralised.  Social workers often carry massive case loads and their contact with the children with whose care they are charged can be sporadic.  Why not start by taking Contactpoint’s £224 million making social work a better career?

Baby P: dont’ turn this tragedy into a policy


Addendum 11 September 2009

About a quarter of adults are expected to have to sign up to the ISA, as anyone who regualarly transports children for sports or social clubs will face a £5000 fine could face prosecution if they do not.

BBC today programme segment 11 September

BBC Today segment 12  September 2009


Addendum 16 September 2009

Another invasion of liberty and only the Tories are alert – Jenni Russell CiF 16 September 2009

Control orders

Tuesday, July 21st, 2009

In Kafka’s The Trial (buy Amazon), published in 1925 Joseph K, a bank clerk, is unexpectedly arrested by two unidentified people for an unspecified crime.  Although the novel was never finished (and Kafka actually wished it destroyed) in what exists K spends his time trying to navigate a legal system which is at once ubiquitous, immensely powerful and totally lacking in transparency.

This novel comes to mind whenever I think about control orders, which were introduced by the British Government in the Prevention of Terrorism act in 2005 in response to the House of Lord’s ruling against indefinite detention without charge or trial for foreign nationals contained in the Anti-terrorism Crime and Security Act 2001.

Control orders enable the Home Secretary to impose an unlimited range of restrictions on any person he or she suspects of involvement in terrorism. Among the restrictions that can be imposed are curfews of up to 16 hours enforced by an electronic tag, restrictions on the use of mobile phones and the internet, vetting of all visitors and meetings and restrictions on an individual’s movements. The Home Secretary also has the power to add new restrictions or obligations as he sees fit.  Based on suspicion and secret intelligence, those subject to an order do not know the accusation or case against them and are powerless to dispute it or show their innocence.

Legislation which severely curtails personal liberty in this way, which can be enacted on the basis of vague criteria, and which has inadequate oversight is more than just concerning.  The legality of control orders is currently being tested in the High Court following a critical House of Lord’s judgment in which Lord Hope said:

…a denunciation on grounds that are not disclosed is the stuff of nightmares. The rule of law in a democratic society does not tolerate such behaviour. The fundamental principle is that everyone is entitled to the disclosure of sufficient material to enable him to answer effectively the case that is made against him.

The Liberty 75 conference was attended recently myself and, more notably, Mahmoud Abu Rideh who has been subject to a control order for the past four years.  Prior to this he was interned for three and and a half years without trial.  Mr Abu Rideh must comply with a regime of telephone reporting three times every 24 hours; daily reporting in person to a police station; a 12-hour daily curfew and meetings outside the house and visits to anyone in the house prohibited except for persons cleared by the Home Office.

Mr Abu Rideh’s mental health appears to be severely compromised by his situation and he has made several suicide attempts and at one point was on hunger strike.  And control order do not only affect the person to whom they are subject as their families suffer alongside their subject, as this article explains.

The civil liberty pressure group Liberty are campaigning against control orders and their director, Shami Chakrabarti has said:

As stupid as they are cruel, control orders are the worst hangover from Britain’s War on Terror. No real terrorist is ever going to comply with house arrest and a large number of suspects have disappeared. But an innocent person can be subject to indefinite and severe punishment without ever having been charged or brought to trial.

I agree; the UK Government should show its hand and prosecute any persons who it is currently subjecting to a control order as anything else is cruel and degrading.  I am not aware of any representation having been made on behalf of doctors on this issue but there is a policy adopted in 2003 by the World Medical Association that suggests we should be heard.  It states that there is an:

..ethical obligation on physicians to report or denounce acts of torture or cruel, inhuman or degrading treatment of which they are aware.

Liberty: control orders - details what you can do.

Addendum 9 September 2009 Most control orders likely to be revoked after terror suspect freed

“The Police and Government have a duty not to engender panic as a way of achieving their own ends”

Friday, April 10th, 2009

The Metropolitan Police have launched a new poster campaign clearly pitched to engender paranoia and anxiety in London’s population.  A picture shows a wheelie-bin brimming with carelessly discarded toxic chemical containers accompanied by the smug caption:

‘These chemicals won’t be used in a bomb because a neighbour reported the dumped containers’

At the edge of the shot – to remind us what is at stake – a mother and child approach, totally unaware that such danger lurks in their community.

