Dave Curtis

No, I won't dance with you because...

2012-02-28T16:39:00.000-08:00

You may be wondering why I didn't want to dance with you. Probably you weren't wondering at all and didn't think anything of it but if you were then here is the reason.

No, I won't dance with you because I'm too drunk.

No, I won't dance with you because I'm too sober.

No, I won't dance with you because I'm too sweaty.

No, I won't dance with you because there are too many people on the dance floor.

No, I won't dance with you because there aren't enough people on the dance floor.

No, I won't dance with you because this track is half way through already.

No, I won't dance with you because this track is just starting and I can't tell yet whether I can dance to it.

No, I won't dance with you because the music is too fast.

No, I won't dance with you because the music is too slow.

No, I won't dance with you because the music is too obscure.

No, I won't dance with you because the music is too obvious.

No, I won't dance with you because the music is a charleston and I have no idea how to dance charleston.

No, I won't dance with you because the music calls for balboa and I have no idea how to dance balboa.

No, I won't dance with you because the music is latin and I have no idea how to dance latin.

No, I won't dance with you because the music is blues and I don't know you well enough to dance blues.

No, I won't dance with you because the music is 3/4 and I have no idea how to waltz. Neither do you. We'd look ridiculous.

No, I won't dance with you because I know this track and it starts OK but it has a long challenging drum solo in the middle.

No, I won't dance with you because I don't know this track but it might have a long challenging drum solo in the middle.

No, I won't dance with you because the music seems OK but the last one this DJ played started off OK but then went horrid.

No, I won't dance with you because the music seems OK and so were the last few the DJ played but this DJ specialises in ambushing dancers with horrid undanceable tracks and I bet this will be the one.

No, I won't dance with you because I hate this DJ so much that I won't dance to anything they play.

No, I won't dance with you because you are the DJ and I have told everybody how much I hate your music so it would be hypocritical for me to dance with you.

No, I won't dance with you because I've danced with you too many times already and I don't know any more moves and I'm afraid you'd be bored.

No, I won't dance with you because I've danced with you too many times already and I don't know any more moves and I'm afraid I'd be bored.

No, I won't dance with you because I asked you before and you said no.

No, I won't dance with you because I asked you before and you said you were too tired but then straight after I saw you dancing with somebody else.

No, I won't dance with you because I asked you before and you said the music was too fast but then straight after I saw you dancing with somebody else.

No, I won't dance with you because you're too ugly.

No, I won't dance with you because you're too beautiful.

No, I won't dance with you because you're not a very good dancer.

No, I won't dance with you because you're much too good a dancer.

No, I won't dance with you because you look a bit grumpy when you're dancing.

No, I won't dance with you because you get too excitable when you're dancing.

No, I won't dance with you because you're wearing high heels and are clearly not serious about dancing.

No, I won't dance with you because you're wearing patent pumps and are clearly far too serious about dancing.

No, I won't dance with you because you have scary tattoos and/or piercings.

No, I won't dance with you because you look a bit boring.

No, I won't dance with you because your clothes are too shabby.

No, I won't dance with you because your clothes are too smart.

No, I won't dance with you because you're not wearing enough clothes.

No, I won't dance with you because you asked me and I wanted to be the one to ask you.

No, I won't dance with you because you've seen me at several previous events and you never asked me before so it's a bit late now.

No, I won't dance with you because you agreed to dance with that other guy who I don't like.

No, I won't dance with you because you refused to dance with that other guy who's a friend of mine.

No, I won't dance with you because you've been dancing with guys who are really bad dancers.

No, I won't dance with you because you've been dancing with guys who are really good dancers.

No, I won't dance with you because you've been dancing with old ugly guys.

No, I won't dance with you because you've been dancing with young handsome guys.

No, I won't dance with you because the last time we danced it didn't go very well.

No, I won't dance with you because you look a bit like somebody I danced with and it didn't go very well and I'm not sure if it was you or not but just to be on the safe side I'd better say no.

No, I won't dance with you because the last time we danced you headed off afterwards just a little bit too abruptly at the end.

No, I won't dance with you because the last time we danced you gave me a helpful tip which obviously was not meant to be a criticism but certainly felt like one.

No, I won't dance with you because I looked you up on facebook and I didn't like something I saw there.

No, I won't dance with you because I find you annoying.

No, I won't dance with you because I am secretly infatuated with you and would like nothing better than to dance with you but I'm afraid I would mess it up so I'd better decline.

I hope that makes it clear why I didn't want to dance with you. In case you were wondering.

Breast implant fiasco

2012-01-15T02:05:00.000-08:00

There are two things which the government has got completely wrong in its attempts to deal with concerns about PIP breast implants. It is fuelling anxiety rather than alleviating it and its notions of the responsibilities of private providers are muddled and incorrect.

Everybody knows that health treatment is only provided when clinically indicated. Never before has an indication for an operation been simply "the patient is worried". So it makes no sense at all to simultaneously say that PIP implants are safe but if a patient is worried they will be removed. Why remove something which isn't dangerous? This massively mixed message could hardly be more unhelpful. From everything I can see of the science so far there is no evidence that PIP implants present any higher risk than any other kind, in spite of being described in scarey terms such "industrial". Possibly they have a somewhat higher risk of rupture but that could be dealt with as and when and anyway the evidence is unclear. There is no clinical indication to go looking for problems when none are present, let alone to actually subject a patient to surgery on the grounds that rupture might possibly happen at some time in the future. But it's impossible to say convincingly to patients,"Don't worry, the implants are safe and nothing needs doing" if you simultaneously say, "But if you are worried, we'll take them out". What nonsense!

