Druin Burch

Druin Burch is a consultant physician, a former junior doctor, and the author of books on history and medicine.

How to fix Britain’s ‘sick note’ disease

From our UK edition

Alan Milburn, Labour grandee and member of His Majesty’s Most Honourable Privy Council, has said our country’s sick note system ‘is just bloody insane’. He was in Holland with Sir Gareth Southgate. They visited on our behalf, trying to work out why the Dutch have less than 5 per cent of their youth not in education, employment or training, whereas for us the figure is not far off triple that, at 13.6 per cent. ‘We know that once you enter the welfare system... the stickiness kicks in,’ Milburn said, noting that people have a 50 per cent chance of still being on health and disability benefits 15 years after first receiving them. ‘Everybody talks about the fiscal disaster.

Can AI really spot heart disease in less than two seconds?

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September is here, and the mists and mellow fruitfulness have arrived as promptly as John Keats could have wished. His medical career peaked 210 years ago. He was working as a surgical dresser at Guy’s hospital, a coveted junior post, and in July 1816 passed the examinations qualifying him as an apothecary, a role then beginning to be called by its new name of 'general practitioner'. The annual European Society of Cardiology meeting finished in Munich last weekend. A new 'superhuman' AI tool capable of spotting heart disease in less than two seconds was presented there. This is exciting, but Keats would have been sceptical – and dubious about the business of medical breakthroughs.

Fixing depressed kids is a near-impossible business

From our UK edition

As a young Emergency Department doctor, I developed a spiel for the kids who came in with mental health problems. ‘I do the easy bit,’ I told them. ‘I deal with the physical. Let’s get that sorted first and then I’ll put you in touch with the people who’ll do the hard bit, the important bit, and who’ll help make life brighter for you.’ Often I told them this as I stitched up gashes they’d made in their arms or legs or chests. Frequently the gaping skin, parted to reveal glistening fat or muscle beneath, lay beside rows of older scars. Sometimes there’d be no scars save their despair, and I’d be taking blood to check on their overdose.

The joy of aphrodisiacs

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Men and women have put more effort into finding aphrodisiacs than alchemists ever put into changing lead into gold. Metals at least hold still; other people's sexual success has the bewitching fluidity of quicksilver. One of the oldest medical texts, the Ebers papyrus, recommended wrapping a wilting penis in henbane and animal brains, in beans and sawdust of pine and willow, in onion and goose fat and pig’s dung. Elsewhere in the ancient world, as in the Babylonian code of Hammurabi, doctors like myself were punished if we failed to treat a condition after claiming it was fixable - by having our hands cut off, for example. This concentrated our minds wonderfully.

Is the high-street pharmacy in danger?

From our UK edition

Only in France have I ever looked forward to attending a pharmacy. Napoleonic Paris, in response to the fatal incompetence of its citizens at foraging, mandated that pharmacies should come to their aid in identifying mushrooms. Across France they still do. I have wandered into many, clutching samples of my haul. Back in Britain I just eat them, but in France I get a second opinion. Firstly, I’m more adventurous there, knowing I have an expert safety net near at hand, and secondly the mushrooms are slightly different. There is the added appeal, though, of showing off. An indrawn breath and an impressed nod greeted one particularly fine bolete, and it tasted all the finer as a result.

Why people cared about Jason Arday

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Don’t badmouth the dead, said Chilon of Sparta. Over time, the phrase became a positive injunction to say nothing of the dead unless it was good, de mortuis nil nisi bonum. Christopher Hitchens had a different rule: say anything you like, so long as it was something you’d have been willing to say while they were alive. For him, death did not work as absolution, and the lives of figures public enough to merit scrutiny while they lived merited the same scrutiny in the aftermath of their death – perhaps even more acutely, because death was a time to reflect on who they were. When someone dies, and especially if they die by their own hand after public humiliation, as seems likely to have happened with Jason Arday, a great deal changes.

We need more emergency phone alerts

From our UK edition

Last night, my phone, which was set to silent, erupted with the sort of siren one associates with immediately life-threatening emergencies. If you live in England or Wales, yours probably did too. “There is a very high risk of wildfires,” read the message that appeared, once I’d fumbled the cacophonous phone out of my pocket. My lawn is brown and crunchy and we are living through the hottest summer of our lifetimes. I’ve just finished a twelve-day stretch working in a hospital with no air conditioning, and had finally sat down to consider a glass of chilled rosé, so it was useful to be brought up to speed with the fact that it’s been a trifle warm.

