The Impossible Girl (spoilers) #DoctorWho #Spoonie

Last night was the season finale of Doctor Who. I  thought it was one of the best episodes for quite some time, certainly the best of the season. But it also got me to thinking. A major theme was losing and gaining control - both for the Doctor and his current companion, Clara. And that's also a huge issue for spoonies, people with long-term illnesses that cause crippling fatigue.

The baddies in this episode were the Whispermen, who kidnap the Doctor's friends Clara, Vastra, Jenny and Strax to lure him to the one place he must never go: his grave, on the planet Trenzalore.

When we become ill, it's as if we've been kidnapped and taken to a different planet. We are snatched away from our everyday lives, held hostage by the limitations of our conditions.

There is no body in the Doctor's tomb. Instead there is a time tunnel, made of scar tissue from all the Doctor's travels through time and space. The villain of the piece, the Great Intelligence (hammed up wonderfully by Richard E. Grant) enters the time tunnel, aiming to split itself into fragments scattered throughout the Doctor's timeline and corrupt it absolutely, undoing all the good he's done.

Clara follows it into the time tunnel in an attempt to reverse the damage. Things take place around her. Previous incarnations of the Doctor run by. At first she feels out of control. She has no idea what's going on.

Gradually she works out her purpose. The Doctor is always there, though not always in the same form. She can recognise the best thing for the Doctor to do: she saves his life.

It's the same for us. At first, everything is confusion and feeling out of control. Fatigue, pain, brain fog. But gradually, a pattern emerges. We work out what to do. How to live our lives in the best possible way for ourselves and those around us. Maybe we're not saving the Doctor (or maybe you are?) but in our own way we're time lords, pacing and resting so we can do the things we really want to do.

We're the impossible girls and boys. We learn our purpose. We regain control over our lives.

We're spoonies.

#BADD Growing Up Beside You

This is Imperial Place, Borehamwood.

A few days ago, someone asked me for directions to get there. I gave the directions. Off he trotted. I assume he got there - I have no reason to think he didn't.

OK, I hear you say. But why am I telling you this little anecdote?

Well, he asked me. There were other people around, but he asked me - the woman in the wheelchair. Unless you use a wheelchair yourself, you have no idea how rare this is.

You're much more likely to find someone looking at you like you're a bit weird because you're laughing, or standing up, or walking a few steps (YOU FRAUD!), or smoking a cigarette, or getting things off the top shelf in the supermarket, or clothes shopping, or drinking alcohol.

I mean, how dare I have anything approaching a normal life? I'm a cripple! It's surprising enough to see me out on my own without a minder, never mind doing things that everyone else - regular people, whose legs and stuff work - does.

Why does this happen? There has been a tradition of "Othering" disabled people, setting up an "us and them" dichotomy. Once disabled people are established as "them", they are seen as one homogenous mass. At the very most, they are split into "wheelchair users", "blind people", "deaf people" and so on. Within each sub-group, there is no scope for variation. So, for instance, a punk rocker using a wheelchair is far more shocking than an able-bodied punk rocker would be.

Other wheelchair users like myself may have experienced the shock it causes when they stand up, or walk a few paces. The standard definition of the subgroup "wheelchair user" is "totally unable to walk", and many members of the general population with no experience of disability are completely thrown by any standing or walking ability.

Similarly, use of a wheelchair is associated in many people's minds with learning difficulties. I have had an assistant in Clinton's Cards telling me how to use a book of stamps. (I told her I was doing a PhD and I thought I would cope.)

What can be done to counter this Othering? More and more exposure to more and more disabled people, showing our variety and the realities of our different lives, and how close they are in so many ways to the lives of everyone else in the world. Yes, that needs a more accessible society and a decent welfare system, so we're maybe talking long-term. But there are some good guys out there already. Think back to my Imperial Place experience.

Each individual like that who "gets it" is one more person who can spread the word that disabled people are - in the end - just people. It's best when it starts in childhood. So what we need to do is for you to grow up beside me, and I'll grow up beside you. Paolo Nutini says it well, I think.

This is my post for Blogging Against Disablism Day 2013. You can find the other links on Goldfish's great blog (which I recommend in general!) here.

