The Bewilderness

National Hell Service: The Costs and Benefits of Politics

In socialised medicine, the ability to read costs and benefits is curtailed. The National Health Service has been allowed by the National Institute for Clinical Excellence to fund a pill that aids smokers to stop the habit.

Champix costs £1.95 per patient per day. Anti-smoking campaigners welcomed Nice's provisional ruling, saying the £163.80 cost to the NHS for each 12-week course would be more than recouped from the NHS's £1.5 billion annual bill for treating diseases caused by smoking.

Others questioned why people who chose to take up smoking should receive help from the public purse to give up when Nice has turned down funding for a number of Alzheimer's and cancer drugs.

However, this decision may save a certain number of lives. Yet, it represents another step towards state intervention in health on the grounds of cost. Other behaviours identified as costly or destructive to the National Health Service could be prohibited through law, bans and aid to wean people from their 'addiction'. With the new mood-altering pharmacopeia coming, this presents new possibilities for state health.

Yet, the NHS is unable to clean its hospitals or record deaths accurately.

Mr Shapps, MP for Welwyn Hatfield, said: "We now know that C. difficile infects eight times as many people as the far better-known MRSA (staphylococcus aureus) and it actually kills twice as many patients."

The report cited disturbing figures that last year, C. difficile claimed the lives of 4,752 patients - a 25 per cent rise on the previous year and a 111 per cent increase since 2004.

Overall, 11,000 people had died in the three years since 2004 "to some degree attributed to clostridium difficile", the report said.

To reduce the figures, people under the age of 65 who contract this bug may be given an alternative cause of death.

The reason why we cannot assess costs and benefits accurately is that a socialised health service is a politicised health service.

Blair's African Memorial

Blair's cavalcade has now hit Sierra Leone where he was made Chief for Life, a position that must have made him yearn for similar changes at home. He was renamed Chief Matoh, Chief of Peace and looked "bemused", declining to wear a hat. Could this have been fear that he would look even more ridiculous for the legacy photos? A minor insult to his grateful hosts was a worthwhile cost for avoiding greater ridicule in the press. Whilst the inhabitants of Sierra Leone were overjoyed at the end of a vicious civil war, helped by British troops and glad to see monsters put behind bars, Blair's good deeds need no reminders:

Mr Blair earlier made a passionate defence of his interventionist record in Sierra Leone and other African states. He said that many lives had been improved and the neighbouring countries of Liberia, Guinea and Ivory Coast were saved from chaos by his decision in 2000 to send troops to end the civil war......

Mr Blair’s aides have been frustrated by the portrayal of his tour as a backward-looking attempt to highlight past foreign policy achievements. They say that Mr Blair is trying to lead a late push to build pressure for bolder steps to help Africa at next week’s G8 summit in Germany.

His speech may prove an insight into the Blair's vision of his own history, but intervention in Sierra Leone had little impact on Liberia or the Cote D'Ivoire. If one were more charitable, then you could argue that Blair's brand of intervention paved the way for further interference in the other two countries. The French have never stood for arrant nonsense from their informal colonies, and Blair's liberal foreign policy is at complete odds with their own.

This caravan of justification, designed to deflect attention away from Blair's preceived foreign policy failure in Iraq, has proved another photo-opportunity as the vultures of electoral failure revert to the politics of envy.

Fertility's Powerful Professionals and Powerless Parents

The Human Fertilisation and Embryology Authority (HFEA) has wide powers to regulate the application of fertility technology, ranging through Viagra, IVF and "saviour siblings", children raised specifically to save a sibling. The latest code of conduct issued by the HFEA allows medical practitioners to evaluate candidates for fertility treatment in regard to the future welfare of the child.

They say the guidance issued last week extends the right of doctors and nurses to deny couples the chance to have children.

Lawyers specialising in fertility law say the guidance previously applied to interventions such as IVF and insemination with donor sperm. But the code published last week states that doctors offering "any treatment such as surgery or the administration of drugs" at clinics licensed by the he Human Fertilisation and Embryology Authority (HFEA) must also take into account the welfare of a future child.

