Has the NHS become the ‘No Health Service’?
Over the last two weeks I have had several people ask me about the health issues I was experiencing during 2022-2024
My experiences of the National Health Service is an exemplar case that shows how, for a number of reasons, the UK health system has entirely lost its way.
In two separate sections I will first describe the two health issues and my general experiences.
I will return to discussion of how the NHS is failing you, me and everyone in the third section at the end.
I had been considering writing a post like this for a while, but my other work kept getting in the way. I can’t use that excuse this morning, so here goes…
Biliary Colic, Cholecystitis, Cholangitis or Something Else?
During 2019 I had my first experience of the excruciating pain that can be an upset gall bladder. Those of you who know what I am talking about might liken it to the pain John Hurt’s character would have felt had a real alien been trying to burst out of his chest.
Biliary colic, cholecystitis and cholangitis are actually three similar yet completely different causes for pain that eminates from the gall bladder:
(1) Biliary colic results from the obstruction of the passage of digestive fluids from the gallbladder via a bile duct, usually by a gall stone (cholelithiasis);
(2) cholecystitis is inflammation of the gall bladder wall which itself is usually caused by obstruction of the bile ducts by a gall stone; and
(3) cholangitis is inflammation of the bile ducts themselves.
The first, biliary colic, is usually the more acute presentation that causes excruciating pain in the middle area of your back and the area below your right lung and rib cage in the front, and the latter two are often the longer term or more prolonged but no less insidious pain causers.
For my own part, I was having bouts of what appeared to be all three. The acute phase would begin and I would end up curled in a ball on the floor on my left side, sometimes in so much pain that I would pass out.
After 2-3 hours the acute phase would end and I would go through 12-24 hours of aching in my back that was often accompanied by either a strong headache or a full blown, lock me in a dark room, migraine.
This happened at least twice in 2019, another couple of times in 2020, and in 2021 I had two bouts that were so bad that I was also visited by pretty severe jaundice. My liver decided being a liver wasn’t fun any more and my whole body turned a wonderful shade of dark yellow.
Not once, but twice. And about three months apart.
I was working on a maternity health modelling project at the time and a wonderful older obstetrician and gynaecologist with a significant history in abdominal and hepatobiliary medicine who decided on viewing my sunburst ochre pallor, and on hearing that I had spent more than 15 hours waiting doubled over in pain in an A&E that was staffed by tattooed unkempt Band 2 and 3 staff who could do little more than take observations (pulse, temperature and respirations) behind a door in an otherwise open hallway and had NOT been seen by a nurse or doctor, that three days of intravenous antibiotics was necessary – because it looked like an infection might have set into either the bile ducts or my pancreas.
That done, he also said I needed to find a local GP who could order an ultrasound of the offending bile-producing organ.
Trying to get into a GP in the area where I was living at the time was a nightmare. Many either were not taking new NHS patients at the time or worse, were not taking on new patients at all.
Several were also of the fixed mind that unless you had by that point had at least two covid-19 mRNA injections, or sometimes three, they were not willing to see you in their clinic at all.
So much for the ‘voluntary’ and non-mandatory covid-19 injections. This, at least, was where I got lucky. Two of the wonderful people in my research collaborative knew a GP in the next town over who, as luck would have it, was not pushing covid-19 jabs and was a second generation doctor whose interest was patients, not propaganda.
She, and one of her parents who I would come to meet later, were the old school doctor type that listened and tried to find out the cause of your health issue rather than simply treating the symptoms of the complaint – like so many young doctors today who simply want to get through their alloted list of patients in 7 or 15 minute increments so that they can get on with their TikTok lives.
This is where it got interesting. The ultrasound showed no real swelling of the gallbladder wall, no issues with the bile ducts, and only minor age-related “sludge” in the gallbladder itself.
Other than the excruciating pain I had endured, the images of my skin looking decidedly first-term Trump-ian and blood tests that showed my liver, like Elvis, had vacated the building, you would never have known there was a problem.