The scenario is clearly simplistic, as well as being inconsistent with previous government statements.  Are these terrorists, so overcome by fanatical zeal they find themselves unable to dispose of incriminating evidence with necessary care, the same terrorists whose plots are so devilishly complicated that investigators supposedly needed 42 days to unravel their schemes?

For several years now, the Government and security services have been feeding us information about the ever-present threat to us from international terrorism in the shape of Al-Qaeda.  Al-Qaeda is apparently well financed, well organised and poised to strike at the heart of our freedoms.  The danger is so serious that it necessarily requires a government and security force with increasingly wide ranging powers to defeat it.  But their threat has also not materialised, and in 2005 the only significant attack on UK soil has not been successfully linked to them.  So, with international terrorist attacks increasingly appearing largely a fantasy, and in the face of civil liberties protests against draconian and frequently misused police powers, the Met’s posters are more about maintaining the police’s might and authority by reiterating the precariousness of our security, and the necessary evil of strong policing, than about catching terrorists (such as they do exist) per se.

Appealing to our wish for security is a technique at which politicians are already well practised.  The Government’s assessment of the current terrorist threat, made available in the name of keeping us informed, is ‘severe’.  This ‘threat level’ has been published since August 2006 and has since been either ‘severe’ (terrorist attack highly likely) or ‘critical’ (terrorist attack imminent) ever since.  With such an apparently unwavering crisis, one is reminded of the plot of 1984 wherein a state of perpetual war was used to justify the control of Oceania by Stalinist methods.  Constant news of inevitable attacks feeds the assertion that threats are all around us and can only be tackled by strong government, whose actions are all ultimately in the common good.  Furthermore, having over-exaggerated the security risk, continued absence of any attacks serves to strengthen their point, and ‘prove’ the success of their policies.

The social divisiveness of all this, and especially the current campaign, need hardly be pointed out.  Given that it’s almost impossible to differentiate between a man wearing a rucksack full of books and a similar man with a rucksack full of explosive there will inevitably be a large number of people falsely detained following the actions of well meaning, but ultimately misguided amateur anti-terrorist sleuths.  It pays to do a little maths;  imagine that there are 8 million people in London and that amongst their number there are 150 ‘terrorists’.  We know from this poster campaign that every member of the public is under suspicion.  Let us suppose that the intuition displayed by members of the public in spying on our neighbours with the aim of catching terrorists is correct an incredible  99.99% of the time.  Since our ‘test’ is very sensitive, our 150 terrorists are successfully caught, but it still gives a false positive rate of 0.01% which means that 80 000 people will be wrongly identified and possibly victimized.  Such simple calculations and the collateral damage they imply appear to have been entirely overlooked.

The Police and Government have a duty not to engender panic as a way of achieving their own ends.  Many people find modern life distressing enough without having to feel that they must be constantly on the look out for terrorist cells; the psychological health of society at large should be considered before the use of alarmist campaigns.  Successful society relies on mutual trust and widespread suspicion encouraged by this campaign is more akin to that seen in communist East Germany than to 21st century Britain.

Update – this piece appeared in the Daily Mail 15 April 2009 With recent police activity, anti-terror adverts and CCTV everywhere no wonder we’re all scared stiff.  Whilst I agree with much of what it says, it does read like the transcript of a right wing shock jock show.  Here’s the Mental Health Foundation report he talks about.

Privacy: a personal view

Sunday, February 8th, 2009

It’s not important to most people that my paper 3 MRCPsych results came out on Monday last, alongside the snow. Unremarkably, the pass list was first published on the internet before individual letters were sent in the post; despite passing, my name wasn’t on that list. When I’ve explained to people that I opted for my results to remain private, most of them have wondered why.  It seems to me that as individuals we’re expecting to have less and less control over what information is available about us.