MPs and doctors believe this could mean that men suffering from sexual dysfunction or women with problems such as blocked fallopian tubes would be denied treatment if the clinic thinks it will not be in a child's interests for them to reproduce. Women with thyroid or hormonal problems that could affect their fertility, or men wanting Viagra or to reverse a vasectomy, could also be denied treatment.

The denial of fertility treatment on the grounds that the future welfare of the child could be compromised is a subjective value-judgement. The code of conduct defines risk factors for the welfare of the child in terms of behaviour or convictions that could cause serious physical or psychological harm. If these factors are not defined, there is also a catch-all phrase to hand for the medical professionals (HFEA Code of Conduct 3.3.2 (d)).

any other aspects of the patient’s (or, where applicable, their partner’s) circumstances which treatment centres consider to be likely to cause serious harm to the child to be born or any existing child of the family.

The HFEA Code of Conduct was drafted to ensure that professionals had all means at their disposal to exclude parents who they judged were a risk to the child. This provides far wider powers to professionals for the refusal of fertility treatment, than social services would have for taking children into care. Doctors and nurses may even break professional confidences and share information if they judge that this is intrinsic to assessing the future potential of a family unit. (HFEA 3.4.7)

The powers over these decisions are stacked in favour of the professionals. Parents have the right to respond before a final decision is made, and if this is negative, could get further guidance and counselling from those who have just told them that they are not fit to be parents.

There is a need for fertility clinics to assess the fitness of parents as part of the professional judgements of doctors and nurses. Yet, the Code of Conduct widens these powers without providing sufficient right of review or redress for the aggrieved parent. We understand that such a wide remit can lead to abuse in the hands of the unscrupulous or the ideological motivated. Professionals, like politicians, require restraint, especially in such a sensitive area as the right to endow or deny potential parents. 

Blair's blithe farewell to the shores of tripoli

The 'longest farewell tour', as the visitations of Blair have been dubbed by Cameron ("he who has not yet been tempted") reached the shores of Tripoli yesterday. In this, the Prime Minister attempts to bind the hands of his successor and remind everyone of a foreign policy success, disarming Libya's weapons of mass destruction.

After talks, Libya announced that they would purchase weapons from Britain, as another desert dictator joins the BAe gravy train.

The Libyan Prime Minister, Al-Baghdadi Ali al-Mahmoud, announced later that his country would buy missiles and air defence systems under a new agreement. British officials insisted that no such deal had yet been reached.

On his flight from London to Tripoli Mr Blair described his unlikely relationship with the Libyan leader, once regarded as an international pariah for his alleged support of terrorism, including the Lockerbie bombing in 1988. He said that they spoke by telephone several times a year, were on first-name terms and got on “pretty well”.

In this, as in many other areas, Blair has acted as point man for shared attempts by the United States and Britain to achieve joint foreign policy goals. Once Gaddafi was reeled in, Blair has taken it upon himself to massage and feed the old ogre so that he stays onside in the West. One wonders if he decided to cement the relationship with economic access and defence co-operation so that this informal relationship could not be jeopardised by the lumberings of the undiplomatic Brown. Where else will Blair use his charms to prepare for what he sees as damage limitation?

Afghanistan: Brown's Continuity

Gordon Brown has made a statement on the war in Afghanistan. With some emphasis upon reconstruction to fit in with his overall policy themes of aid and international development, there is continuity, as expected, between his perception of the conflict and Blair's. This cannot be a surprise, when there is not much room for reform within a coalition. Brown's potential and solo action is reduction of troop numbers or withdrawal.

''We've got to make sure the drug trade is not the only economic activity in Afghanistan,'' he said, pointing to the need for the West to support more economic development.

His comments suggest he is unlikely to approve any further large increase in British troop numbers in Afghanistan in the near future, but will tilt policy more to the need to win the hearts and minds of the Afghan people.

He is likely to continue Tony Blair's push to get other Nato countries to shoulder more of the military burden in the most dangerous regions.

The future Prime Minister views Afghanistan as a key commitment in the upkeep of both NATO and the alliance with the United States. His emphasis upon self-sustaining economic growth beyond the drug trade is a view shared by other members of the coalition, yet an unwieldy governance structure has provided space for corruption and inertia. The omission of this key problem leads one to doubt whether Brown will engage or change the underlying issues of the Afghanistan campaign.

