For some, candour need not be a “duty”

Hole Ousia

On the 1st April 2018 Duty of Candour Regulations will come into force in Scotland:

The Scottish Press has reported this. Here is one such headline:

However this headline is not correct.

I have finally had a question about Duty of Candour answered by the Scottish Government’s “Openness and Learning Team”

Certain professional groups, who are involved in shaping health and social care,  are exempt from the duty of candour regulations:

  • all Healthcare Improvement Scotland staff
  • all Scottish civil servants (such as the Department of Health)


  • the Scottish Government.

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Two years of no sunshine

Hole Ousia

On Thursday 22nd March 2018 I will be standing outside the Scottish Parliament with this banner.

This will be a peaceful, one-man protest, two years to the day that my petition for a Sunshine Act was closed. My petition closed on a most positive finding: that the Scottish public, in an official consultation (by the Scottish Health Council) concluded that declarations of competing interests should be mandatory and recorded centrally in an open register.

I was hopeful that the campaign on Realistic Medicine might have encouraged some action before now as the issue of competing interests has been part of a number of health inquiries

However it is now two years on and the Scottish Government has provided no meaningful update. This is the reason for my protest.

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Antidepressant prescribing: still much to learn

Hole Ousia

The above meta-analysis was published in the Lancet today and I woke up to read headlines like this:

The lead author, Andrea Cipriani, Department of Psychiatry, University of Oxford, was quoted :

From my perspective this meta-analysis confirms that antidepressants, used over 8 weeks can improve mood in those diagnosed as experiencing severe depression. However, this study cannot say much beyond this, such as the balance between benefits and harms or the appropriate length of treatment. As such, the authors (as reported here) cannot justify statements about under-treatment.

As spokesperson for the Royal College of psychiatrists, Professor Carmine Pariante, stated:

I do not agree with Professor Pariante that the this meta-analysis "finally puts to bed the controversy on antidepressants" as we are now aware that the majority of those taking antidepressants (estimated in Scotland to be 1 in 7) take them indefinitely and there is a dearth of research…

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“Villains and Demonisers”

Hole Ousia

Almost a decade ago, one of the advisors to the Scottish Government on prescribing of antidepressants stated that it was the general public and their “distaste” for antidepressants that were the “real villains”. It was statements like this, from well-meaning colleagues, that led me to write this article, which I called “Window Tax”

Almost ten years on, and the Current Chair of Royal College of Psychiatrists in Scotland, when referring to antidepressant prescribing, describes those who ask questions about this in terms  of “demonising”:

For two decades now I have been asking what duration of antidepressant treatment is “appropriate”, being increasingly aware that many of the 1 in 7 who are now estimated to be taking antidepressants in Scotland, are in fact taking them indefinitely.

I do hope that it is not the case that I am considered a “villain” or “demoniser” for having asked this question. This is a…

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Tools, substitutes or companions: three metaphors for thinking about technology


Centaur_(PSF)Here are three metaphors for how we think about digital and robotic technologies:

First, as tools. Passive instruments which extend our own power. Hammers enhance your hitting, video calling extends your presence, algorithmic trading merely implements the rules you designed for trading. Tools seem like passive objects, without their own desires, but a moment’s thought will tell you that even passive objects have psychological effects (that’s why we say ‘to a man with a hammer every thing looks like a nail’).

A second metaphor is to think of technologies as substitutes. This is the metaphor which dominates robotics – and the ever repeated image of the humanoid robot, whether doing human labour (and potentially putting them out of work), or rising up and a waging a war against humans to replace them. Here’s an interesting post from Marginal Revolution, which pours cold water on self-driving trucks…

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Paradigms, pathologies and shifts

Hole Ousia

The following extracts are taken from this perspective published in the Scotsman, 11 January 2018:

Pfizer has seemingly concluded that Alzheimer’s disease is far more complex than we had ever anticipated.

Perhaps this indicates that the 110 year old “paradigmatic pathology” of Alzheimer’s disease does itself need a paradigm shift.

Meantime, the “Edinburgh Consensus” demonstrates limitless faith in the current paradigm, to the extent that they recommend that research criteria should be introduced into the NHS.

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