The other thing the government has got completely wrong is the notion that private providers have any kind of obligation, legal or moral, to do anything at all about this mess which is of the government's own making. If I get a procedure or operation done privately then I pay for it and that is that. Depending on what has been agreed, the private provider might or not have some kind of obligation to deal with complications of treatment which arise immediately. Or part of what I have purchased might include some kind of follow-up. But if I pay for a one-off procedure and the private provider delivers this competently and in good faith then their obligation to me is discharged. Or perhaps would be limited to providing at a later date some information about the treatment they have provided. I certainly could not expect to return years later, for example with a wobbly knee replacement, and expect them to give me another one for free. Still less could I expect this if in fact there was nothing at all wrong with me and no clinical indication for anything to be done. The private providers who are refusing to get involved in this insane process are in my view acting entirely properly. And people who know me will know I am no fan of private medicine.

The government and some senior doctors are making this situation much, much worse. I resent the fact that health resources and particularly NHS resources are going to be diverted towards what should have been a non-problem or at worst a minor problem because things have been exacerbated by the way public concerns have been handled. The NHS is already under pressure, clinical services are being cut. My patients with serious illness already complain about difficulty in getting to see their GPs. Now we see that the worried well are being advised to consult with their GPs with the prospect that this may lead on to completely unnecessary specialist consultations, investigations and ultimately surgery.

With Lansley, one always wonders how much is due to a secret agenda to dismantle the NHS and how much to simple incompetence. On this occasion I am prepared to give him the benefit of the doubt and say that this fiasco is probably occurring through a mixture of his own short-comings and the poor advice he has received. All the same, it's still pretty appalling.

Letter to Observer re Burzynski clinic

2011-11-27T13:09:00.001-08:00

My email to the readers' editor at the Observer re this article on raising the money to send a girl with cancer to the Burzynski clinic in USA.
http://www.guardian.co.uk/theobserver/2011/nov/20/a-family-gripped-by-cancer

The worst year of my life: cancer has my family in its grip

Hi.

I think you should take a really serious look at what hasgone on around the publication of this article. Of course it’s a moving accountof knowing a child with cancer. But the whole emphasis is on people clubbingtogether to allow her to receive some treatment which is unavailable on theNHS. The overall impression is horribly misleading, which is that there is someexpensive and sophisticated treatment which is for some reason inaccessiblethrough the NHS. Actually, the obvious reason it’s not provided by the NHS isthat it plain doesn’t work. Unlike a number of treatments which are availableon the NHS (e.g. herceptin), the chemicals used by this clinic are fairlysimple and easy to manufacture and if there was any suggestion that this waseffective treatment the NHS would be providing it or at the very least therewould be clinical trials proceeding in the UK which would be available to NHSpatients.

The awful truth is that all the well-meaning people who haveraised money for the cause have been taken in by the clinic’s publicitymaterial. The fact that the Observer has also been taken in makes things somuch worse. The NHS is facing exceptionally difficult challenges and the lastthing we need is a respected, liberal newspaper contributing to the impressionthat the NHS provides a second-class, limited service and that “proper”treatments are available in the US for those who have enough money.

I know that personal issues and emotions will make thisdifficult, but please try to unpick what has happened and undo the damage youhave done.

Yours sincerely

- David Curtis

--
Professor David Curtis
Consultant and Honorary Professor in Psychiatry

Three's random number approach to billing for data

2011-09-18T15:01:00.000-07:00

Dunno if anybody else is interested in this. It documents my attempts so far to get Three to explain to me how my computer could possibly have used the mobile broadband data they were billing me for. Basically what happened is I maxed out my prepaid monthly data by accidentally using MESH to sync with all my son's video downloads. I realised my mistake and stopped it but thereafter had to buy smaller chunks of extra data which I had to pay for individually. That's when I noticed that Three was billing me for much larger amounts than I could envisage using. I switched off everything, ran a monitoring program, left the computer alone and then phoned their helpline to find out what they claimed I'd used. As an example, they claimed I'd used 77 MB at a time the computer was unattended and nothing significant was running. I thought maybe I had a virus or something. I tried to find out more and to get some suggestion of how this usage figure could possibly be accurate. Result is email trail below.

An additional annoying thing you have to bear in mind is that each time I would send an email I wouldn't get a reply for a week but in the meantime I would get a phone message asking for me to call them. I knew this wouldn't get me anywhere and told them to stop doing it but they never did (see latest email from me).

They claim I used data which my computer logs say I didn't use and they have given me no explanation for the discepancy. They assure me their billing system is correct. They've offered to refund half the excess. Why? Are their figures wrong? Then refund all of it. Or correct? Fine, then I'll pay.

I don't care about the money. I care about the notion that a phone company can just say a customer has used a particular amount of data and provide no evidence and bill the customer. Even if the customer's own computer logs contradict this.

I'm complaining to the Ombudsman. Will update with any progress.

Emails start here:

STOP PHONING ME!!

Hi.

I emailed you before telling you not to phone me but you're still doing it. I've got a message on my voicemail asking me to phone you back on 500.

This is very annoying.

I already said I only want responses by email, not by phone.

The phone message said he was phoning in response to my email. But my email said not to phone!! What's the point?

I don't like getting random voicemails.

I can't phone you back on 500 because my queries relate to a mobile broadband account, not a phone account.

If I phone your helpline it would cost me money. Also, more importantly, my time sitting through your menus and then I know perfectly well that whoever I spoke to won't tell me anything new.

I've said repeatedly that what I want is somebody with some technical expertise to respond by email to my entirely legitimate query. I don't want to keep being fobbed off by customer services with vague half-explanations which make no sense and reassurances that your billing system is accurate when my own logs show it plainly isn't.

As I stated before, I am now in the process of pursuing a complaint against you with the Ombudsman. I will add your annoying communication behaviours to my complaint.

Regards

- Dave Curtis

-----Original Message-----

From: Dave Curtis [mailto:david.curtis@qmul.ac.uk]

Sent: 27 August 2011 19:10

To: 'Responsefrom3@3mail.com'

Subject: RE: Data usage on 9460602346

Hi.

