Dr Shahzad Alikhan

Gaddafi War Crimes

2011-06-12T02:59:00.000-07:00

What is the evidence again of Gaddafi's war crimes?

Until fairly recently there was "no confirmation whatsoever" that Gaddafi was firing on his own people, despite this being an apparent justification for military intervention:-

http://www.defense.gov/transcripts/transcript.aspx?transcriptid=4777

Q: Do you see any evidence that he actually has fired on his own people from the air? There were reports of it, but do you have independent confirmation? If so, to what extent?

SEC. GATES: We’ve seen the press reports, but we have no confirmation of that.

ADM. MULLEN: That’s correct. We’ve seen no confirmation whatsoever.

That was in March, since then unless I'm (very possibly) mistaken, all we have is Luis Moreno-Ocampo having said in mid-May that he has "proof" and "strong evidence" of crimes against humanity etc, without any details.

Is there anything more concrete and up to date? I do really want to be corrected, because otherwise it beggars belief that our government is reportedly spending £3 million a day on this war whilst looking to 'save' money to the effect of £200 million by cutting things like housing benefits, which will potentially leave many people vulnerable on the streets, or at the least having to live in increasingly adverse circumstances.

To think like this again...

2010-06-07T14:34:00.000-07:00

1^st August 2007 (11.34 pm). My first day as a doctor.

I might as well write about my first day as a real, live, paid, working doctor. I started off in A&E basically, right in the front line, and it went okay but I feel so humbled in front of patients. My first real patient ever was a Mrs.*****, a 69 year old lady who had chest pain and has a long history of cardiovascular problems, including a previous MI and a CABG and an angioplasty. The blood supply to her heart is obviously poor despite all this, so I essentially had to, with some support, work out what to do about this. I prescribed clexane, clopidogrel and some pain relief, and wanted to check troponins at midnight, which I’ll look up tomorrow. ECG didn’t look like an MI. But anyway, it was strange today, being called “doctor” and talked to with respect by a patient for the first time ever really. As a med student, you get treated nicely but this lady was really very nice to me and I really wanted to help her; I even held her hand walking her to the X-ray and got a few strange looks from the staff/other patients for doing so, but fuck it, she was old and had pain in her legs. I’d like a doctor who did shit like that for mum etc if it came down to it.

I’m not sure what I felt at the end of the day; I sat around in the pub with a couple of other doctors having a few drinks and I think we all found the first day a bit weird but strangely satisfying, despite the amount of stupid things we all had to ask everyone. It’s mainly about getting used to the way things are run and where things are kept, but I still need to revise my medical knowledge. As for my patient, I’ll check up on her tomorrow when I can. I’m on-call tomorrow which might be tricky. It’s all about calmness and composure. I was called to a cardiac arrest today for some reason but didn’t really have to do anything luckily. But tomorrow I might have to be the main medic running the show, or at least one of three.

Friday 24th August 2007

Another night…I’ve been a doc for about 3 or 4 weeks now. I’ve had to deal with a few rough situations lately; declared a patient dead for the first time in my professional career this week –

I thought it would be ok, thought I’d just go in there, clinically look at the body and walk out. In reality though – there’s a dead man lying there. Fresh bruises on his jaundiced body. I feel toneless limbs, look into unresponsive, dilated eyes that are stained with dull red blood starting to clot. The expression on the man’s face doesn’t change. He’s dead. It’s scary – and I scribble my entry in the notes quickly, mumble a declaration to the charge nurse and hurry to the nearest toilet. I don’t puke, but I’m kind of tachypnoeic and a bit flushed, and have to spray my face liberally with cold water to get a hold of myself. Then the next day, another patient of ours starts to go off, and I’m in the thick of it this time, doing chest compressions; apparently my compressions restore an output, but he dies later. His wife and daughter hold his hand whilst we ventilate, and I realise that this could one day be me, with my dad, my family. I look out of the window, and try to focus my thoughts on causes of sudden respiratory arrest – was it anaphylaxis, a pneumothorax, perhaps a pulmonary embolism? Answer – who gives a shit. It’s a dead man, and his family are in tears. I can’t help but engage emotionally but I’m scared that if I do, I’ll be a shit doctor – and if I don’t, I’ll just be a shit person.