Technology has changed a lot even in my lifetime. I’m old enough to remember the days before the world wide web and mobile phones, although it’s becoming harder and harder to believe that that time ever existed. I can actually recall the first time I tried to access a website; it didn’t load properly and I thought it was rather dull (I’m not a visionary). You don’t need me to tell you the opportunities that the world wide web has brought. But we’re still weighing up one of the major disadvantages of the new information technologies: the increasing ability of government and private organisations to capture and share enormous amounts of data concerning private citizens or ‘us’.

Most of us don’t seem to care too much, but I object to these invasions of my privacy. I don’t see why anyone should know my exam results apart from me and those people I might wish to tell. Equally plans which will require me to possess an identity card, not just a piece of plastic but backed up by a personal information database, to enable me to walk the streets are sinister and odious. Furthermore, the UK population is watched by four million CCTV cameras and 7.9% of the population is on the national DNA database despite an EU ruling that holding the genetic data of those never having been charged with a crime was unlawful. There are also proposals for a ‘superdatabase’ of citizens’ emails and mobile phone calls.  Clause 152 of the current Coroners and Justice Bill will allow government departments very broad powers to share personal information.  The plans for NHS records could mean that your notes could be read by over one million people (see below)

Of course I can’t say that this datasharing is without benefits. We must all give up a reasonable amount of our privacy to enable to fight against crime and to allow us to move smoothly through the days in a complex society. What I say is that the balance is wrong and that our data is being collected to deal with vague and insubstantial threats and/or ruthlessly mined by poorly regulated commercial organisations whose intentions are unclear. Either way we are being carelessly treated and the UK is sleepwalking into a surveillance nightmare where privacy is seriously compromised.

There are signs of a return of sense.  Publishing last week the high profile authors of a report published by the House of Lords today agree that privacy is under treat. The committee chairman Lord Goddard said:

“The huge rise in surveillance and data collection by the state and other organisations risks undermining the long-standing traditions of privacy and individual freedom which are vital for democracy.

If the public are to trust that information about them is not being improperly used there should be much more openness about what data is collected, by whom and how it is used.”

Privacy is a precondition to a life of quality and also at the root of freedom. I think it’s important to fight back where one can. The Government has a plan to make all NHS patient records part of a nation wide ‘spine’, where potentially every NHS employee, of which there are over a million, could access your records. The Big Opt Out website tells you how to remove yourself.

At the end of this month The Convention on Modern Liberty is being held. No2id are an organisation campaigning against ID cards. Here they tell you why ID cards should concern everyone who lives in the UK.

On behalf of Derek Summerfield: Open letter of Protest

Wednesday, February 4th, 2009

On behalf of Derek Summerfield:

Dear colleagues,

We need your support for a potentially influential open letter of protest regarding the inauguration last November of Dr Yoram Blachar, longstanding President of the Israeli Medical Association (IMA), as President of the World Medical Association (WMA). The WMA is the official body tasked with overseeing the ethical behaviour of doctors worldwide. For Blachar to be their President is a bit like appointing Bush’s ex-Attorney General Gonzales (“the Geneva Convention is quaint”) as head of Amnesty International. This letter, and what flows from it, should certainly play a part in the public identification of Blachar’s IMA as oblivious to ethical codes when it comes to Palestinian people.

We are focusing on torture, and Israeli doctors’ institutionalised involvement in it, in this letter- though of course the case against the IMA for refusing to act regarding violations of the Fourth Geneva Convention - the rights of a civilian population in a conflict zone – is equally damning.

Public pressure and a call for the WMA Council to fulfil their mandate to act will help to cut the ground from beneath the feet of Blachar and the IMA regarding torture, and more besides: as Hadas Ziv of Physicians for Human Rights Israel has written, if Israeli doctors were withdrawn, the everyday practice of torture in Israel could not continue as it does. We have real hopes for this initiative, which with luck and effort may also create a ripple effect well beyond matters medical.

We are seeking as many hundreds of signatures from physicians around the world as we can get for a letter – see below – that will go to the WMA Council, but at the same time will be publicised or published in an international medical journal and hopefully other media. The WMA is an organisation for physicians specifically, so this call is for physicians – though we are aware how much support for solidarity work on medical issues has come from other kinds of workers and professionals, and hope you can help recruit signatories. Regarding UK, I would see as bedrock the 150 physicians who signed a letter of support for a boycott of IMA in the newspaper The Guardian in April 2007, but we need a body of signatories from as many countries as possible- not least from USA, Israel and Palestine.