Will the NHS get serious about prescribing weight loss drugs?

From our UK edition

‘The weight is over,’ read an advert on the side of a bus outside my hospital this morning. The first really effective pill for weight loss has now been on sale in Britain for just over a month. Wegovy – it has the same brand name as its injectable equivalent – is a semaglutide. Ozempic is the same drug at a lower dose, sold to treat diabetes. Mounjaro is more effective than Wegovy but is injection-only. Lilly hopes its rival pill – Foundayo, orforglipron – will soon be licensed here; already it’s on sale in America. Drugs have a brand name, which is capitalised, and a generic name, which is not. (An odd exception is aspirin, which was Bayer’s trade name, but which they largely lost as the result of the first world war. Since, as part of the conglomerate I. G.

The NHS is not in a crisis of racism

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The Society of Radiographers have said racism is rising in the NHS.  They give the example of a patient refusing a chest X-ray from a black radiographer, saying ‘black people frighten me.’ Other anecdotes cite patients calling healthcare staff ‘dirty foreigners’ or ‘monkeys’. The Society of Radiographers says the problems have got worse in the past 18 months. They blame ‘increasingly hostile public attitudes’, and single out ‘nationalist movements such as Operation Raise the Colours’. They offer no evidence for that. Their published findings are neither large enough nor systematic enough to establish a trend, but at first glance they chime with a recent survey that is: the NHS Staff Survey, sent annually to 1.5 million NHS staff.

Why I’m ignoring the hosepipe ban – and you should too

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I returned from holiday to find parched lawns and a deliciously cool babbling brook where the road had been. Up the hill stood signs warning motorists that work was in progress, and the source of the leak was surrounded by temporary barriers. The scene was quiet and peaceful, dappled by sunlight on flowing water, and entirely undisturbed by human effort. The hosepipe ban takes a problem the government has created and tells us it’s ours My village is currently subject to a hosepipe ban, like much of England. Coming home yesterday I rescued my wilting hollyhocks – which are drought-tolerant plants – with a hosepipe, and I am willing to do so again.

Burnham is wrong to model social care reform on the NHS

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There have been trimmings and ornaments: the bus fare cap and the performative opening of a No. 10 North in an office block above a Manchester branch of the Slug and Lettuce. But Burnham’s first major act as Prime Minister is to walk back into the flames that consumed his last stint in high office. In 2010, his attempt at a legacy-defining Beveridge moment – creating a National Care Service – partially cost Labour power. Two failed leadership bids and exile to Manchester followed. Today, Burnham formally announced he’s having another go. 'I’m making this choice and I’m prepared to put everything I’ve got behind it,' he said. For now the Prime Minister is benefitting from the honeymoon glow of a bounce in the polls. That may not be enough.

A free-to-use National Care Service will never work

From our UK edition

As a former adviser on social care reform to a Conservative prime minister, allow me to explain why Andy Burnham's proposals on the issue – which I don’t know about, since he hasn’t revealed them – are wrong. Hints have been dropped, and a speech is planned for Wednesday. Burnham is committing himself to tackling the problem that brought David Cameron to my ward at the John Radcliffe Hospital in Oxford. He came in response to concern from a Witney constituent about delayed discharges. As ever, more than half my ward was occupied by patients termed ‘medically fit for discharge’. They were in hospital beds because the queue for carers at home, or for a care home bed or other supported accommodation, was long.

The NHS is fundamentally dishonest

From our UK edition

This weekend, the excellent health editor of the Sunday Times, Shaun Lintern, revealed how NHS England has been suppressing damaging reports from national clinical audits it funds. ‘The lesson from every major patient safety scandal is that failing to confront uncomfortable truths only allows unsafe care to persist,’ the paper quoted Jeremy Hunt as saying, adding that the NHS ‘should be championing independent scrutiny and transparency – not creating the impression that reputational management is taking precedence over patient safety.’ Unable to control what the NHS does, managers naturally concentrate on controlling how it’s perceived It’s more than an impression.