Holiday

I am off to Oslo. I will be back on Tuesday. Samizdata always beckons.

The Insecurity State

We cannot view control orders as virtual house arrest. Now that a further three individuals under control orders have absconded, one must ask how secure we are.

Three suspects held under controversial British anti-terrorism "control orders" have absconded this week, police said on Wednesday, an embarrassing blow for a key plank of Tony Blair's security strategy.

The announcement, following the disappearances of at least two other suspects last year, means that more than a quarter of those subject to the controversial orders -- imposed on suspects who are not charged with a crime -- are now missing.

The British prime minister introduced the orders, under which suspects are electronically tagged and subjected to a range of restrictions, after courts threw out Blair's measures to jail suspects indefinitely without charge.

The Labour government has proved incompetent in identifying and detaining terrorist suspects. It took Reid to combine the destruction of civil liberties and a surveillance society with increased lawlessness. When we look back, we will find the objectives of soft totalitarianism are combined with the erosion in the rule of law and an increase in insecurity.

EU: The 'Silent Constitutionalists'

Tony Blair has confirmed that he will attend the up-and-coming conference on the European Constitution alone. Gordon Brown will not accompany him, as the government's position is agreed: seeking a "simplifying amending treaty". This is the same form of words as President Sarkozy of France has adopted as he tries to forge a new consensus prior to the conference on June 21st to the 22nd. He has been travelling around the European Union, drumming up support for this approach as a replacement for the Constitution. An amending treaty can be approved by the French Parliament whilst the Constitution would require another referendum.

However, we need to understand that the core of the simplified treaty: abandoning the title of the Constitution, dropping the formal legal identity of the Union and the Charter of Fundamental Rights, and ensuring the vote meets Poland's expectations; will all dilute too far for the ratifying group.  President Prodi of Italy has begun to set out the redlines of the Constitutionalists and has argued that a division may prove to be the way forward.

Mr Prodi – claiming to speak on behalf of 18 EU states which have largely ratified the original text – rejected "radical changes" to the foreseen institutional reforms. He listed the EU foreign minister, a lengthier presidency, the extension of qualified majority voting, the union's legal personality and the abolition of its three-pillar structure as elements which "must be preserved."

"If the compromise does not convince us, we will not sign it," he warned, clearly stating that a multi-speed Europe could bring about the long-sought breakthrough on the controversial issue.

"At this point, a vanguard of countries could…be the best way to proceed towards a more integrated union, on condition that door remains always open to those countries willing to join later," he said.

This may hopefully prove an impossible impasse. Poland, Great Britain, the Netherlands, the Czech Republic and France all require a simplified treaty to stay withing Europe, a treaty that bears little relation to the existing ratified constitution. As Prodi has complained, we have learned the positions of the Eurosceptics. The lynchpin is Germany and the 'silent constitutionalists'. Will they drop the treaty in favour of unity or will they strike out in a historic division, leaving the nationalists in the slow lane? This will prove Sarkozy's first failure.

Afghanistan and Pakistan: Islamic Brothers, National Foes

The diplomatic effort to mend fences between the Karzai government, hamstrung by the resurgence of conservative mujahideen forces in the Afghanistan assembly (the Majlis), and the weakened President Musharraf, has been co-ordinated by Germany as the President of the G-8 and the European Union.The foreign ministers of both countries are due to meet next week at the G-8 meeting in Germany.

Both Afghanistan and Pakistan have skirmished in recent days over the Durand boundary. The cause of the initial attacks is unclear, as boundaries mean little in these tribal hinterlands. Yet they have been used by Karzai's government to aggrandize calls for Afghan unity and turn eyes away from the corruption and lack of security that has marred the reconstruction era.

Whilst the Pakistan intelligence services are reported to support proxies to undermine foreign Islamist influence within the Taliban movement, the fundamentalists have united in preparation of a post-Karzai government. Late last year, they passed an amnesty law that absolved warlords and Taliban from the accusation of war crimes.