In other news – did my 2nd central line today (with help from ****). Also stuck in another catheter (tricky this time); did another NG tube yesterday. Taken shitloads of blood. I think my practical skills are developing nicely.

Mephedrone claims another victim

2010-04-02T09:17:00.000-07:00

So Eric Carlin becomes yet another casualty of the government's stupid attitude to drugs;

http://ericcarlin.wordpress.com/2010/04/02/my-acmd-resignation-letter-to-the-
home-secretary/

resigning on 1/4/2010 over pressure on the ACMD to rush a decision regarding the classification of mephedrone - despite the lack of any real research into its pharmacology, long or even medium-term effects, and the lack of appropriate consideration given to what extent a 'ban' will actually effect any significant harm reduction in the future.

In fact some evidence seems to suggest that decriminalisation is a more useful strategy than than simplistic reactionary prohibition in terms of harm reduction . The most well known example is decriminalisation of personal possession of all drugs in Portugal:-

http://www.time.com/time/health/article/0,8599,1893946,00.html

The Cato Institute report on drug decriminalisation in Portugal showed:-

"that between 2001 and 2006 in Portugal, rates of lifetime use of any illegal drug among seventh through ninth graders fell from 14.1% to 10.6%; drug use in older teens also declined. Lifetime heroin use among 16-to-18-year-olds fell from 2.5% to 1.8% (although there was a slight increase in marijuana use in that age group). New HIV infections in drug users fell by 17% between 1999 and 2003, and deaths related to heroin and similar drugs were cut by more than half. In addition, the number of people on methadone and buprenorphine treatment for drug addiction rose to 14,877 from 6,040, after decriminalization, and money saved on enforcement allowed for increased funding of drug-free treatment as well".

Furthermore the new laws, which will come into effect in a few weeks, are "expected" to target other "substituted cathinones" as well. This should have implications for 'khat' usage (from which cathinones are derived), which is very common in the UK amongst Ethiopian and Somali immigrants. Khat usage is so mainstream amongst these populations that to criminalise its use is effectively to criminalise an entire ethnic minority. I have no idea how the government will fairly enforce this legislation in practice.

A reply from the foreign office

2010-02-01T02:54:00.000-08:00

Received this today.

01 February 2010

Dear Dr Alikhan

Thank you for your email about Mr Akmal Shaikh, who was executed in China on 29 December, 2009.
The UK condemns in the strongest terms the execution of Akmal Shaikh and Ministers and officials worked tirelessly to try and prevent it. We made 27separate high level representations to the Chinese authorities, including by the Prime Minister and Foreign Secretary who were both personally involved in this case.
We deeply regret that our concerns , and in particular those surrounding mental health issues, were not taken into consideration despite repeated calls by the Prime Minister, Government Ministers, Members of the Opposition and the European Union.
The UK respects China’s right to bring those responsible for drug smuggling to justice. But the UK is completely opposed to the use of the death penalty in all circumstances and will continue to work on its abolition worldwide.
At this time our thoughts are with Mr Shaikh’s family and friends. We continue to offer them all the support we can.

Yours sincerely,

Mary Withall
Mary Withall | Assistant Desk Officer| Country Casework Team|Consular Directorate | WH4.3| Foreign and Commonwealth Office | London SW1A 2AH

'Patients' - preferred and practical?

2010-01-22T17:04:00.000-08:00

[This is a copy of an e-letter I wrote whilst reading journals and killing time on nights to The Psychiatrist (formerly Psychiatric Bulletin), published online Jan 2010. Scheduled for publication in print March 2010. It is a response to an article presenting findings that mental health service users in Hertfordshire, in keeping with findings from elsewhere, tend on the whole to prefer to be referred to as "patients" rather than other terms which seem to be preferred in the language of mental health trusts and national guidelines such as "clients" or "service users".]

http://pb.rcpsych.org/cgi/eletters/34/1/20#9543
http://pb.rcpsych.org/cgi/reprint/34/3/117

Simmons et al. (1) suggest that the majority of recipients of mental health services do appear on the whole to prefer the term ‘patient’, according at least to evidence from studies in London and Hertfordshire.