I don't know why you bothered waiting a whole week and then sent me that last email. It adds nothing to your previous ones.

You still haven't given me one plausible scenario whereby my computer could possibly have used the data you say it did. You should be the experts here. You should be the ones who could say what could possibly have happened given the log I sent you of my processes running and the log you have of what you claim is my usage. I would expect you to be considering that I might have some invisible malware or that your dongle might be malfunctioning (or that your usage meters are).

I have repeatedly said that I want somebody with technical knowledge to email me but all I get is somebody from customer services parroting what somebody in billing has told them.

I also really hate trying to have an email conversation when I only get a reply after a week. And I really hate being advised to phone your helplines which I previously did repeatedly. If I was billing you for my time you would owe me a fortune. The disputed amount of your charges is trivial by comparison.

I consider myself to have exhausted your complaints process and so I will go on to make a formal complaint with Ombudsman Services: Communications. I will also inform OfCom of this issue.

Regards

Prof David Curtis

-----Original Message-----

From: Responsefrom3@3mail.com [mailto:Responsefrom3@3mail.com]

Sent: 22 August 2011 18:45

To: david.curtis@qmul.ac.uk

Subject: Data usage on 9460602346

Dear Mr Curtis

I’m sorry you had to write to us again about the out of allowance charges on your account. I understand you’re concerned as your log doesn’t match the usage details given on your July bill. I apologise as you’re unhappy with the response sent.

I can assure you there’s no mistake in our billing system and we’ve checked this twice for you so far. The business objects report is a tool used by our billing team to check how much data was accessed in the month and accordingly generate the bills. However, we don’t make a note of website and links you access to ensure privacy of your data.

I’m sorry to hear you’re upset with our customer service and the upgrade option given to you. I’ve passed your feedback to my manager so we can use it in future for improvements. Considering the situation and we can make an exception and apply £58 credit (to refund 50% of the charges in dispute) if you agree to continue with us for another three months at least. Please let us know your decision and we’ll be happy to help.

Just so you know – if you feel you need more allowance, we suggest you to move to a higher package.

Hope I’ve managed to explain everything clearly and you’re happy with my offer. If you have any more questions, please call us on 500 (free) from any Three mobile or on 0843 373 0500 (5.1p/min from a BT landline, other networks may vary) between 8am to 10pm.

Kind regards

Monica Gidwani

Three Customer Services

TRACKING NUMBER: A00005349509-00016044151

-----Original Message-----

From: david.curtis@qmul.ac.uk

Sent: 15 Aug 11 20:54:58

To: <responsefrom3@3mail.com>

Cc:

Subject: RE: Data usage on 9460602346

Hi.

This is nonsense. You haven't addressed my concerns at all.

I have a log of programs running on my computer which as far as I can see provides no plausible explanation of the data you claim I am using. You haven't given me one.

I challenge you to present with one plausible scenario which accounts for the log I have provided you with and the data you claim I have used.

As far as I am concerned, you may as well be making up these numbers. What is your system measuring exactly? Have you sold me a dongle which randomly generates a few dozen megabytes of traffic whenever it feels like it? How am I supposed to know there is not some fault with your system?

Your process is completely untransparent. You just declare to me that I owe you money and you take it. As far as I can see I didn't owe you money at all. But you took it anyway.

Of course the last thing I want to do is to upgrade my contract and pay you even more money every month. How stupid do I look to you?

You are really terrible at replying to emails. How on earth can it take an ISP so long to reply to an email?

What on earth is a "business objects report"? Do you even know? Ask your billing team why I should take their word for something when everything I know about my own machine, including the log I sent you, shows that their report is wrong.

If you had an interest in the quality of the service you provide you would be very concerned indeed that your billing system might not be accurate. As it is, all you can do is lamely repeat that you are right and that I (with my log) am wrong.

I did say I wanted somebody with some technical knowledge to reply to my email but I can see that hasn't happened.

I was going to keep my contract with you but your email responses are so aggravating that I am contemplating looking for an alternative provider.

Regards

- Dave Curtis

-----Original Message-----

From: Responsefrom3@3mail.com [mailto:Responsefrom3@3mail.com]

Sent: 15 August 2011 20:27

To: david.curtis@qmul.ac.uk

Subject: Data usage on 9460602346

Hi David

Thanks for patience while we checked details for you.

Our billing team checked the log you sent but couldn’t explain the same. They said that they verify any usage made by you on the business objects report. They checked the details on this report and the usage done once the allowance exhausted from the 17 July until the 27 July reflects against your account. For security reasons, we can’t see the websites that you access.

I realise that you weren’t happy about the charges for the unbilled amount in your bill dated 5 July. I understand we charged you £114.368 as unbilled amount + £15.98 as line rental charges. I appreciate that you have cleared the balance.

What we can do for you is apply a credit of £65.17 on your account and upgrade your contract to the 15 GB price plan for £15.99 so you can get more data allowance. The end date of your contract was 29 November 2010 we’ll also extend your contract until 29 November 12.

Or if you prefer we can apply a credit of £65.17 on your account and upgrade your contract to the 15 GB price plan for £20.99 and then extend your contract until 29 May 2012.

Please let us know if you’d want us to apply the credit and how much to extend your contract. We’ll adjust the credit with your future bills. Thanks again for your patience.

I hope to hear from you soon. If you want you can call us on 500 (free) from any Three mobile or on 0843 373 0500 (5.1p/min from a BT landline, other networks may vary) between 8am to 10pm.

Thanks

Salomie Bhastekar

Three Customer Services

TRACKING NUMBER: A00005349509-00015865633

-----Original Message-----

From: david.curtis@qmul.ac.uk

Sent: 27 Jul 11 21:17:20

To: <responsefrom3@3mail.com>

Cc:

Subject: RE: Your billing query

Hi.