The prospect of a war-crime tribunal was held like a Damocles' sword over any recalcitrant Afghan political personality - be it Burhanuddin Rabbani, Yunous Qanooni, Rashid Dostum or Rasool Sayyaf. In the able hands of former US ambassador Zalmay Khalilzad, it did wonders while ensuring Hamid Karzai's election as president and in consolidating US dominance in Afghanistan.

What was astonishing was that the amnesty bill covered even Taliban leader Mullah Omar and Hezb-e-Islami leader Gulbuddin Hekmatyar. Clearly, an Afghan "revolt" was afoot against the existing political order imposed by the US. Implicitly, it called into question the raison d'etre of the war, since the largest group in the mujahideen-dominated 249-member lower house of Parliament consists of the elected members of Hezb-e-Islami besides a sizable number of former Taliban figures (such as Mullah Abdul Salam Rocketti) who act as the Taliban's political wing in Kabul.

Whether an opportunistic and self-serving law passed by the shifting factions of the Majlis can be placed within the grander narrative that meaningful strategies provide, is very debatable. Medium term trends, such as the re-emergence of an Afghan national interest and the reawakening of Pakistani interest in the Taliban, serve as complexities within the reconstruction process. Yet, the weakened insurgency of 2007, forced to turn to Iraq's would-be emirs for terror tips instead of exporting battlehardened jihadis, has found that the seeds of conquest are far more difficult than the neglectful 1990s. Even Pakistan is unwilling to allow Al-Qaeda a free hand in the tribal borders and has begun to take steps that will ensure the insurgents revert to puppets, a resource that can be turned on and off at will, as Kashmir's bloodshed pays testament.

By the end of 2007, the insurgent Taliban may have passed from Al-Qaeda's gloves to a smaller role as a tool in Pakistan's need to maintain pressure on the West and the internal dissenters of Musharraf, if his dictatorship holds. The instability of Pakistan and the resolution of its crisis of legitimacy will have the strongest bearing over the development of the insurgency.

Iran: The Rise of the Narco-Nuclear State?

The army is aware that the Iraqi militias wish to spin the British withdrawal from Iraq as a defeat, caused by their actions. They have continued to increase their attacks on the British troops in Basra, as part of this campaign. The real problem is overstretch, and continued insurgent attacks do exacerbate this problem.

As the British increase their forces in Afghanistan, they are drawing down in Iraq. Although the drawdown in Iraq is based on pragmatism, the enemy apparently is attempting to create the perception of a military rout. So while the British reduce their forces in southern Iraq, they are coming under heavier fire and the enemy makes claims of driving “the occupiers” out.

The  difficulty is guaging how far, from the patchy information released, security in southern Iraq has passed from the British forces to the Iraqi security forces, or to the militias. The Independent has reported that the whole of Shi'astan is now subject to the control of the Mehdi Army (also known as the Sadrists) and rival militias. This has caused an upsurge in violence over the last ten days.

The grip of the British Army around Basra and other southern provinces was always tenuous and is now coming to an end. Although the government in Baghdad speaks of gradually taking control of security in the provinces from US and Britain, the winners in the new Iraq are the militia, often criminalised, that have colonised the Iraqi security forces. Diwaniya is in Qaddasiyah province, which was never under British control but the pattern in all parts of Shia Iraq is very similar.

Iraq is following the patterns of other failing states, promoted by Iran. The militias have turned from smuggling drugs with the connivance of the Iranian authorities, to planting opium in Iraq itself. The militias wish to obtain more of the profit for themselves, cutting out the middlemen, and reaping more of the cut from their customers in the Gulf. This is a destabilisation strategy, that will further Democratic plans for withdrawal, and aid Iranian influence.

Like the Israeli aid to the Muslim Brotherhood, in order to undermine Fatah, Iranian destabilisation is a tactical opportunity that obscures strategic disaster. A weak and chaotic Iraq, slipping into the hell of failed states on their doorstep, will result in lawlessness within Iran. Drugs militias will note that customers lie east as well as south.

The current complexities of Iran will find that the rise of criminal gangs in Iraq always leads to spillover. Will Iran prove to be the first narco-nuclear state?