We have not reached this point lightly. The IMA has rebuffed all appeals made to it on such issues over many years- whether from outside individuals or organisations like Amnesty, from Palestinian sources, or from reputable Israeli organisations like Physicians for Human Rights, the Public Committee Against Torture in Israel, or B’Tselem. So too, until now, the WMA, which Blachar has worked hard to neutralise. If normal channels don’t work, won’t work, we either give up and go home (which is turning away) or, honouring the gravity of principles at stake, go on to more direct challenges.

Whilst this action is of course consistent with the broader campaign for an academic boycott of Israel, what is at stake here is an issue in itself and signatories do not necessarily have to feel that they have committed themselves to a pro-boycott position in general.

We are sending out this call as widely as possible, including to Noam Chomsky, Norman Finkelstein and other prominent scholars. Please can you all consider this and use your own networks to recruit medical signatures on an urgent basis- 2 weeks, say.

Below is the letter, and below that is a background briefing paper conveying a reasonably succinct summary of the evidence upon which this call is based.

I am also attaching a blacharlancet letter to the international medical journal The Lancet in 1997 in which (see 4th paragraph) he actually defends torture- “moderate physical pressure”- in Israel!

In summary:

  • We are seeking the signatures of medical doctors/physicians worldwide.
  • We would like them simply to email me individually with name, position (if a professor, say so) or medical speciality, city or town. For those not currently in post (eg retired physicians) just tell me your speciality and home town/city.
  • Because my work email is sometimes affected by spam filters, can signatories please use:

Please act with urgency (2 weeks to collect signatories). 

Do get back with any queries.

In solidarity

Derek Summerfield (on behalf of the UK Medical Committee for Palestine). 



Dear WMA Council Chair Dr Edward Hill and the Council

We the undersigned physicians from X countries wish to publicly protest and appeal against the recent appointment of Dr Yoram Blachar, longstanding President of the Israeli Medical Association, as President of the World Medical Association. We believe that his Presidency makes a mockery of the principles on which the WMA was founded in 1947, which was as a response to egregious abuses by German and Japanese doctors in World War Two.

The WMA’s own Declaration of Tokyo (1975) specifies that “physicians shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, and in all situations, including armed conflict and civil conflict”. The WMA Annual General Assembly of 2007 made it clear that inaction was not an option, stating that “this is the first time the WMA has explicitly obliged doctors to document cases of torture of which they become aware. The absence of documenting and denouncing such acts might be considered as a form of tolerance and of non-assistance to the victims”.(1)  There are still more recent calls from authoritative academic sources for the international medical community to go much further in actively allying itself with efforts to suppress mistreatment of prisoners. (2)

Amnesty International concluded as long ago as 1996 that Israeli doctors working with the security services “formed part of a system in which detainees are tortured, ill treated and humiliated in ways that place prison medical practice in conflict with medical ethics”. (3) Dr Blachar, already IMA President, took no action. Amnesty’s briefing to the UN Committee against Torture in September 2008 “focuses on Amnesty International’s (continuing) concerns about Israel’s failure to implement the Convention against Torture in the Occupied Palestinian Territories and the intensification of measures amounting to cruel, inhuman and degrading treatment and punishment”.(4) 

A well publicised report in 2007 by the Public Committee Against Torture in Israel (PCATI), based on the detailed testimony of 9 Palestinian men tortured between 2004 and 2006, gives a graphic demonstration of the extent to which Israeli doctors continue to form an integral and everyday part of the running of interrogation suites whose output is torture. (5) The IMA have conceded that they were aware of this report, but did nothing.  More recently, at a meeting on December 10 2008 in Tel Aviv, with Dr Blachar presiding only weeks after his inauguration as WMA President, Physicians for Human Rights Israel again sought to confront the IMA about this and similar evidence in the public domain.

