Jeremy Harris

All the Cochrane evidence on statins for the treatment of a wide range of conditions is here: http://www.cochrane.org/search/site/statins?f[0]=bundle%3Areview It's fair to say that the evidence is not as powerful in some case as the popular press might make us believe, but that's also true of a fairly large number of medications. I wholeheartedly agree with your cynicism with regard to the reporting of evidence from trials and studies. I've probably reviewed about 40 or 50 sets of data from such trials or studies in recent months and the way the data has been manipulated in many of them is pretty shocking.

Thanks, you're not the first case I've heard regarding the cost of getting the sacrificial anode changed, and I know of one case where the tank split, possibly because the anode wasn't changed. I put a lot of thought into fitting one in the early stages of our build planning, but despite the good communications with ESP, decided it was not the best solution for our house. I also found many near-identical looking units for sale on the Chinese marketing site Alibaba, and despite the fact that I know ESP have said that they manufacture these units, I do suspect that they are imported from China, with perhaps some modifications done here for the UK market, to comply with our regulations etc. I'd like to be proved absolutely wrong, with hard evidence that these are not in essence Chinese made units re-badged, tested and certified for the UK, but I had a look inside one when we were looking at fitting one and was also sent a few internal photos by one of the many Chinese vendors of near-identical looking units, and have to say they looked pretty much the same to me. If they really are wholly made in the UK, then I'd be happy to be corrected.

@jack, you're right, there's no way that a GP can be fully up to date on every aspect of primary health care, it's just far too wide a range. In my case, the failing was made by the consultant I was referred to when still living in Cornwall. @SteamyTea has already made reference to the pretty awful standards of health care down there, and sadly they've been like that for decades. The failing was then compounded by five other GPs, as we moved around from place to place, who simply carried on prescribing various medications without questioning the original diagnosis. The worst GP failing was the one before last, who ignored my evidence of apparently low blood pressure from home readings, when in reality my blood pressure was only a bit low because of the medication. I'm about to change practice, so am hopeful that I can start off with a clean slate. I have a feeling that I'm not flavour of the month with our current practice, with the exception of the new GP, as when she confirmed that I'd been misdiagnosed, and received medication for decades that didn't need, I wrote to the practice manager and because of the nature of the complaint she had to refer it to the NHS contracting team, who are currently investigating the whole practice. Apparently mine hasn't been the only complaint, there have been others, although all I know is that, as the NHS complaints people wrote to me to confirm their investigation and mentioned that I was not the only complainant.