Although our guidelines prefer other terms, the American Psychiatric Association Practice Guidelines (2) exclusively use the collective 'patients', to refer to individuals receiving psychiatric care. Similarly the Canadian Psychiatric Association Clinical Practice guidelines (such as those for Treatment of Depressive Disorders(3)) refer solely to 'patients'. Although other terminology is in use and under debate, "patients" is possibly also preferred by Canadian recipients (4). Cultural differences in attitudes to psychiatry and the organisation of healthcare services may account for the difference in terminology.

I also wonder to what extent individuals receiving mental health services who are or have been detained formally under the Mental Health Act in the UK would consider themselves 'clients' or 'service users'. It is possible that those that have been detained (currently or in the past) may prefer the term patient (because they were admitted to a hospital), whereas those individuals who receive or have received treatment primarily in the community may have a different perspective of mental health services and prefer terminology with fewer associations with perceived paternalism.

A final consideration might be to what extent the incorporation of the terms ‘client’ and ‘service user’ into psychiatric parlance, if fully embraced, would be practical when taken to its logical conclusions – by this I mean, should we for example be referring to “in-clients”, and “out- clients” rather than “inpatients” and “outpatients”?

Dr Shahzad Alikhan
CT1 Psychiatry

Declaration of Interest: none

1. Simmons P, Hawley CJ, Gale TM, Sivakumaran T. Service user, patient, client, user or survivor: describing recipients of mental health services. The Psychiatrist 2010 v. 34, p. 20-23

2. American Psychiatric Association Practice Guidelines: http://www.psych.org/MainMenu/PsychiatricPractice/PracticeGuidelines_1.aspx

3. Canadian Psychiatric Association: Clinical Practice Guidelines : https://ww1.cpa-apc.org/Publications/Clinical_Guidelines/depression/clinicalGuidelinesDepression.asp

4. Preferred Terms for Users of Mental Health Services Among Service Providers and Recipients. Sharma V et al. Psychiatr Serv 51:203-209, February 2000

China, why bother with psychiatry?

2009-12-28T09:59:00.000-08:00

copy of email to David Miliband

Dear Mr Miliband

Doubtless you are currently bombarded with emails regarding the plight of Mr Shaikh. In any case without repeating what countless others will have said, I will just add that to support Mr Shaikh is merely to support the view that mentally ill offenders should be offered thorough psychiatric assessment before any penalty, especially one as harsh as death, can justly be legally applied - which is the common sense view, and the view of our own legal systems. China, if allowed to proceed with this simplistic action-reaction judicial process without a fair multiaxial assessment are basically setting the medico-legal clock back a hundred years.

Dr Shahzad Alikhan MBBS MA (Cantab)

Archbishop of Canterbury, an ironic genius?

2009-12-25T11:22:00.001-08:00

Is it just me or is there not something bizarre about Archbishop Dr. Williams' Christmas speech in which he bemoans "Children [are] being robbed of their innocence"?

http://www.dailymail.co.uk/news/article-1238325/Children-robbed-innocence-Archbishop-Canterburys-Christmas-warning.html

He even commented that "...in our rush to make children become independent, we are robbing them of the ability to learn and grow...".

For this to come from the leader of an institution which, after all, encourages the indoctrination of children from a young age to believe in most-likely fictional entities with an entourage of superstition and prejudice, is beyond belief for me.

Children in some parts of the world will sadly never experience sufficient privilege to have a free-thinking, liberal education as that that children in the UK are entitled to. He mentioned something to do with children in Congo and Sri Lanka being exploited in civil wars etc, the relevance of which I am not quite sure. Children should not be denied a childhood, we all agree on this - but it's easy to say all that when you have the means and resources to afford the £11,000 a year private school at which his children were educated.

About children in the Congo and Sri Lanka he states- "Their suffering is an insult to the purpose of God and a a contemptuous refusal of the gift of God by those who keep them in their different kinds of slavery".

