Here’s a short piece I wrote for BMJ.com blogs:

According to a recent article in the Guardian newspaper I’ve worked in the two most polluting buildings in the UK. Over the course of one year the Royal London Hospital in Whitechapel was responsible for the emission of 46,218 tonnes of CO2, (rated G). Cambridge’s Addenbrooke’s hospital – in whose A&E department I worked – was the second worst, receiving an F rating. Overall eight of the ten worst polluting buildings in the UK were hospitals which on average emitted 4089 tonnes of CO2 per institution yearly. At the other end of the scale, tourist information centres emit on average 140 tonnes per year.

Hospitals are always going to struggle to be energy efficient. Despite modernisation many are still sprawling behemoths with “legacy” buildings whose origins sometimes stretch over the course of more than a century. In those days ‘energy efficiency’ was having a rest before beating the maid. Unlike offices, the nature of health care means that hospitals never close and heating costs will be high due to the needs of ill patients.

But still, walk into any hospital department and you’ll find every room is lit at all hours and every computer terminal is on whether or not it is being used. Heating systems are unresponsive and temperature regulation tends to involve opening the windows. This profligacy is hardly surprising as there’s little incentive to conserve* and things like computers aren’t designed to be powered down anyway. Some lights have most likely not been turned off for several years and I’ve only every worked in one place with motion activated lights.

All this will change I hope, although compared with, say, hand disinfecting energy efficiency has a very low profile in the NHS.

* NB: Lest it be thought I am preaching, I am no better than anyone else in this regard.

***

Links

BMJ and the Hippocratic Oath: how the BMJ fails on both

NHS sustainable development unit – they’re not completely ignoring the problem it seems

Maisy and George and the future of their planet – a rather mawkish film by the BMJ, but some interesting interviews

NHS needs to tackle energy consumption – Telegraph 22 June 2007

The Observer front page on Sunday last ran the headline:

Four psychiatric patients dying every day in NHS care

In the safety conscious NHS culture, every time something untoward happens an incident form is filled in.  An incident form should be completed if, for instance, a patient was given  by mistake 10mg of Olanzapine rather than 5mg.  Sometimes the incident can actually be quite trivial.  I have filled in incident forms on three occasions, once when patient had a heart attack in my office, once when  patient scarpered before I’d finished assessing him and once when, on the side of a table, I ripped a brand new pair of trousers on the first day I wore them.

The National Patient Safety agency  collect details of these patient safety related incidents (my third incident wouldn’t be included in this).  These are published on their website on a trust by trust basis.  According to the Observer, The Liberal democrats have added up the number of deaths across the country 2007-08 and have come up with a figure showing that 1282 people died in patient safety incidents in mental health settings.  The Observer reports what Normal Lamb, the Liberal Democrats Health spokesman, has to say about their calculation:

These figures are shocking. It’s a scandal that four people a day are dying while under the care of the NHS, and nearly three a day are ending up seriously harmed. It’s an appalling indictment of NHS psychiatric care.

These deaths are the result of inadequate attention and resources being given to mental health, despite the patients being among the most vulnerable and needy in the whole health system

Now, I’m not about to argue that mental health care in the NHS is ideal, nor that it’s not underfunded.  However without further breakdown as to the circumstances surrounding each death or serious injury I don’t think that it’s fair to reach these conclusions.  A proportion of these deaths will be due to suicide and, although the numbers of these have reduced, they will be difficult to stop entirely.  But there will also be a large number due to natural cause.  A lot of people work within difficult mental health settings at only small personal gain; their care will not be perfect but this represents a disservice to their hard work.

Celebrity watch:

Ronny O’Sullivan who defends his world snooker championship title next week talks in the Guardian about the problems he has encountered with depression.  Seemingly an extremely intense man, he appears to have discovered that running helps him cope. 

O’Sullivan is a fanatical runner and its impact on helping him cope with depression is profound. “Running clears my mind, and gives me a reason to get out of bed in the morning. Once I’ve had a run I can hit some balls for a couple of hours and by then it’s the afternoon and I think, ‘Yeah, it’s been a positive day, really.’”

Sublimation was Freud’s name for it.

Phil Spector, 1960s pop supreme inventor of the ‘Wall of Sound’ and dubbed the ‘first tycoon of teen’ by Tom Wolfe has been convicted of the murder of B movie actress turned nightclub hostess Lana Clarkson.  Spector had a reputation for eccentricity and talked during his trial about being on psychiatric medication.  My web searches haven’t come up with anything particularly illuminating concerning his mental health, although these people claim him as bipolar with this quote from the Observer. 

I consider myself a disturbed human being, but I’m under control. I’ve been blessed with a genius, but I’ve been punished with insomnia and manic depression. I’ve fought the devil for 20 years

I’m sorry I’m not writing much at the moment, I’ve got another bloody exam, but in the meantime:

Britain’s highest decorated serving soldier has criticised the provision of mental health care for UK soldiers: BBC: Veteran mental care ‘a disgrace’ and Ex-soldier’s battle for mental health 28 February 2009 / Guardian: Minister defends care given to war veterans 1 March 2009 / Independent: Soldiers rally to VC hero’s defence 2 March 2009 / Mirror: Young war veterans are three times more likely to kill themselves than civilians – exclusive / Independent: Dr Walter Busuttil: Some veterans have traumas from four conflicts 28 February 2009.  What interests me the most is that PTSD is always referenced in press and in popular discourse uncritically as if its validity were established beyond doubt, which illustrates how willing British society has become to describe our difficulties in terms of psychological disorders. 

Whilst I am on the subject, it may soon be quicker to list the things that don’t give you PTSD than the things that do.  Here the the Guardian website reports, with the help of the BMJ Strokes can give you post traumatic stress 27 February 2009

AstroZeneca is in trouble with its antipsychotic medication Quetiapine regarding when the company knew this medication increased the risk of developing diabetes.  Nine thousand US citizens are taking court action, saying that they have been harmed by the medication.  The Wall Street Journal reports that there are allegations that the company sought to suppress unflattering studies.  The Times reports on 27 February that concern about AstraZeneca’s conduct over Quetiapine has cost the company 7% of its share price.

In mid February, it was speculated that psychiatrists might recommend that Peter Sutcliffe the Yorkshire Ripper could be realised – Ripper’s fit to be released from Broadmoor – Sun February 17 2009  Since the only UK prisioner less likely to be released is Ian Brady, one wonders why they didn’t save their breath.  And so it turned out:  Yorkshire Ripper Peter Sutcliffe likely to spend rest of life in jail Times 18 February 2009

As a science/medicine blogger, it’s sometimes difficult to find something current to write about that Ben Goldacre at Bad Science and Vaughn at Mindhacks haven’t already covered better than you.  Goldacre has an acute ear for folly, and is an expert at exposing bullshit.  Vaughn at Mindhacks is a powerhouse of intellect.  It’s been phasers on kill for them both against the article Well connected?: the biological implications of social networking Riposte: “Facebook causes Cancer” – Bad Science / Facebook causes marble loss – Mind Hacks.  Also try Age Concern backs social networks but Ben Goldacres blood pressure still rising – Technology blog Guardian 25 February 2009 and Facebook: it’s not neuroscience – Guardian Comment is Free 25 February 2009