I have a vested interest in the bad evidence for hypertension, as I was "diagnosed" with it over 30 years ago, during an annual aircrew medical. I was sent to see my GP, who then referred me to a consultant, who did a whole barrage of tests and could find no underlying cause, so gave a diagnosis of "essential hypertension" (in essence, "we have no idea why your blood pressure seems high, so this is the name will give it"). I was put on various hypertension medications over the years, some of which had unpleasant side effects (and one indirectly led to me losing a tooth). I ended up taking an angiotension receptor blocker (ARB) for several years, as these had the least noticeable side effects. Having hypertension doesn't often have any noticeable symptoms, but I noticed that on the rare day when I forgot to take a pill, I could tell by around lunchtime, as I seemed to have a lot more energy. I mentioned this to my GP and he didn't really take much notice (but, to be fair, he was on run-down before taking early retirement). I had also mentioned to my GP several times over the years that my home BP measurements were, if anything, on the low side, and went so far as to keep sending him printouts from an Excel spreadsheet before every annual medication review to prove this. As I wasn't exactly happy at my GPs attitude, I went and found out about Cochrane late last year and read every single review they had conducted. The first shock was to find out how relatively ineffective anti-hypertension drugs are (at best they reduce BP by around 10 to 15mmHg, often less). Based on the collected evidence presented by Cochrane I decided to ask my GP if I could have a 24 hour ambulatory blood pressure monitor test, as the Cochrane evidence was clear that no diagnoses for hypertension should be made without one (bit late after 30 years of taking pills, though!). He said they hadn't got a machine available, so I decided to buy one, despite the high price, as I was determined to find out what was going on. I did two separate 24 hour ABPM sessions, one mid-week, when I was working, one on a Sunday when I was relatively sedentary. Both sets of data were very similar, and showed my BP to be low. As I was fed up with my GP. and he was retiring anyway, I decided to halve the daily dose of the ARB I was taking, wait a couple of weeks and do another 24 hour ABPM session. That showed my BP was the same as on the full dose. I then just stopped taking the medication altogether, and a couple of weeks later did two more 24 hour ABPM sessions, which showed my BP to be slightly lower than normal and well below the stage where treatment was needed. One side effect was that I had loads more energy and generally felt a great deal better. By this time a new GP had replaced the one I'd been seeing for over 15 years. I was due for a medication review, and wanted to cancel my long-term repeat prescription, so I armed myself with all the Cochrane evidence, my home BP readings going back for the past few years and the results from all the 24 hour ABPM sessions, then went to see her. She looked at my records, looked at the file I'd given her, then said that I should never have been diagnosed with essential hypertension as it was very clear that all I had was "white coat hypertension", something around 20 to 30% of people have, where their BP is elevated when measured in a clinical environment, but normal when measured at home. She apologised on behalf of the NHS for the 30 years of treatment I'd put up with, the slight harm this had caused and she stated very clearly that her predecessors had failed to do proper diagnostic checks before just prescribing me medication that I did not ever need. Even now, several months later, it still seems odd not taking a pill every morning, but I feel a lot better overall for not taking the damned things. I do still feel angry that the calcium channel blocker that I was originally prescribed, and which I took daily for over ten years, caused my gums to swell which then resulted in gingivitis, moderate gum erosion and the loss of a tooth. I also feel angry that after that episode (which at the time I hadn't realised was due to a drug side effect) I was prescribed an ACE inhibitor, that had the nasty side effect of causing perennial rhinitis, that at the time I just thought was hay fever, or an allergy. Thankfully my old GP did pick up on that after a couple of years of me suffering from it, and changed me on to the ARB , to control my non-existent hypertension, and all they did was cause me to feel a bit fatigued. Overall I'm bloody angry at 30 years of mistreatment, with associated side effects, more than a bit of worry and stress about something it turns out I never suffered from, not to mention the cost to the NHS (and my wallet) from all those prescriptions that weren't needed. Do I trust my GP now? No, to be honest I no longer do. From now on I will question and independently check anything any doctor says to me.

Here's the Cochrane evidence for Fluoxetine (ProzacTM) :http://www.cochrane.org/CD004185/DEPRESSN_fluoxetine-compared-with-other-antidepressants-for-depression-in-adults?o=prozac For those that can't be bothered to read the link, these are the authors conclusions:

The scientist within me has proved this to be true, though, otherwise I wouldn't have written what I did. Take a look at the Cochrane evidence, or better still, volunteer to help - anyone can help in some way, not just those with a background in peer reviewing papers. It's an eye opener to see just how really bad the evidence is from the majority of medical trials and studies, frankly it's appalling in some cases, and should have more publicity. Last time I mentioned Cochrane to my GP, she agreed that it was the gold standard for evidence of treatment effectiveness, but shook her head and said that very few of her colleagues bothered to check the Cochrane evidence and often prescribed on the basis of papers they had read in journals or promotional material sent out by pharmaceutical companies, as long as it fell within NICE guidelines. Cochrane is a voluntary body that collects all the available evidence on any particular condition or treatment and independently reviews that evidence to check whether the conclusions drawn from it are valid or not. The shocking thing is that a great deal of them aren't.

If the UFH is considered to be the only form of heat energy input to the house (it won't be, by a variable amount depending on other incidental heat gains) then it needs to be able to provide the house total heat loss for any given temperature difference between outside and inside, which is on the spreadsheet. In practice, you can knock around 80 W per occupant off that heating requirement, plus a couple of hundred Watts or so for the incidental heat gain from appliance heat loss (essentially everything in the house that draws power, from phone chargers, through lights to the TV and PCs). There will be additional incidental heat gains from cooking, solar gain, showers, baths, hot water system standing losses etc, all of which will reduce the total heating requirement, so the total heat loss on the spreadsheet is very much a worst case figure.

Regarding charge time, it depends on the power output of the ASHP. Our 6 kW ASHP would charge a 12 kWh unit in two hours, perhaps slightly less under ideal conditions when the ASHP can exceed 6 kW output, slightly longer under less ideal conditions when the output can drop a bit below 6 kW.

