Monthly Archives: February 2010

Solving the antibiotic resistance problem

Many people take antibiotics, in fact it is hard to understand how people ever managed without them. The trouble is, some people don’t finish the full course they have been prescribed, but stop taking them once their symptoms have gone. The few bacteria left are likely to be the ones most resistant to the antibiotic, and they will be the ones that go on to breed. Occasionally a highly resistant strain of bacteria results, and an antibiotic then  becomes useless in cases associated with that strain. Today, we have some diseases caused by bacteria that are resistant to almost all of our antibiotics.

I’m not sure whether this has already been tried, and I am already sick of googling today, but one approach must surely be to chemically tag each capsule in a prescription. At the end of a course, a patient might be forced to provide a blood sample, which could then be checked for the presence of each of the chemicals. This could be a precondition of the prescription. If a patient is found not to have taken the full course, they could be kept under supervision while they take a full course, imprisoned if need be. Or perhaps a heavy fine would suffice. It sounds a bit heavy handed of course, and only appropriate where the consequences justify it, but the creation of another resistant strain would affect very many people, and in some cases, people would die. When someone puts others’ lives at risk through their own selfishness or stupidity, then it is appropriate to be heavy handed.

I have no means of calculating the precise figures, but millions of lives have been saved by antibiotics in the past.  Millions in the future could die because of the actions of a few thousand today, so this is a problem we should take seriously, at least until we have the means to either design lots of new antibiotics or find other cures.

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Open letter to next UK PM

The UK has suffered more than two decades of bad leadership, and it needs to change if it is to survive as one of the world’s top countries. As things look at the start of 2010, we will soon be replacing a very bad government with a merely bad one, and that will not do.

Conservatives say they want to invest in high speed rail, protect the NHS, hold public pay for a year, and be green. Oh dear.

Rail travel in the UK is still based on 19th century technology and it is long overdue for replacement by a 21st century system. All round the world, there are trials of rapid transit systems based on small pods, driven automatically on light rail. Such a system can deliver extremely responsive transport, with each pod holding only a few people, going to their specified destination almost as soon as they want to leave. Performance engineering says that such a system can use rail at up to 80% occupancy. That would be several times as good as even London Underground’s Central Line at rush hour, and 200 times the level achieved by regional railways. Regional rail is plagued by signalling problems and broken down trains, but a pod-based light rail system would use inter-pod signalling and pods would be able to push other along, solving both of these problems at a fraction of the price of yesterday’s poorly designed signalling systems. We don’t need a high speed rail network using antique trains. We need a proper 21st century rail network that is more energy efficient, faster, more reliable with lower congestion, and more responsive to individuals’ needs.

The NHS is similarly afflicted by yesterday’s solutions. The conservatives say they will protect its funding from cuts, but it is perfectly possible to reduce costs and improve performance at the same time. In an age where a PC can outperform a GP in diagnosis, and a robot can outperform the highest skilled surgeon in operating, we are paying our doctors the highest wages in the world for some of the lowest performance. Wards are filthy, and mistakes and negligence needlessly kill tens of thousands of people every year. Misguided centralisation and micromanagement policy has wrecked the potential of IT to deliver enormous savings, while out-dated outsourcing contracts have resulted in cleaning companies leaving wards dangerously dirty because profit motivation has replaced dedication to the patient. Management in the NHS manages to remain village class in spite of world class funding. The NHS should not be protected. It is long overdue for a roots-up replacement by a properly designed health care system based on the needs of the population and delivered by proper use of both people and technology where they are best suited. This would cost a fraction of today’s NHS and be far more effective.

Public service wages shouldn’t just be held steady for a year, they should be greatly reduced and many public sector workers laid off or redeployed. In almost all areas, public service wages are too high compared to wages for equivalent work in the private sector. High pensions based on the last few years of salary have encouraged departments to promote people to high levels just before they retire, so that as many people as possible benefit from the scheme. The result is that taxpayers are paying almost as much in pensions as wages for many public sector workers. In spite of higher wages and much higher pensions, public sector workers are often poorly skilled compared to their private sector equivalents, work fewer hours, and take more sick leave. They are generally also much better protected from consequences of poor performance. The public sector includes a large number of jobs that could be cut. There are too many quangos doing work that is unnecessary or executed so poorly that it is useless. These should also go.
What is needed throughout the public sector is a wholesale reappraisal of terms and conditions, with wages aligned continuously and automatically with the 40th percentile of private sector equivalents, both in wages and pensions. All jobs throughout the public sector should be reconsidered  in terms of need, with proper checks for duplication of roles. Any jobs that are found to be unnecessary should be eliminated. Panels made up of taxpayer representatives other than public sector workers should have a veto on the creation of any new jobs. This would cause enormous resistance but needs to be done and would result in a much better public service all round.