In any event and just in case, the GP referred me to the hepatobiliary consultant clinic at the hospital. As for the hospital and our wonderful NHS? They said the waiting list was over two years.
If anything needed to be done, it wasn’t going to happen fast or it was only going to happen as and when something became unbearable and/or ruptured.
In the meantime, I had been reading a lot of old medical literature and clinical research papers looking at the issue I was having and the various treatment pathways. Anything published in the last 7-10 years simply told the surgeon: “remove the gallbladder, go play your next round of golf, job done.”
However, there was a lot of historic clinial trials and research into a natural bile salt called Ursodeoxycholic Acid (UDCA). Japanese doctors had discovered UCDA in the 60’s or early 70’s from, as the first part of the name – urso – suggests, bears.
There had been many clinical trials of UDCA involving several thousand patients. I reviewed the 25 most complete and relevant of these trials (see spreadsheet image below) and my analysis found that when administered for 18-24 months:
- around 30 percent of UDCA recipients at a dose of 500-750mg per day saw complete dissolution of their gall stone and biliary colic issue and had no further pain or symptoms. These patients may need regular brief periods on UDCA in the future if they started to show relapse, but this was not the focus of most of the clinical trials.
- around 40 percent saw partial (50-80 percent) dissolution with maybe only one additional biliary colic bout during the 18-24 months after commencing UDCA treatment.
- the remaining 30 percent appeared to have little or no change in their symptoms.
The decidedly minor side effects of taking UDCA across all of the reviewed studies were limited to:
- occassional loose bowel movements or diarrhoea in around 6-8 percent of recipients.
- severe diarrhoea leading to ceasing UDCA in around one percent of recipients (most of whom ended up in the it didn’t work 30 percent).
- occassional mild or moderate increase in serum aminotranspherase in around three percent of UDCA recipients.
What was interesting was that of the 30 percent for whom it was found UDCA had little to no effect, several of the studies had used this classification to hide an odd ‘gotcha’.
In those studies the patient, usually during the first 3-6 months, had a single bout of biliary colic and as a result were immediately given a cholecystectomy (surgical removal of the gallbladder).
This made it difficult to know whether UDCA had actually failed for them or whether they just hadn’t been on it long enough and the surgeon had knee-jerked too early.
Overall, taking UDCA for a prolonged period (12-24 months) was beneficial for most people and for a good percentage, meant they could avoid a general anasthesia and surgical removal of the gallbladder.
The current cost of UDCA in the UK for an 18-24 month period was less than £200 compared to a £3,000-5,000 operation. So why is it that recent studies have found at least 60 percent of hepatobiliary specialists don’t know about UDCA?
Here’s where the murky footsteps of big pharma greed make an appearance. At some point in the last 15 or so years UDCA came out of patent and became a relatively cheap medicine with several even cheaper generics hitting the market.
As with all medicines that come out of patent, it was no longer bringing in any significant profit for the original manufacturer.
It seems that from around 2007-2008 the original manufacturer started paying funding suggesting that surgeons publish papers that, completely antithetical to the previous 30+ years of studies, incredibly claimed UDCA did nothing to alleviate symptoms and was a worthless medicine.
Don’t bother, say some of the studies. Just go straight to surgical removal. If that one pharma company wasn’t going to make profit from selling UDCA, they were going to make certain nobody else was either. UDCA seemingly got relegated to the annals of history.
The kindly GP I had been recommended to by my research colleagues – nay, close friends – was willing to listen to me regarding UDCA and actually gave me prescriptions for it for the entire time I was awaiting any sort of response from the hospital consultant’s clinic.
I took UDCA for a little over 18 months. I had one very minor bout of biliary colic about 4 months into the treatment but, that one bout came during a period when I was also trying different things that I had taken out of my diet to see which, if any, when reintroduced, might be aiding in my gallbladder unhappiness.
You see… I was interested in the cause because the cause will often lead to the cure. I am no pharma company’s patient for life.