 In its 2008 annual report to the UN Committee Against Torture, the UAT Coalition, a coalition of 14 Israeli and Palestinian human rights organisations, concluded that “since the Committee last reviewed Israel, the practice of torture and ill treatment has continued unabated.  The UAT Coalition wishes to inform the Committee that in its opinion the use of torture and ill treatment by Israeli authorities against Palestinians is both widespread and systematic.  The UAT Coalition has recorded evidence of acts, omissions and complicity by agents of the State at all levels….until this culture of impunity is addressed this situation is unlikely to improve”.(6) 

In November 2008, PCATI filed a contempt of court motion to the High Court of Justice against the government of Israel and the General Security Service for their responsibility for a policy that grants a-priori permits to use torture in interrogations. The IMA have never challenged torture as state policy in Israel.

Dr Blachar went as far as to justify the use in Israel of “moderate physical pressure” (condemned as torture by the UN Committee Against Torture) in the fourth paragraph of a letter published in the international medical journal The Lancet in 1997 (7) This surely unprecedented action by the president of a national medical association has not been disowned, and renders him unfit for the office of WMA President. In the age of evidence-based medicine his rejection of the documentary record has been unprofessional and frequently contemptuous, as when on the British Medical Journal website he labelled as “the lies and filth he spews” and “anti-semitic” a BMJ publication which cited Amnesty, Johns Hopkins University, the International Court of Justice, a UN Rapporteur and Physicians for Human Rights Israel. (8) IMA membership of WMA appears to have been a figleaf:  The IMA website pays lip service to medical ethics but Dr Blachar has overseen a studied failure to take the actions mandated by the Declaration of Tokyo.

We conclude that under Dr Blachar’s leadership the IMA made a decision on political grounds years ago to turn a blind eye to torture in Israel and the institutionalised involvement of doctors. On an issue that goes to the heart of the moral authority of the profession, Dr Blachar has offered shameful ethical leadership to doctors in Israel and worldwide.

It could scarcely be more scandalous that he now assumes the Presidency of the official international body overseeing medical ethics.  This appointment will seriously damage the public reputation of the WMA and its work, and indeed risks making it a laughing stock. We call upon the WMA Council to oblige Dr Blachar to step down as a matter of priority. Since the WMA is mandated to ensure that its member associations conform to its codes, we also request an investigation into the IMA record highlighted above.  


1 World Medical Association. Doctors urged to document cases of torture. Press Release 8 Oct 2007.

Miles S, Freedman A. Medical ethics and torture: revising the Declaration of Tokyo. Lancet 2009: 373:344-48.

3    Amnesty International. “Under constant medical supervision”, torture, ill-treatment and the health professions in Israel and the Occupied Territories. London. Amnesty International. MDE 15/37/96. 1996.

4    Amnesty International. Israel/OPT. Briefing to the Committee Against Torture. MDE 15/040/2008. 2008.

5     Public Committee Against Torture in Israel. Ticking Bombs- testimonies of torture victims in Israel. PCATI  2007.

6      Defence for Children International. Palestine Section. UAT Report: Torture and ill-treatment in Israel and the OPT. 2008.

7    Blachar Y. The truth about Israeli medical ethics. Lancet 1997;350: 1247.

8     Blachar Y. Response from the Israeli Medical Association. Rapid Responses,, 15 December 2004




Background information for those considering adding their signature to the letter above: 

1. See a facsimile of Blachar writing in The Lancet, justifying “moderate physical pressure” (torture). See 4th paragraph.

2. Brief summary of the case: Torture and the Israeli Medical Association.

Torture in Israel has a long history and there is a mountain of documentation in the public realm attesting to it- from both international and regional (Israeli and Palestinian) human rights organisations .

In 1993 the existence of a “fitness for interrogation” form came to light, to be signed by a doctor. Since interrogation customarily meant torture, the doctors signing these forms were giving the green light to the interrogators and their methods and were thus part of the process themselves.