Did you look at the log I sent you? I don't see any programs there which could account for the data usage.

I have the impression you are not actually bothering to reply to the specific content of my emails but that you are just cutting and pasting various stock answers which you have.

I also think that it is completely unsatisfactory that you take several days to respond to each email I send. And then you ignore the content.

Please take a look at the log I sent you and point out to me any processes which could possibly be accounting for the usage you claim.

I think I had already switched off windows update and you'll see that I did not have anything like google maps running. 77 megabytes is quite a lot of data and I challenge you to give me one concrete example of any process I was running that could really have downloaded that amount.

I don't know what you mean by saying the usage was initiated at intervals. If you have a more detailed log of my usage send it to me by all means. I can't see a detailed log by accessing My3.

You claim that I used data and you want to charge me for that. I have evidence that I did not use the data that you say I did. All you tell me is that your billing team thinks it is correct. I have a log of my computer activities which says it isn't.

Please send me a proper reply from somebody technical who actually understands these issues. Please stop inviting me to phone you, which is just pointless and annoying.

Please reply to this email promptly.

Regards

- Dave Curtis

-----Original Message-----

From: Responsefrom3@3mail.com [mailto:Responsefrom3@3mail.com]

Sent: 27 July 2011 20:16

To: david.curtis@qmul.ac.uk

Subject: Your billing query

Hi David

I’m sorry you had to write to us again about the usage on your account. I understand you’re upset as you don’t agree with the charges.

I apologise for the call you’ve received even when you had requested a reply in writing. We called to get the matter sorted at the earliest. I’m sorry if this has annoyed you.

I realize you think that our billing system is not recording your usage correctly. Until now we didn’t have any complains about the tracking of data. However, after you contacted us about the usage on your account, we had sent the details to our billing team to look in to it further.

They have investigated the matter and found that the usage on your account was initiated at intervals. I understand the computer was unattended, however there might be applications running in the background which get updated due to the settings on your computer if the internet is connected.

This could be an anti virus software, windows updates or web services like Google maps which get updated from time to time to get the latest updated on your computer. This could be the main reason for the charges you’ve incurred.

Please check your usage on My3 as the data here gets updated on a real time basis. This will give you a clear idea of the usage you’ve made and the balance on your account so you don’t go over your allowance.

The options given on our previous response are still available. Please get back to us if you would like to go with any one of them so we can take the necessary action on your account.

I hope this information helps. If you have any more questions, please call us on 500 (free) from any Three mobile or on 0843 373 0500 (5.1p/min from a BT landline, other networks may vary) between 8am to 10pm.

Kind regards

Sukruti Lakhote

Three Customer Services

TRACKING NUMBER: A00005349509-00015790647

-----Original Message-----

From: david.curtis@qmul.ac.uk

Sent: 20 Jul 11 08:18:33

To: <david.curtis@qmul.ac.uk>, <responsefrom3@3mail.com>

Cc:

Subject: RE: Your billing query - TRACKING NUMBER: A00005349509-00015631098

Hi.

Please stop trying to speak to me on the phone. It's annoying.

Please reply to my email below.

Regards

- David Curtis

-----Original Message-----

From: Dave Curtis [mailto:david.curtis@qmul.ac.uk]

Sent: 11 July 2011 09:31

To: 'Responsefrom3@3mail.com'

Subject: RE: Your billing query - TRACKING NUMBER: A00005349509-00015631098

Hi.

I don't think you're addressing the key issue. You keep saying that I am using data but I don't think your recording methods are working properly.

To take one concrete example, you say that at 13.06 on 27/6/11 I used 77,608,177 bytes. Please find attached a log of internet access for my PC at that time. The computer was unattended. I don't see any processes running which could plausibly have used that amount of data at that time.

You just keep stating that your records are accurate but I don't see how they can be. It looks like you may be using a random number generator to record how many bytes I am using. Or there may be some kind of technical fault on your dongle.

Please get somebody technical to look at this log and then get back to me with a plausible explanation of how this amount of data could have been used at this time.

Regards

- David Curtis

-----Original Message-----

From: Responsefrom3@3mail.com [mailto:Responsefrom3@3mail.com]

Sent: 08 July 2011 13:33

To: david.curtis@qmul.ac.uk

Subject: Your billing query

Hi David

I’m sorry you had to write to us again about the data charges on your July bill. I understand you’re concerned as you didn’t expect high charges according to the usage you made.

I apologise for sending a call back request even though you only wanted a written reply to your previous email. I’ve passed your feedback to my colleague so this doesn’t happen again.

Following our several conversation with you, we’ve got the usage details rechecked by our billing team. They confirm that the usage information and charges on your July bill were correct.

But, we don’t keep details of websites accessed on our records to maintain your privacy. It seems your usage went higher than usual because you might have accessed content that uses more data allowance while uploading or downloading.

To keep a close look on your usage in future, please keep checking the allowance left after each session on My3 online. Or, you can even check your modem manager but you’ll have to reset this manually. If not reset, it will include past usage details and end up giving the incorrect picture.

Considering your situation, we can waive off half of your June and July bill amounts if you agree to upgrade to a new 18 or 24 month contract on the 15GB plan. If you want to consider this option, please call us and we’ll discuss more details.

If you don’t want to upgrade the contract term, we can change the plan and apply a £20 credit on your July bill as a gesture of goodwill. Then, we can lower your usage limit to any amount as low as zero. This will restrict your outside allowance usage charges each month.

Hope you consider our offer and don’t feel the need to leave us anymore. If you have any more questions, please call us on 500 (free) from any Three mobile or on 0843 373 0500 (5.1p/min from a BT landline, other networks may vary) between 8am to 10pm.