Multiple Sclerosis Awareness Week #MSAwarenessWeek

MS Awareness Week starts today, 29th April 2013.

This is the one week a year when we - people with MS, our families and friends, and the organisations that support and inform us -  try to spread the word about what multiple sclerosis is and the many ways, often invisible but nonetheless potentially devastating, it can affect us.

This year's awareness week comes with the disturbing news that only 40% of those eligible to receive one of the seven licensed MS drugs are actually getting them. This may be down to a lack of information and problems accessing specialists. The UK ranks 25th out of 27 in Europe on prescription rates, which given our relative wealth is really not good enough.

Decisions should be taken nationally about this kind of treatment and specialist care plans drawn up for each patient, with regular reviews allowing for treatment options to be assessed on a regular basis.

People with MS tend to do a lot of falling, both physically and mentally. That's OK. The thing is getting up again. Those of you who don't have MS, please understand that this can sometimes take us a little while.

It's MS Awareness Week. But we have to be aware of MS every day of the year.

For more information on MS, please visit:
MS-UK
MS Society
MS Trust

Placebos, sham surgeries and CCSVI

Recently GPs took part in a survey which showed that 97% of them had used placebos at some point in their careers. The truth is inevitably more nuanced than that headline figure: 97% had used what the researchers called "impure" placebos such as antibiotics for viruses, and the figure for "pure" placebos, treatments containing no active ingredients at all, was in fact 10%.

"Pure", inactive placebos such as sugar pills may seem the more dangerous, but "impure" placebos may be actively dangerous to health. For instance, antibiotics can have side-effects and may promote antibiotic resistance.

Most of the doctors questioned thought that any risk of damaging the trust between doctor and patient was unacceptable, but that it was possible to prescribe a placebo to a patient without actively lying to them. For instance, half of the doctors told the patient that the intervention had helped others.

Is this ethical, particularly if it's possible that the patient would have got better anyway? If something is at the extreme ends of a range of measurements, the likelihood is that it will move towards the average. This is the statistical phenomenon called regression to the mean. The medical application of this is that if someone is ill, on the whole they're likely to get better whether there's any intervention or not.

There may be a psychological effect from receiving a placebo, even if the patient knows that's what it is. One study found that even when the patient was fully aware that their treatment had no active ingredients, the placebo effect was still seen. However there were methodological flaws in that study. More research is needed, to see if the results can be replicated.

Placebos are commonly used in trials to assess whether a new medication is better than no treatment at all. How can a surgical intervention be tested? Sometimes sham surgery is used. Sham surgery forms an important control, as anaesthesia, the incision, post-operative care, and the patient's perception of having had an operation are the same.

However again there are ethical issues, as all surgery has the potential to harm the patient. As a result, sham surgical procedures are rare in human subjects.

In a classic study in 2002, patients with osteoarthritis in the knee either had standard surgery, had their knee joint washed out, or had an incision made in the skin and sewn up again. All the patients in the trial therefore experienced "surgery" of some sort, but didn't know which type. All three groups reported similar levels of pain reduction and improvement in mobility, suggesting that the standard surgery produced no advantage over placebo.

A sham surgery trial has recently reported relating to the controversial CCSVI theory of the causation of MS, which hypothesises that MS is caused by compromised drainage of blood from the central nervous system. The proposed treatment is balloon venoplasty, whereby a small balloon is threaded into the vein and then inflated to clear the blockage. Since 2009, around 30,000 MS patients worldwide have had this treatment, almost always privately rather than as part of a trial.

In this small trial, 30 patients received either the balloon venoplasty treatment or a sham surgery. The treatment did not provide sustained improvement in patients. In fact in some cases, there was a deterioration.

Clearly this was a small study, and more research is needed. But in the meantime, the researchers, who studied under Paolo Zamboni, the developer of the CCSVI theory, have urged patients to enroll for trials rather than pay for the treatment privately.

Overall I believe placebos certainly have a valuable place in research, assuming of course that patients know they may receive the placebo rather than the active treatment. In the GP surgery, I'm not so sure. We should be using evidence-based medicine: that means the best available treatment for the condition, not sugar pills or inappropriate antibiotics. I suspect placebos will always be with us though, one way or the other.