Why the bus £2 price cap might just pay off for Burnham

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Andy Burnham has announced a reduction in the cap on English bus fares, down from Starmer’s £3. Remarkably, he might be right to do so. 'For too long people have said that cheaper transport isn't an option,' he has announced. I don't accept that. I've done it before and I will do it again now: a £2 cap on bus fares for millions across the country. Lower fares will help people get to where they need to, giving them breathing space to help with the cost of living. The one-year measure will cost some half a billion pounds, and this time won’t apparently be freed up by cancelling an ID card scheme that wasn’t itself funded.

The joyous ridicule of Stella Creasy’s avian error

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‘Stella Creasy’s bird-brained parrot alert,’ ran a Steerpike headline yesterday. The Labour MP for Walthamstow had posted a video of herself in a London park. The video showed a parakeet, with the MP explaining it was definitely not a parakeet.  ‘Walthamstow has anyone lost a parrot?’ she wrote. ‘There’s one in Lloyd park right now! Please share to help reunite it with its owner!’ For centuries Londoners made fun of country bumpkins by saying they hadn't even seen the lions – meaning those at the Tower. The lions are long gone, but somehow it is now possible to be a country bumpkin in Walthamstow  The MP has faced some serious abuse on social media in her time.

The NHS can’t cope with this heat

From our UK edition

The weather in 1976, like the football ten years before, lingers in our national memory. But already on some measures this year is worse. Back then, the heat was drier and the nights cooler. We have already had six days above 35C, for the first time ever, and more warm nights in a single week than in the entirety of 1976. A recent study by British university researchers suggested that during eleven hot days in June, the weather in England and Wales was responsible for 2,200 deaths. Rather than a summer lull, my hospital is dealing with the sort of surge we normally see in winter. The same is true nationwide. Those of us not hospitalised by the heat will be noticing the sheer quantity of perspiration of which we’re capable.

It must be harder for the NHS to strike

From our UK edition

The BMA makes lots of vague demands for recognition and autonomy, control and civility – Madeline Grant, hearing similar words coming from Angela Rayner recently, called them generic, vibes-based slop. But what the BMA specifically wants is more money – for less work.  Wales is invoked as an exemplar; rarely a good sign in arguments not involving male-voice choirs or leeks. The BMA wants consultants’ top salary point immediately raised by £16,000, to match the Welsh, and to copy the contractual obligation there for doctors to get a fully-paid day and a half a week free of clinical duties. They want higher rates of pay for out of hours work, improvements in pensions, and the working week cut by five hours. Strike action to support these goals was backed by 76 per cent.

Does it matter what politicians drink?

From our UK edition

Keir Starmer is fond of a beer. We knew he liked beer when we knew nothing much about his policies except that they were in favour of everything that was good and against everything that was bad. We could be excused for feeling that the impending coronation of Andy Burnham offers more of the same. A Labour MP told the Today programme that Burnham explaining his policies was irrelevant given he’d ‘already shown he’s a very successful politician’. What we do know is that Burnham, too, likes beer. He and Starmer eagerly lean on the one point where their pose and their personality agree - Guinness for Burnham, real ale for Starmer.

Would Oxford still open its doors to a poor, white boy like me?

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Magdalen College, Oxford, is over-represented at The Spectator. Not long ago, Paul Johnson and Matthew d’Ancona were fixtures here. Today, there are Sam Leith, Douglas Murray, and Harry Mount. Unbeknownst to them, there is also me. I was there at the same time as all three, and a while after Matt Ridley. Poor white kids who are clever enough to go to Britain's ancient universities will find it much harder to get a look in Murray, I believe, spent time in a bad state school, but like Leith and Ridley reached Oxford via Eton; for Mount it was Westminster. I came the other way, a route which is now at the heart of a row over whether white kids from disadvantaged backgrounds are being shut out of many Oxbridge diversity schemes.

The true cost of ending the doctors’ strikes

From our UK edition

After three years, and a cost to taxpayers of over £3 billion, the junior doctor strikes are finally over. For now. The vote was narrow. Of those who voted, only 53 per cent backed the deal. The BMA reports the pay rise comes to 6.6 per cent by April 2027, with more to follow. Pay progression will be faster. The government will now pay doctors’ postgraduate examination fees, which the Royal Colleges run, as well as their college membership fees, a deal which guarantees the price of both will swiftly rise. A government with some steel would see the complaints of doctors as an opportunity. Workers’ rights too often mean the opposite, supporting the rights of those who work least In addition, the government has promised an extra 4,500 training posts.