Kind regards

Monica Gidwani

Three Customer Services

TRACKING NUMBER: A00005349509-00015631098

-----Original Message-----

From: david.curtis@qmul.ac.uk

Sent: 03 Jul 11 07:43:55

To: <responsefrom3@3mail.com>

Cc:

Subject: RE: Response from Three

Hi.

Please send a reply to my message by email.

I don't want to speak to you on the phone. It's a waste of my time and doesn't get me anywhere. If you have something to say, put it in an email.

My message was a formal notification that I am in dispute with you. Please send me a formal reply by email.

I am contemplating leaving your company.

Regards

- Dave Curtis

Sent from my HTC 7 Pro

-----Original Message-----

From: Responsefrom3@3mail.com

Sent: 01 July 2011 20:26

To: david.curtis@qmul.ac.uk

Subject: Response from Three

Dear Mr Curtis

Thanks for writing to us. We tried to call you but couldn’t get through.

We’ve taken a look at your query and have some options that we’d like to speak to you about. Please call us on 0800 358 4916 between10am and 5pm (Monday – Friday) - free from a Three mobile, network call charges may be applicable from any other phone.

Thanks for your patience.

Kind & Regards

Rohit Minj

Three customer service

TRACKING NUMBER: A00005349509-00015616042

-----Original Message-----

From: david.curtis@qmul.ac.uk

Sent: 30 Jun 11 17:13:42

To: <responsefrom3@3mail.com>

Cc:

Subject: Re: Response from Three

Hi.

This isn't getting sorted out on the phone and I don't want to have to pay for any more phone calls to you. I don't have a three mobile so it costs me money to speak to you.

Please give a proper response to my message below. The monitoring software on my computer says that there was no program running which might have used the data at the time you state.

Regards

- Dave Curtis

Quoting Responsefrom3@3mail.com:

> Hi David

> Thanks for writing to us. We tried to call you but couldn’t get through.

> We’ve taken a look at your query and have some options that we’d

> like to speak to you about. Please call us on 0800 358 4916

> between10am and 5pm (Monday – Friday) - free from a Three mobile,

> network call charges may be applicable from any other phone.

> Thanks for your patience.

> Regards

> Dipali Shirgaonkar

> Three customer service

> TRACKING NUMBER: A00005349509-00015585755

> -----Original Message-----

> From: welcome@three.co.uk

> Sent: 28 Jun 11 09:01:20

> To: <3_customer.services@3mail.com>

> Cc:

> Subject: Feedback from Hutchison 3G web site - Category:

> Email-me-Account Related - 07412014788

> Forename: David

> Surname: Curtis

> Email:

> DOB:

> Contact No:

> Postcode:

> Three No:

> Feedback:

> Dispute re data usage Your company is claiming that I am

> using large amounts of data and I have built up a large bill this

> month. I have been trying to identify which programs are using this

> data. However when I log my usage it does not match wha

> t your company claims. For example, at 13.06 on 27/6/11 you claim I

> used 77,608,177 bytes. But the only process accessing the internet

> was svchost.exe, which ran at 13.00, 13.05 and 13.10. I do not

> believe this program used this data. Your company will

> not tell me what site was accessed at this time and I have no

> evidence that this data was really used. In fact, from all I can

> tell, it was not. I therefore dispute your claims of the data I

> have been using. Please investigate this matter further and g

> et back to me. Regards - Dave Curtis

2011-09-14T16:14:00.000-07:00

World Congress in Psychiatric Genetics 2011

I'm on my way back from the 2011 World Congress in Psychiatric Genetics, so here's a brief subjective account of some aspects of where the field seems to be.

Methodology

Results from sequencing studies, particularly whole-exome sequencing, are starting to trickle through. They are likely to turn into a flood over the next year. Sequencing studies carry the promise of finally being able to detect rare DNA changes having a really major effect on disease risk. Some concerns exist that sequencing studies confined to the exome may miss important mutations in non-coding regions. It remains to be seen how severe this problem will be in practice. Sequencing the genome rather than the exome is more expensive and yields vast amounts of data which may be difficult to interpret. Even with exome sequencing, a major challenge will be how to recognize which are likely to be disease-relevant mutations among the many thousands of variants each subject will possess. With sequencing studies we can expect to find pathogenic variants but the challenge will be to know that we have found them.

It is probably fair to say that there is a growing realisation that chip-based genome-wide SNP studies can only detect common variants with a minor effect on risk. Alongside this is some refocussing on the task to identify rare variants with major effect size. It can be expected that sequencing studies will make a major contribution to this. There is little or no suggestion so far that the genes already identified as having common minor effects will also be found to harbour rare pathogenic mutations.

Interest continues in chromosomal deletions and duplications as rare but important risk factors in autism and schizophrenia. Some studies have looked at these variants arising de novo rather than being inherited. Although such de novo events seem to produce disease in some individuals it remains the case that in others inherited variants act as risk factors. Considering the genetic epidemiology of these conditions, it is clear that inherited factors make a major contribution to risk. Hence the study of de novo mutations occurring in random positions may not add substantially to our understanding.

Autism

The role for chromosomal insertions and deletions - copy number variants - as occasional causes of autism is further consolidated. Each of these chromosomal abnormalities disrupts the functioning of a number of genes and in most cases it is not clear which individual gene is responsible for the autism risk. However there were also reports of a small number of sequence variants in specific genes and these could probably be added to the list of those already known to be occasionally mutated in autism.

Schizophrenia

As for autism, the role for copy number variants as rare causes of schizophrenia is consolidated and is now accepted as an established finding. Again, no additional individual genes are specifically implicated although it was claimed that evidence pointed to the involvement of genes coding for proteins present in the synapse. Thus there is a developing notion that schizophrenia may be a disease of disturbed synaptic functioning.

From chip-based genome-wide association studies, it seems that there is still only one gene implicated in which common variation produces a minor effect on risk of schizophrenia. And nobody seems to have any idea what this gene does.