Unhelpful response to the #WOWpetition

I don't know if you're already aware of the WOW petition. It was started a little over 3 months ago by comedian Francesca Martinez, and is well on target to achieve 100,000 signatures by its closing date. That means it would considered for debate in the House of Commons.

WOW stands for War on Welfare. Because frankly, that's how it does feel. Like this soulless government has declared war on those of us forced to claim welfare benefits.

Let's say you're on Disability Living Allowance, and when that gets changed over to Personal Indepencence Payment you lose out. Well OK, that's just one thing (apart from the blue badge, and Motability car, and disabled railcard, and so on that it passported it you to). Maybe you can manage without the DLA. Maybe.

But you're also on contributory Employment and Support Allowance, and you've been on it nearly a year. So that's about to stop.

And that's before we get anywhere near the changes to Council Tax Benefit, and to Housing Benefit (the Bedroom Tax).

Tens of thousands of sick disabled people are about to go under financially. And this government just doesn't give a damn. Oh, they always have a soundbite:

There's a lot of misleading stories about the impact of our welfare reforms on disabled people, which could lead to unnecessary scaremongering. Our reforms will make sure the billions we spend every year give more targeted support and better reflect today's understanding of disability. Hundreds of thousands of disabled adults and children will actually receive more support than now with the combined effect of benefit changes under universal credit.

Targeted. Some people receiving more support than now. Well, as someone pointed out to me today (thanks Eggy!) all the NHS funds don't get allocated to intensive care: support is required at all levels of need.

So, returning to the WOW petition, what it asks for (among some other things) is a cumulative impact assessment, not looking at the effect of each benefit "reform" (*spit*) separately, but how people will be affected in real life. Real people are complicated. Lots of us claim more than one benefit (partly because the system's so complex!)

When a government e-petition gets 10,000 signatures, the department responsible for it gives a reply. It's taken a while for the WOW petition's reply to turn up: I only just noticed it, and the petition has over 27,500 signatures.

To summarise the reply, it seems to be:

• We're not avoiding you.
• This is hard.
• The policies haven't all been decided yet.
• There are impact assessments for individual benefits or for all tax, benefit and expenditure changes across households, but nobody's ever done what you're asking for, which is in between.
• Did we mention this is hard?

My reply to that would be, with the greatest possible respect (and as civil servants they would know what an insult that is!) pop down to Ryman's, buy a new scientific calculator and get on with it. These are people's lives you're messing around with (at the command of your political masters), and there is a clear case for a cumulative impact assessment to be done.

If you haven't already signed the WOW petition, would you take a look and consider signing it? The more signatures on the petition, the more pressure sympathetic MPs like Michael Meacher can put on the DWP on our behalf.

Thanks!

Edit: I'm all for avoiding unnecessary government expenditure, so I'm sure it would be fine for the DWP to use this cumulative impact assessment, which Scope and Demos have just done. It calculates that those disabled people most severely affected by the cuts will lose £4,600 each year from what are already low incomes. As Richard Hawkes the chief executive of Scope says:

At the moment there’s no place for disabled people in the Chancellor’s aspiration nation.

Sadly, that seems to be very true.

PCC reply to my complaint about Daily Mail cartoon

I complained to the Press Complaints Commission about this cartoon, which was published in the Daily Mail on 25th February 2013.

This is their reply.

Commission’s decision in the case of

Various v Daily Mail

A number of complainants expressed concern regarding a cartoon which had accompanied an article about Disability Living Allowance (DLA). The cartoon had depicted a man with a blister, saying “it’s a bad blister, but a bit of Disability Living Allowance should make it better”.

Complainants considered that the newspaper had breached Clause 1 (Accuracy) by inaccurately suggesting that DLA could be claimed on the basis of such a trivial injury. They also considered that it had been misleading to imply that people in receipt of DLA do not have genuine need for the benefits they receive.

The complainants considered that the cartoon had been discriminatory towards the disabled, in breach of Clause 12 (Discrimination). A number of complainants also said that they had found the article offensive.