But we’ll come back to that later.
Posterior Subcapsular Cataract, Meibomian Gland Dysfunction, or Computer Imaging Artefact?
At around the same time as the 2021 bouts of biliary colic I started to have issues with my eyesight. Some days, and often for stretches of 3-7 days, I would awake to find my vision was quite blurry.
I didn’t wear glasses and aside from the occassional age-related ‘floaters’, had not had any real issues with my eyesight for many decades. I had even had multiple eye tests as part of the health checks for pilots and student pilots over the last two decades, exceeding the requirements every time.
My observations of this vision disturbance were that I would only be able to focus, with some significant effort, on things that were within a very small range of about 2 feet – between 3 feet and 5 feet in front of my face.
Anything too close and anything beyond 5 feet was so blurry that at times even signs with very large letters were becoming impossible to distinguish. Several days later I would get up and everything would be back to normal.
I would have normal vision for a couple of days before the whole cycle of scary bluriness would start over.
After the third or fourth cycle of this I went to the ophthalmology specialist clinic at the local hospital and because it was acute, was seen the same day. Oh… and when I say ‘day’, I mean I was there all day as one of the first people through the door when the clinic opened at 9:30am until when they were closing the doors at 5:30pm.
Most of the day was spent sitting in a chair in the reception area waiting to be seen, and it was only when, at about 3pm, the person who had driven me there went to ask the receptionist whether I would be seen that day that the receptionist realised she had forgotten to even put me in the queue in the first place!
From then on I was rushed through a series of “scan this”, “image that”, “let me insert these drops”, “scan something else”, “pressure test this”, and onto a final test at 5:30pm that, because the nurse had gone home who was trained to use the new machine that went ping (a Monty Python reference for those of you who are under 40), they found they could not do.
The young first-year opthalmology student consultant’s diagnosis? Go home. It’s probably migraine related blurred vision and will go away in a day or two.
According to her I was having migraines 3-7 days out of every 10-12 days and that was nothing to investigate? Yes… nothing to see here, move along. Next patient please!
It didn’t go away. It kept coming back. In trying to work it out for myself because, as with the biliary colic thing, I assumed the only person interested in truly fixing it was me, I started to make notes on what I did, ate and how I slept in the days leading up to each blurred vision event.
Two things stood out. First, that on the night of the last day of clear vision I would sleep a lot heavier than most other nights and not awake during the night at all. Second, that on the days I had blurry vision my eyes were incredibly dry and itchy and I was having to use moisturising drops and saline drops constantly.
On the days when my vision was clear there would be no dry eyes or itching. This led me in a roundabout way to investigate Meibomian Gland Dysfunction (MGD).
There are two types of lubrication that your adnexa (the area around your eyes) create, and both are equally important. The one most people are familiar with is tears. Tears are that clear salty saline-like solution that keep your eye ‘moist’ that you create from lacrimal (tear) glands.
The second type is an oil called meibum (may-bum… yes, I know exactly how funny that sounds to the 8 year old in all of us). Meibum is created in the tiny meibomian glands that live in the lower lid of your eye.
MGD can happen when the glands get blocked, when the quality of the oil they secrete drops, when you are having allergic reactions or when there are issues with some hormones in your body.
There even used to be a documentary that was available on YouTube where they showed the oily film over the lens of the eye in a particular type of imaging scan but I cannot locate it at the moment.
In any event, there is one other cause for MGD that many of our young ophthalmology students seemingly don’t even learn about any more. The usual suspect websites (WebMD and Johns Hopkins) don’t even mention it nowadays.
That is, when your eyelids don’t completely shut during sleep and the lens of one or both eyes becomes dry overnight. This issue should be the easiest to diagnose and is certainly the easiest to treat…
Except when doctors are no longer trained to diagnose it and there is no financial incentive returned from the relatively inexpensive ‘cure’.
This is taken from a long document. Read the rest here substack.com
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