There are not yet convincing reports of rare sequence variants in specific genes having an aetiological role in schizophrenia. It is hoped that some may be identified through sequencing studies of large numbers of cases.

Bipolar disorder

By contrast with schizophrenia, it is probably fair to say that copy number variants do not make a substantial contribution to bipolar disorder.

Genes previously implicated as having a minor effect on risk of bipolar disorder continue to be supported, along with one or two others. Those previously identified consist of CACNA1C and ANK3. CACNA1C codes for a subunit of a calcium channel and there is some evidence also to implicates genes coding for other subunits of this ion channel and other related proteins. Indeed, the product of ANK3 seems to be involved in the functioning of this channel. Thus one could build up the picture that bipolar disorder might involve abnormal functioning of this calcium channel, which fits nicely with reports that calcium channel blockers can be effective treatments for bipolar disorder. The genetic variation so far identified in these genes consists of common variation with a small effect on risk. There is not yet any convincing report of a variant having a major effect which could be described as causing the illness. Again, it is hoped that such variants may be identified by sequencing studies which are getting underway.

Alzheimer's disease

A few more genes in which common variation affects risk of late onset Alzheimer's disease have been fairly convincingly identified, bringing the total to around ten. However with the exception of APOE the magnitude of the effect is very small. Nevertheless, these findings may be useful in terms of directing attention to a possible role for novel pathogenic processes involving inflammation.

Late onset Alzheimer's disease demonstrates less in the way of familial clustering than do schizophrenia and bipolar disorder. Thus there does not seem to particularly be the expectation that important rare variants will eventually be discovered in addition to the common ones already found.

Paper on cost to patient of medical interventions.

2011-06-12T13:38:00.000-07:00

My paper on cost to patient of medical interventions got published. So I suppose I may as well mention it here.

Patient experience – the ingredient missing from cost-effectiveness calculations

My response to "listening exercise" on proposed NHS reforms

2011-05-18T00:46:00.000-07:00

Arizona is proposing fining obese Medicaid recipients who do not comply with a diet. People are complaining that this represents a "nanny-state" mentality but if the state is providing your healthcare and you are behaving in a way which makes this more expensive, why shouldn't the state try to recoup some of that extra expense?

Fining non-dieters sounds impracticable but it would be fairly straightforward to allocate a specific cost to a wide range of activities which would tend to make people less healthy and hence to require more expensive healthcare. One could assign such a cost not only to each cigarette or each unit of alcohol but also each calory of food consumed. Thus there could not only be components of tobacco and alcohol duty which were badged as related to healthcare costs but also a health tax on food and drink related to calorific and salt content. As an example this would either make diet drinks cheaper than their sugar-containing equivalents or else the manufacturer would have to bear the cost, making it less attractive for them to produce and promote high calory drinks.

A similar financial approach could be applied to other behaviours impacting on health. For example, getting a bus instead of walking or cycling reduces fitness. Hence one could impose a health tax on such journeys as well as having a specific component of duty on petrol badged as the health cost of driving instead of walking. Conversely, one could financially reward activities expected to increase fitness. For example, there could be a government-provided health subsidy for swimming tickets, gymn membership and purchase of exercise equipment and bicycles.

We are told that the cost of providing healthcare to the population is rising and that one reason for this is that people make unhealthy lifestyle choices. The proposed approach makes explicit and fair the relationship between the state as the provider of universal healthcare and the citizen as the consumer. It says that people are free to make choices and can choose behaviours which will be on average increase the costs of their healthcare but that when they do so they should be expected to bear this additional cost themselves rather than expecting other members of society to do so. Implementing this additional revenue stream would be seen as fair and would alleviate the financial pressures which are claimed to be driving these reforms.

2011-05-15T15:39:00.000-07:00

Seriously ill people will clutch at straws. Homeopaths are in the business of selling those straws.

Advertising Standards Authority response to complaints about homeopathy websites

2011-03-19T11:28:00.000-07:00

Here is the response you get from the ASA if you complain about a homeopathy website. Seems fair enough to me.

Dear Sir/Madam

ADVERTISING CLAIMS ON HOMEOPATHY WEBSITES

Thank you for your recent complaint.

As you may know, the Advertising Standards Authority (ASA) has received over a hundred and fifty complaints about over a hundred different websites for homeopathy. Complaints cover a range of issues from specific claims made by individual advertisers to general concerns about the sector as a whole. Because of the volume of complaints, we are sending this letter to everyone who contacted us on these issues to let you know what action we intend to take.

The ASA has an established position on claims that can be made, and those claims that are not likely to be acceptable for homeopathy, based on the requirements set out in the CAP Code and previous ASA adjudications. Although we have not historically received many complaints about advertising for homeopathy, the Code has general requirements for substantiation of claims in the health sector and the Committee of Advertising Practice (CAP) offers specific advice on marketing health-related products and services. Further information about the requirements of the advertising Code is available on our website www.asa.org.uk and from www.copyadvice.org.uk.

We are seeking to enforce compliance with the Code even-handedly across the sector by contacting all of the advertisers we have received complaints about as well as the bodies that represent homeopaths and homeopathy in the UK. We will be explaining the Code’s requirements, giving advice on how to ensure advertising claims do not breach the Code, and asking advertisers to remove any claims which do not comply. More information about what that means in practice is provided in the CAP Help Notes on Substantiation for Health, Beauty and Slimming claims and Health, Beauty and Slimming Marketing Communications that Refer to Medical Conditions. You can find these documents on our Copy Advice website, as indicated above. Because the ASA has only been regulating websites since 1 March many of the advertisers we contact will not be familiar with us or the work we do and will need help and assistance from us. For that reason, we plan to monitor compliance 3 months after making our expectations of them clear. We feel that this will give advertisers, some of whom are very small and have limited resources, sufficient time to make the necessary changes.