They are a pain. I found fixing them to the wall was more stressful than wiring them, though (we have plaster uplighters in four rooms, plus the hall and landing). I found that leaving an excess length of 1mm² T&E hanging out of a 20mm hole in the wall, and backing board behind the plasterboard, worked OK, as the excess cable could just be pushed back inside the wall/service area when fitting the light. Ours just had terminals on the lamp socket, and that was pretty easy to remove from the light, making wiring a lot easier. The only awkward bit with the wiring was refitting the lamp socket into the light with the cable.

Medical science also has a great deal to do to clean up it's act and start working to a recognised scientific method. From just a few months of reviewing evidence from studies, I can state categorically that around 80%, perhaps more, of the evidence from medical trials and studies is flawed, and well over 50% of it is very deeply flawed, so much so that it's just wrong. Clinical decisions have been made on much of this flawed evidence, too, and that has added to our problems, rather than aid them. Another thing that has become clear from reviewing evidence is that almost all the deeply flawed evidence is produced by pharmaceutical company studies and trials. Even some work from apparently reputable sources has been found to be flawed, where that work has been sponsored by industry. The main issues seem to be reports of studies and trials that fail to include all the data; it seems very common for findings that don't support the objective of the sponsoring company to just be omitted from the reported evidence, and it's often not easy to find out details of those excluded findings. IMHO, this is a much more serious issue than the corruption within the VAG group over their doctoring emissions testing, yet it's one that receives relatively little publicity.

Take a look at the work being done by Cochrane (http://www.cochrane.org/ ). Much of it highlights just how dire a great deal of medical research is. One could be forgiven for thinking that medical researchers had never heard of the scientific method, their work is so appallingly bad. It's not just research either, a lot of the measurement methods used every day in medicine are really poor. Blood pressure is a really good example. The actual measurement equipment and the technique, be it auscultation or oscillometric, is reasonably good, and probably has a repeatability and accuracy of around +/- 5mmHg, but there are large errors introduced by the way the patients arm is held, the height of the cuff relative to the heart and whether the measurement is made on the dominant or non-dominant arm. These variations are enough to make the difference between someone being diagnosed with high blood pressure when it's really normal, or someone with high blood pressure not being diagnosed at all. Add in that around 20% or more of the population will appear to have elevated blood pressure when it's measured in a clinical environment ("white coat hypertension") and that the accurately measured effect of even the very best anti-hypertension drugs is similar to the normal measurement error in magnitude, and this whole area of health care starts to look very dodgy indeed.

Here the protection from falling part of the regs (Part K) requires a minimum height of 1100mm from the floor. The 900mm is the requirement for toughened glass on any glazing below that height from the floor. The applicable part relates to railings, barriers etc from first floor height or above, so should apply to a full opening. If you're intent on fitting custom bifolds, then I'm sure that there will be some form of restrictor that can be fitted, but I also think you'll need to raise the lower edge higher off the floor, perhaps with fixed glazing, or even an externally mounted glass barrier, like a Juliet balcony. Personally I'd avoid a bifold solution like the plague, just because of the long term seal issues that are almost guaranteed to occur.

I think you may run into a problem with the regs, if they are the same as here, as they require first floor windows to be fitted with a device to limit the opening, so a child can't just open the window fully and fall out. Usually these restrictors can be unlatched, but it's a two handed job, deliberately so, to make it difficult for a small child to do. For that reason I doubt that you could get a bifold system to work, plus bifold doors are notorious for losing airtightness after a year or two, as the sealing force on the folding joint is pretty hard to maintain. 2400mm is too wide for a single side opening casement, too, although you might be able to find someone who would make custom top hinged frames; I'm not all sure how wide you can go with top hinges, but it'd be little different to a glazed door fitted on it's side. Restrictors would still be needed, but they can be fitted easily enough to top hinged glazing. One challenge to overcome is how to insulate the corner pillar to prevent a thermal bridge and the associated condensation risk, which may be difficult if you want a slim look in the corner with the windows open. Finally, how high above the floor is the lower edge of the first floor opening? I can't recall off the top of my head what the regs say about the minimum height for the lower edge of a fully opening aperture, but have a feeling it's around 1100mm above floor level. If the windows are 1500mm high, then unless the room has higher than average ceilings, you may run into problems there, too. Worth checking the regs that apply in NI, though, as they may well be different to those that apply here, so some of the points above may not be correct.