The welfare and employment system needs to be redesigned. It should be just and fair throughout. No-one should ever be so poor that they can’t afford basic essentials of life, nor should anyone over be better off on benefits that by taking any job on offer to them. Minimum wages should be realigned so that full time work enables a basic standard of living above that possible by living purely on benefits. Taxpayers should not have to support inefficient or greedy businesses nor low prices for products that only some people want to buy. Today’s market includes a great many products that have effectively been produced at taxpayer subsidy, but products that can’t make it in the market without exploitation of workers or taxpayers shouldn’t make it at all. Once minimum wages are set, welfare will be needed by far fewer people. Recipients of incapacity benefit should be re-assessed properly and if they are capable of any kind of work, even part time, they should be transferred to job-seeker’s allowance, which should also be set at a level that supports only a very basic standard of living, delivering an incentive always to take any work on offer. When people start work, their pay should be subjected to a gradually rising tax rate, and their entitlements to benefits reduced gradually as their wages increase, so that everyone will always be better off working. Other benefits should be appraised and the same principles of fairness and incentive applied throughout. Welfare should never be an alternative lifestyle, but should instead be a robust safety net.

Welfare should also be linked to a person’s history of paying into the system. Too many payments are made to economic migrants who have never contributed anything. Obviously we must protect everyone from extreme poverty, but it is fair that people who have contributed should have a higher entitlement to support when they are down on their luck.

Other laws should also be changed so that people who are prudent and save should be rewarded, not punished.

Being green is another of the Conservatives’ claims to power. Of course government should educate people and incentivise care of the environment. But that doesn’t mean throwing money at every passing green cause without proper analysis. A good many green policy errors have already made the environment worse. The environment cares nothing about politics, and it is imperative that government relies on proper scientific studies for its inputs. Payment of research grants should not depend on the meaning of the data produced, but on its accuracy and on the quality of scientific research on which it is based. Scientists should be free to do science, and politicians should use the inputs wisely to produce policy, testing it on an ongoing basis via the scientific method. Before major investments, government should properly consider the alternatives, including those likely to arrive over the appropriate time-frame. So for energy policy for example, we should evaluate the costs of solar farms in the Sahara desert using 2020 solar technology and include those in comparison with other solution sin the same time-frame, rather than necessarily going with those that are cheaper today. This and other related technologies in transport and industry should also be factored in to environmental models as far as energy consumption and the associated emissions are concerned. Since the future is different from today on many factors, models should not assume that the future is the same as today, but take into account likely changes as far as possible.

The justice system needs to be redesigned. Today, penalties bear little relation to the magnitude of the crime, so that leaving a bin lid open can result in a higher penalty than shoplifting or mugging. A complete re-apprasial of crime and punishment is needed, with punishments set on a sliding scale that reflects the impact of the crime more sensibly. Fines that can be levied by non-court authorities should be severely limited in size and scope. Punishments should automatically rise on second and subsequent offences so that career criminality is deterred. Criminals should void other rights while they are committing their crimes. Prisons should be very basic in terms of accommodation and lifestyle, again making them places to avoid. Any right to early release should depend on exceptionally good behaviour, rather than being the norm.

The electoral system needs to be changed to one I described in my previous blog, redesigning democracy for the 21st Century, which give MPs voting weight according to the national representation for their party. This is a proportional representation system that still allows good local representation without disadvantaging groups that are spread more evenly throughout the country as the current system does.

If all the above recommendations were to be implemented, the UK would have a cheaper and better public service, better health, better transport, better justice, and be a safe and pleasant land, where living responsibly would be very rewarding and pleasant. If the new government avoids tackling these issues, our country will continue to slide, becoming an unfair, unjust and unpleasant place to live, with a poor standard of living for all.