I fail to see how the motivations of civil wars with complex political and cultural backgrounds and the associated suffering and child abuse can be related abstractly to “the purpose of God”, whatever that even means. Perhaps God’s purpose is to inflict suffering for all we know? He insults the real reasons for their suffering by turning attention away from the real problems at their root cause by relating it somehow to ‘God’.

I would also argue that it is equally an insult to the freedom of our society,and the opportunities of scientific learning and philosophical extrospectiveness that our educational system allows and encourages, to allow our children to simultaneously be given blows to the head through religious indoctrination. We have the opportunities here, yet they can be lost or inadequately availed of when you enhance the profile and significance of religion to children.

His points , however badly made, I would wager, were probably meant to be that:-

A ) society is encouraging the over”independence” of children, and not allowing a proper childhood through over-exposure to various kinds of perceived negative social and environmental factors

B) There is lots of child exploitation and suffering around the world

It appears that rather than allow children to grow, explore, learn and establish independent views, Archbishop Williams would rather they were mentally subjugated into becoming “dependent on God” (and Christianity) in his words. Ridiculous. The hypocrisy of the bemoanment of child abuse hardly needs to be pointed out- members of the church have been involved in the sexual abuse of children itself in a number of high-profile incidents, and it is the exploitation of the natural dependency of children that leads them to be easy targets.

The lack of insight, hypocrisy and glib display of attention to real world suffering displayed in this Christmas sermon will be difficult to surpass for Dr. Williams.

Psychiatry, Crime and Religion

2009-11-07T06:49:00.000-08:00

Edited version of letter to the Times : 7.11.09

Major Hasan’s actions constitute a terrible crime and I feel for the dead, wounded and their families - yet as a junior psychiatrist growing increasingly disillusioned with Islam to the point of agnosticism, the incident also really evokes my academic curiosity as a fascinating case study.

This is a complex crime, and as anyone would agree, we should not jump to conclusions regarding the man's motives. It is of course a ‘crime’, but deeply embedded in a context of mental illness - because the man is a psychiatrist by profession, because he himself was likely suffering with mental health problems (having needed counselling himself), and, possibly because of the element of devout religious belief - which could, when held maintained in an absolute and inflexible manner, be regarded as a type of delusion within itself (although controversially and not by any real psychiatric definition, not by the majority of members of the psychiatric profession and not necessarily by myself).

This kind of belief system can easily be the basis for further distortion and manipulation by slow radicalisation, confusion with contradictions regarding political and spiritual allegiances, leading to the devastating consequences that have been witnessed by the world.

Such cases are normally scrutinised from legal and clinical perspectives taking into account potential motivating and enabling factors which can usually be fairly easily identified. However, with Islam, because of the vast disagreements in interpretations of its scriptures, it is difficult to understand how great a role religious factors may have played in Major Hasan’s actions, but I think it is at least honest to acknowledge that Islamic teachings do contain ideas which can be seen as permitting and legitimising ‘context-appropriate’ aggression.

Essentially, from a junior psychiatrist’s perspective I would sympathise that to an extent this man was torn between loyalties, he was shocked and scared by his own patients' tales of war and their post-traumatic stress disorder, leading to great fear of being stationed abroad and this was a contributory factor leading to deterioration in his mental state. It may emerge that Major Hasan had his own mental health issues and was quite probably depressed. He was the wrong man for the position of a US army psychiatrist; he was an army doctor and he attacked and killed the very same soldiers that would have been his patients and his daily caseload. It is arguable that doctors with particularly strong religious and political motivations are not greatly suited to roles in the military and political arenas, because their clinical objectivity and primary duty of care to the patient, which is the basis of medical ethics, is at risk of being muddled by these non-clinical influences and affiliations which should remain private and personal.

I would hope for the sake and safety of armed forces personnel that a method of closer and more accurate evaluation of the suitability of medical personnel with regard to their mental health and potential conflicts of interest will arise from this dreadful tragedy. I see these events and their implications as being as great an affront to the integrity of the medical profession as they may be to the nature of Islam.

Dr Shahzad Alikhan MA (Cantab), MBBS (Lon)