Amnesty International concluded in 1996 that Israeli doctors working with the security services “formed part of a system in which detainees are tortured, ill-treated and humiliated in ways that place prison medical practice in conflict with medical ethics”.Amnesty, and others, who approached the Israeli Medical association (IMA) to urge them to take a stand were consistently rebuffed. This too has been my experience when I published articles in mainstream medical journals- notable the British Medical Journal and the Lancet. In response to one of these, published in the Lancet in 1997, the longstanding president of the IMA Dr Y Blachar actually justified the use of “moderate physical pressure”, the euphemism in Israel for torture, and declared as such by the UN Committee Against Torture!  I’m attaching a pdf of this letter.

 The moral position and strategic line taken over many years by the IMA was well captured by a remark made by Professor Eran Dolev, than IMA Head of Ethics (yes, Ethics!) in an interview in 1999 with a visiting delegation from the Medical Foundation for the Care of Victims of Torture, London (for whom I was principal psychiatrist for 9 years). Prof Dolev stated that that “a couple of broken fingers” during the interrogation of Palestinians was worthwhile for the information it might garner.  When I published this in the Journal of the Royal Society of Medicine, verified by those present at the interview, Dr Blachar defended  Prof Dolev.

Indeed 2 years earlier, after a human rights conference in Gaza in 1997, I had written to Dolev in his capacity as Head of Ethics. An Israeli physician had told me that a medical colleague had confessed to her that he had removed the intravenous drip from the arm of a seriously ill Palestinian prisoner, and told the man that if he wanted to live, he should co-operate with his interrogators. I asked Dolev to investigate but he never replied, even after reminders. 

When an Israeli psychiatrist Dr Ruchama Marton, a psychiatrist, publicised the unethical role that fellow Israeli doctors were playing in detention centres by  labelling seriously mentally ill Palestinian detainees as “malingerers”, and denying them treatment, the IMA charged her with slander rather than investigating the allegations.(2)

The titles of 11 Amnesty reports on Israel/OPT between 2002-7 contained the word “torture”.

Torture continues to be state policy in Israel. The Israeli human rights documentation centre B’Tselem recently confirmed (April 2007) that almost all Palestinian detainees suffer physical and mental abuse amounting to torture, citing the testimonies of 73 men gathered between July 2005 and January 2006. The IMA maintains a studied silence.

No recent firsthand evidence is more telling than that compiled by the Israeli organization Public Committee Against Torture (PCATI), entitled ‘“Ticking Bombs”. Testimonies of Torture Victims in Israel’. Published in May 2007, their report records the detailed testimony of 9 Palestinian men tortured by Israeli security services between 2004 and 2006. Here is graphic demonstration of the conclusions published by Amnesty International in 1996, and over and over again by other organisations,, that Israeli doctors form an integral and everyday part of the running of the interrogation suites whose output is torture. Doctors, several of whom are actually named, saw the prisoners at various points between episodes of torture (which in one case led to spinal cord damage), did not take a proper history, did not protest on these men’s behalf, and typically prescribed simple analgesia before returning them to their interrogators. They did not need to ask the prisoners what had happened to them because they knew perfectly well. It is also remarkable that doctors in position of authority were directly involved in several of these cases, and are also named: the Chief Medical Officer of the Israeli Prison Service, Dr Alex Adler; the Chief Medical Officer of Israeli Police Dr.Tzvi Lankovski; and- most telling of all- no less than the Chairman of the Ethics board of the Israeli Medical Association, Professor Avinoam Reches. These accounts carry the imprimateur of a human rights organization of many years standing and high reputation. The named doctors have not demanded a retraction or sued the report’s authors in order to clear their names. When 7 of us published a short account in the Lancet, the IMA wrote to us to threaten to sue, though in the same email they conceded that Professor Reches had been sent a copy at the time. Thus the IMA condemned itself out of its own mouth, since inaction in the face of reputable evidence of torture, and of doctor’s involvement, violates the WMA codes- in particular the anti-torture Declaration of Tokyo- to which the IMA is signed up as a member. As the Executive Director of Physicians for Human Rights-Israel put it in the Lancet in 2003, the IMA’s collusion with torture is part of “its long tradition of siding with ‘national Israeli considerations’ rather than with universal medical ethics”.