The ASA will not be publishing individual adjudications on this occasion. We will however publish specific, up-to-date advice to the industry and its representative bodies in due course and we will work with them to ensure that advertising for homeopathy is compliant with the Code.

Thank you for taking the trouble to contact us. While you will not see immediate results please be assured that we are working hard in the background to resolve the issues that have been complained about.

Yours sincerely

Georgia Taylor | Investigations Executive
Direct Line 020 7492 2146 | E-mail georgiat@asa.org.uk

Advertising Standards Authority
Mid City Place 71 High Holborn London WC1V 6QT
Telephone 020 7492 2146 www.asa.org.uk
Legal, decent, honest, truthful

Review of Medicines Act 1968: Informal consultation on issues relating to the product licences of right (PLR) regime and homeopathy

2011-02-03T10:53:00.000-08:00

There was an invitation to respond to this consultation. Here's the email I sent:

Hi.

This whole project is lunacy. Why are you wasting tax-payers money on it? Why don’t you waste your time licensing sunlight and lettuce?

Even thinking about thinking about licenses for homeopathy is an insult to every hard-working NHS professional trying to alleviate people’s suffering using evidence-based practice. Anybody involved in such an endeavour should go take a long hard look at themselves in the bathroom mirror and then flush themselves down the toilet.

There, that’s what I think.

Regards

- Dave Curtis

--
Professor David Curtis
Consultant and Honorary Professor in Psychiatry
Dept Adult Psychiatry
3rd Floor Outpatient Building
Royal London Hospital

Why GWAS's are evil

2010-12-27T10:28:00.000-08:00

OK, yes, I know that genome-wide association studies have identified some important genetic effects but there are some important downsides too. I truthfully do not know whether the benefits have outweighed the costs.

Why am I saying this? (None of this is supposed to be original. Conversely, I am not going to go to the trouble to find the myriad of people who may have said the same thing first. So sue me. I think that's what blogs are for?) Here are some pertinent points:

Nobody believes anything if it's not in a GWAS

Studies which would previously have been judged to give perfectly respectable evidence to implicate a candidate gene are nowadays completely ignored because the stupid GWAS missed said gene. People don't believe a candidate gene study which yields a corrected p value of 0.001 derived from 20 markers but they do believe a GWAS which produces one p value of 10^-8. There is no logic in this position. But a lot of people take this attitude. At a recent conference summarising results of association studies all except GWAS's were completely ignored.

People think that a GWAS covers the genome

It so does not! I have looked at GWAS data and there are simply enormous gaps where no marker is typed. Many of the alleged "markers" on a chip are not actually markers at all because they are completely or almost completely monomorphic. The reliability of genotypes is often atrocious. Try downloading the genotypes from some publicly available source and see how many stupid obvious errors you find. Then think of the much larger number of errors which you don't know about because they're not obvious. The notion that one has "covered" the genome by running it through a standard chip is nonsense.

A GWAS will never, ever, ever find an important but rare variant

Suppose a risk variant has what is nowadays thought of as a very large effect, RR of 10, and an allele frequency of of 0.0005, which is actually quite high relative to many known mutations. Even if this risk variant happens to be in complete LD with an SNP (rather than falling in one of the many gaps), the SNP will still not show association. If the minor allele of the SNP is in complete LD with this variant and has a frequency itself of 0.1 then the the SNP itself has RR of only 1.045. The GWAS will simply never, ever see important variants with fairly low frequency. Even if the SNP is right on top of the variant and even if the sample is huge. Do the maths.

Anybody who frets about "missing variance" is stupid

Really, I can't think of a more polite way to put it without actually lying. It might be more accurate to say that anybody who frets about missing variance is a stupid and evil, because they are so damaging to sensible scientific thought, but I will admit that perhaps they are just stupid and that they are unaware of the damage wrought by their promotion of their small-minded opinions. To these stupid people, my message is this. Of course a GWAS is not going to pick up all genetic variance, you idiot. If you read the above, you will see that a GWAS will not detect any rare variant. Not a single one. Never. It will systematically miss every single one. Even the ones which fall right on top of one of your SNPs rather than falling into one of the many gaps between them. And then, after you've done a GWAS, you start agonising about "missing variance". Please. Of course there's going to be missing variance. (I'm not very good at talking to stupid people but perhaps I'll improve with practice.)

GWAS's burn up datasets

Once one has submitted a dataset to a GWAS it becomes extremely difficult to extact any further information because one is constantly hit by the correction factor which has to be applied to the GWAS. So all the important findings for the real variants are lost in a mass of noise and even if somebody points at such a finding in the original analysis or else goes back and analyses another marker then nobody else will take any notice because "overall" the result will not be significant. That's because you've got 500K bits of noise obscuring the experiment you wanted to do. The dataset may consist of thousands of subjects and may have taken years to collect. It may consist of pretty much every case of the disease in question in the country, or on the continent. But once you've let somebody run a GWAS on it it's dead.

GWAS's beg for larger and large sample sizes

Because they incorporate tests of large numbers of markers they require huge sample sizes if they are to produce p values which will survive correction for multiple testing. A more carefully targetted study might have produced the same corrected p value with a far smaller resource. GWAS's suck resources away from other projects.

GWAS's tend to find the unimportant results

Because they can't detect rare variants, even with large effects, GWAS's only detect common variants. Selection pressures mean that common variants do not have large effects. So the only loci one "finds" with a GWAS tend to be those which are not aetiologically particularly important and which it is hard to understand the effect of. It would be much more useful to find a rare variant which had a large effect so that one could see what its function was and better understand disease causation. But a GWAS can't ever do that.

I could go on, but that's quite enough for today. Just letting off a bit of steam. Somebody whose opinion counts needs to take a hard look at these issues.

Email to MP re plans for NHS

2010-12-27T09:52:00.000-08:00

Here's an email I sent my MP, for all the good it will do. She's a LibDem minister so she'll most likely just toe the party line.