The Commission considered the cartoon to have been a satirical commentary on the availability of disability benefits. Cartoons are a well-established method of newspapers making satirical comments about current affairs, and the Commission would be reluctant to compromise the ability of publications to pass commentary in this manner. Nonetheless, regardless of whether the cartoon’s message was satirical, the newspaper was required to observe the terms of the Editors’ Code of Practice. Clause 1 (Accuracy) states that “the press must take care not to publish inaccurate, misleading or distorted information, including pictures” and “the press, whilst free to be partisan, must distinguish clearly between comment, conjecture and fact”.

The Commission was satisfied that readers generally would have recognised that the cartoon expressed the robust, and even controversial, opinion of the newspaper about the general availability of disability benefits, rather than a statement of fact about the precise circumstances in which benefits can be claimed. While the cartoon had suggested that benefits are too readily available, it had not implied that everyone on DLA was receiving it unnecessarily. The newspaper had not failed to distinguish comment from fact. There was no breach of the Code.

Under Clause 12 the press must avoid prejudicial or pejorative reference to an individual’s physical or mental illness or disability and details of an individual’s physical or mental illness or disability must be avoided unless genuinely relevant to the story. The Commission made clear that Clause 12 does not cover references to groups or categories of people. The article had not made discriminatory reference towards an individual. In the absence of reference to a particular individual, the Commission did not establish a breach of Clause 12.

The Commission acknowledged that a number of complainants found the cartoon offensive; however, it made clear that the terms of the Editors’ Code of Practice do not address issues of taste and offence. The Code is designed to address the potentially competing rights of freedom of expression and other rights of individuals, such as privacy. Newspapers and magazines have editorial freedom to publish what they consider to be appropriate provided that the rights of individuals – enshrined in the terms of the Code which specifically defines and protects these rights – are not compromised.  It could not, therefore, comment on this aspect of the complaint further.

I am not satisfied with this response. Does anyone know if there are further steps I can take?

Labour doesn't represent me any more

I have voted Labour at every election since I gained my majority, and became a member of the Labour Party around 1990. I am now going to leave the party, and will not be voting for them at future elections. This is not a decision I've reached easily, so I wanted to explain some of my reasons. From conversations with other people, I know I'm not alone.

I have multiple sclerosis and other long-term conditions. I wish I was well enough to work, but I know I'm not. I don't think I'll ever work again, unless there's something I can do from home, for one or two hours each week, and entirely under my own control as and when I feel well enough.

That being the case, I don't think it's extreme to expect society to provide me, and other long-term sick and disabled people, with support. After all, we consider ourselves to be a civilised country, and as Mahatma Ghandi said:

A nation's greatness is measured by how it treats its weakest members.

According to its website, the first and second values on which the Labour Party stands are social justice and strong community & social values. So Labour must agree that sick and disabled people should be supported, right?

Well...it's hard to tell, really. It was the Labour Party which awarded the contract for the unfit for purpose Work Capability Assessments to the iniquitous Atos. They have not, until recently, spoken up against the Welfare Reform Act, which has forced so many genuinely disabled people into abject poverty, and the fear of which has caused many people, sadly, to kill themselves.

Party leader Ed Milliband has relied too much on "I met a man who..." rhetoric, rather than engaging with the issues and meeting those with first-hand knowledge of living with long-term sickness and disability. Was the party trying too hard to keep the support of the middle ground, poisoned as they were by media and ConDem stories of benefit scroungers?

Through all this, and other issues (that's just the one most personal to me), I kept my faith with the Labour Party.

As I write this, the House of Commons is debating emergency legislation brought in by the government so that they don't have to pay back benefit owed to jobseekers after the Poundland workfare ruling. It seems obvious how Labour would vote in this debate. Labour, yes? It's a debate about the use of people's labour. Whether people deserve to be paid for...their labour. The Labour party came out of the whole workers' rights movement. And think back to those values: Social justice. Community and social values.

Well, the Labour Party have told their MPs to abstain.Yep, not vote at all. I mean...what?

So, Labour Party, it's not me, it's you. You walked away from me. You don't represent me any more. I'll be resigning my membership. Ironically, it looks like I'll be abstaining in future elections, as there's no other party I could bring myself to vote for.

And that's the end of me and Labour.