Amnesty International’s briefing to the UN Committee Against Torture of 30 Sept 2008 concludes as before: “This briefing focuses on Amnesty International’s concerns about Israel’s failure to implement the Convention against Torture in the Occupied Palestinian territories (OPT) and the intensification of measures amounting to cruel, inhuman and degrading treatment and punishment…….”

On 2 Nov 2008, the Public Committee Against Torture in Israel, in conjunction with the Association for Civil Rights in Israel, and HaMoked, the Centre for the Defence of the Individual, PCATI “filed a contempt of court motion to the High Court of Justice against the government of Israel and its head, Prime Minster, Ehud Olmert, and against the General Security Service (GSS) and its head Yuval Diskin, for their responsibility for a policy that grants a-priori permits to use torture in interrogations that fundamentally violate the  High Court of Justice decision of September 1999.”

In its 25 Nov 2008 Annual Report, the United Against Torture Coalition (UAT), a coalition of 14 Palestinian and Israeli human rights organisations, has undertaken an in-depth and critical analysis of Israel’s compliance with the Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment. The report examines the continued and systematic use of torture by the State of Israel in both Israel and in the Occupied Palestinian Territories (OPT). The Report includes more than 80 pages of affidavit material, forming the basis of their submission to the UN Committee Against Torture in September 2008, pending the Committee’s next review of Israel’s compliance with CAT due in May 2009. The UAT Coalition examined the use of torture and ill-treatment by the Israeli authorities against Palestinians from the point of arrest, through interrogation and detention as well as the use of coerced confessions in the military courts. Their Report also considers:

  • The use of torture and ill-treatment in non-conventional circumstances, including house demolitions, the Gaza siege and the coercion by Israeli Security Agency (ISA) of medical patients attempting to exit Gaza in order to access necessary medical treatment.
  •  The continued use of incommunicado detention and lack of prompt access to lawyers for Palestinian detainees.
  •  The discriminatory nature by which laws and practices are applied to Palestinian detainees compared to Israeli citizens.
  • The impunity with which ISA interrogators, police officers and members of the Israeli army torture and abuse Palestinian detainees, including children as young as 12.
  • A legislative exemption that allows the ISA (Security Services) to interrogate Palestinian detainees without audio visual recordings as is required in other investigations.
  • The failure of the State of Israel to clearly prohibit the use of torture and ill-treatment in its domestic legislation as recommended by the UN Committee.

The UAT Coalition concludes that the use of torture and ill-treatment by Israeli authorities against Palestinians is both widespread and systematic. The State is either unwilling or unable to fulfill its treaty obligations under CAT. The UAT Coalition has recorded evidence of acts, omissions and complicity by agents of the State at all levels, including the army, intelligence service, the police, the judiciary and other branches of government. The Coalition is of the view that until this culture of impunity is addressed the situation is unlikely to improve.

This, then, is a brief account of torture as state policy in Israel, and of the shameful and unethical role played over many years by the IMA and its longstanding President Dr Yoram Blachar. He was Chair of Council of the World Medical Association (the official international watchdog on medical ethics) from 2003-7- an appointment I sought to highlight and contest in the BMJ in 2003.  And now the Presidency itself! Next thing we’ll have Donald Rumsfeld or ex-Attorney Gen Gonzales (“the Geneva Convention is quaint”) as head of Amnesty International…!!

We are challenging Blachar’s appointment on the torture issue specifically, though the other arm of our case against him and the IMA would be their refusal to hold the Israeli Government and Defence Force to account for their systematic violations of the 4th Geneva Convention – specifically those clauses which guarantee the right of a civilian population in a conflict zone to unimpeded access to services vital to life: food, water, health care etc, and which guarantee health workers, clinics, ambulances etc immunity from military action.  The last few weeks in Gaza have amply and terribly borne out what Physicians for Human Rights Israel (for whom I have the greatest respect) wrote at the time of the 2002 invasion of the West Bank. “We believed that the IMA might be able to curb the appalling deterioration in the attitude of Israeli military forces towards Palestinian health and rescue services. Yet despite severe injury to medical personnel and to the ability of physicians to act in safety to advance their patients’ interests; despite Israeli shells that have fallen on Palestinian hospitals; despite the killing of medical personnel on duty- IMA has chosen to remain silent.”