From: Curtis David (East London NHS Foundation Trust)
Sent: 27 December 2010 17:28
To: 'Lynne Featherstone - Liberal Democrat MP for Hornsey & Wood Green'
Subject: Government plans for the NHS

Dear Ms Featherstone.

I am writing to express my extreme concern at the government's plans for the NHS.

The major reorganization proposed has not been properly thought through. The very process of reorganization will certainly strain the NHS in the short term and is being carried out at a time when the NHS is under extreme pressure for other reasons. It breaks the pledge which the Conservatives made not to subject the NHS to new reorganizations.

The eventual outcome of the reorganization is quite likely to be deleterious for the NHS. There is no reason why GPs are likely to do a better job of commissioning than professional commissioners. It is inevitable that a postcode lottery will be introduced. GPs will be put in the position of rationing care for their patients whereas previously they were advocates for their patients. The patients' trust of doctors will be undermined. Cynically, it looks as though GPs are going to be expected to take the blame for deficiencies in provision which will be outside their control.

There is no reason to suppose that the reorganization will lead to a more cost effective or equitable NHS.

The overall lack of sufficient funding for the NHS is sure to cause problems for both patients, who will certainly receive a poorer service, and for staff, who will be blamed for problems at the same time as they face calls for pay restraint and uncertainty about their own future employment. The effects of restrictions on funding the NHS will be greatly exacerbated by the simultaneous cuts to social service provision.

The increasing privatization of the NHS is very worrying. This is occurring at the same time as medical students will have to start paying large tuition fees. This will contribute to a commercialization of medicine in Britain so that doctors of the future will no longer feel an obligation to repay their debt to society but will be more interested in repaying their own debts and will be more keen to be remunerated at a market rate. This move towards privatization will make the provision of healthcare in Britain more expensive and less equitable.

Given your position and your previous track record I have no expectation that you will do anything to address my concerns, which are similar to those expressed elsewhere by people far more knowledgeable than me, but I thought I would nevertheless put them on record.

Your sincerely

David Curtis

Chromosomal deletions and ADHD

2010-11-25T23:45:00.000-08:00

A study in the Lancet seemed to imply that large chromosomal deletions could cause ADHD - children with ADHD were found more often to have such deletions than control subjects. However there is a flaw in the argument because according to the paper the children with ADHD also had lower IQ than controls. It is already known that large chromosomal deletions are associated with intellectual impairment. So a plausible explanation is that by selecting children with ADHD one obtains a sample with low IQ and such subjects can be expected to have more large deletions by virtue of their lower intelligence rather because of any specific relationship between deletions and ADHD.
Of course, at one level it is true that ADHD is associated with large deletions. But if the effect is mediated by IQ then this is somewhat different from the notion that "deletions cause ADHD". To test this, one would need to study a sample of subjects with ADHD compared with controls who had been matched for IQ.

I did submit a letter to the Lancet pointing this out but unfortunately they have a strict policy of not considering letters submitted more than a couple of weeks after the article is published. So I've reproduced the letter below. Hopefully it's fairly self-explanatory.

Intellectual functioning confounds claim that CNVs are associated with ADHD

David Curtis

Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, London E1 1BB. Tel +442073777729. Fax +442073777316. Email david.curtis@qmul.ac.uk

The claim that rare chromosomal deletions and duplications (copy number variants, CNVs) are associated with a diagnosis of ADHD (1) is unsubstantiated because the increase in CNV rate among subjects with ADHD may simply be due to an association between CNVs and low IQ. The study reports that there is a much increased rate of large CNVs among subjects who have ADHD and intellectual disability (IQ<70, one-tailed p=0.0002) but also a less highly significant increase among subjects with ADHD whose IQ falls within the normal range (IQ>=70, one-tailed p=0.0077). However this latter group has a mean IQ of only 89. If one takes a sample from the general population and then excludes those with IQ<70 one expects to see a mean IQ among the remainder of over 100. Thus it is clear that these ADHD subjects, while having an IQ which is not “below normal” still have an IQ which is “below average”. It is entirely plausible that the results are explained entirely by the fact that the ADHD subjects have below average IQ and that large CNVs occur more commonly in subjects with below average IQ, since it is already established that they are commoner in people with below normal IQ (2).

In order to demonstrate that CNVs conferred a specific risk of developing ADHD one would have to compare a sample of subjects with ADHD against a sample of IQ-matched controls. It is possible that similar caveats may apply to some extent to claims for the association of CNVs with schizophrenia and autism (3, 4), since excluding subjects with intellectual disability does not mean that one has necessarily fully eliminated intellectual functioning as a confounding factor.

1. Williams NM, Zaharieva I, Martin A, Langley K, Mantripragada K, Fossdal R, et al. Rare chromosomal deletions and duplications in attention-deficit hyperactivity disorder: a genome-wide analysis. Lancet. 2010 Oct 23;376(9750):1401-8.
2. Mefford HC, Cooper GM, Zerr T, Smith JD, Baker C, Shafer N, et al. A method for rapid, targeted CNV genotyping identifies rare variants associated with neurocognitive disease. Genome research. 2009 Sep;19(9):1579-85.
3. Stefansson H, Rujescu D, Cichon S, Pietilainen OP, Ingason A, Steinberg S, et al. Large recurrent microdeletions associated with schizophrenia. Nature. 2008 Sep 11;455(7210):232-6.
4. Glessner JT, Wang K, Cai G, Korvatska O, Kim CE, Wood S, et al. Autism genome-wide copy number variation reveals ubiquitin and neuronal genes. Nature. 2009 May 28;459(7246):569-73.

Starting a blog

2010-11-03T15:19:00.000-07:00

Maybe I could use a space to put things up which will be searchable and linkable and which people can comment on. I'll try posting things here and see how it all goes.