I had a similar condition and spent the best part of a day driving around collecting samples. I then rang the planning officer who agreed that I could bring the samples to him to check. When I turned up at the council building with them I was refused entry, on the grounds that the small (around 18" long) lengths of cladding constituted a health and safety breach if carried inside the building... So, I went out the front door with the samples and called the planning officer, telling him I had the samples with me, but that I was being stopped from bringing them into the building. He said he wasn't able to come down to check them, but could I just send him photos. I explained that he already had photos in the D&A Statement I'd submitted with the application. He checked that whilst I was on the phone, then said that was fine, he'd sign off that pre-commencement condition. So, I'd driven around 100 miles or so, wasting a day of my time and the time of those who'd given me samples, simply because the planning officer hadn't bothered to look at the material photos I'd submitted with the application. Was I a bit cross? You could say that. I bet the mic on my car dash cam picked up a few choice words when I was driving back home.

I agree too, and was chatting with a retired nurse a few weeks ago (who specialised as a dietician) and she is of exactly the same view. There's a fair bit of evidence that our immune system needs to be challenged, especially as it's developing, in order to function well. There's a link here to gut flora too, as those with a more diverse range of bacteria in their gut tend to be healthier than those who have a gut that is closer to being a monoculture. There was an article on the BBC website a while ago (here: http://www.bbc.com/news/health-43728319 ) that covers this, and also touches on fermented foods.

Thanks @Brickie, I'm just an admirer of nice brickwork really, and was fascinated to discover that it was normal practice until relatively recently to make bricks on site. We still have one itinerant travelling brick maker left, this chap: http://www.ajmugridge.co.uk/ Worth reading the "history" section on his website.

Never a truer word said! I spent tens of hours trying to reverse engineer our ASHP, and to a lesser extent finding out how to fit a humidistat to the MVHR, because of a lack of information. I suspect that some of this is a form of protectionism, to try and restrict the level of publicly available knowledge so that installers can justify some of the very high prices that they seem to charge.

Yes, it's distilled water, so ideal for use for topping up batteries or use in a steam iron. You can just collect it in a container if you wish, but these things can generate several litres of condensate a day, so any container needs to have an overflow.

My guess is that proper Staffordshire blues weren't made until very high temperature firing was introduced, which would fit with that 1851 date. Almost all bricks, right up until the early part of the 20th century, were made by itinerant travelling brick makers close to where buildings were being constructed, using local clay and sand and firing them using open fires or crude temporary kilns. It wasn't until we had decent transport systems able to deliver heavy loads directly to building sites that it became really practical to centralise brick making in large factories. There was a "living history" display a couple of years ago, just down the road from us, where they had a practical demonstration of how itinerant brick makers worked, just digging out local materials, forming bricks by hand in wooden moulds, stacking them to dry and then firing them in what amounted to a large bonfire. There was a large variation in colour and hardness in any batch, so they used the bricks from near the centre of the fire for the outside walls and the softer ones from the outer side of the fire for inside walls. Staff blues need both a high temperature and an oxygen-free firing process, something that can only really be easily achieved in a closed kiln, so I'm pretty certain they can't be really ancient, despite their use on canal locks. I'm pretty sure that all the Staff blues seen today on canal locks are restoration work, rather than originals, just because they are a lot stronger than other bricks and not so subject to spalling or frost damage.

Not a recommendation really, although I have bought appliances from that supplier and found their service to be pretty good. It was just the first hit I had when doing a quick web search - there may be better value units around. Just three holes, or one larger hole. There are two refrigerant pipes, that are around 8mm to 10mm, but are insulated, plus a condensate drain pipe, that is often only around 12mm to 15mm, and usually pumped via a small peristaltic pump inside the indoor unit. The condensate drain can connect to a waste pipe in the house if that is easier.

No problems at all in running it in any room, the indoor unit just has three pipes, two for the refrigerant and one drain pipe for the condensate. Needs an F gas ticket holder for the install, but there are pre-gassed versions around that get around that. Anyway, pumping the unit out with a vacuum pump and gassing it up is a quick and easy job that can be done after all the installation work has been done, as these things are gassed up from the outdoor unit. Any refrigeration engineer can gas one up in under an hour, or you can break the rules and do it yourself. I gassed up a conservatory air con a few years ago, using a borrowed vacuum pump, bottle of refrigerant and UV dye leak test light. The process is pretty simple, just connect the vacuum pump and suck the system right down, then wait for half an hour or so to allow any moisture inside to come out as vapour, and to check for leaks using the vacuum gauge. Then just connect the refrigerant bottle up, put it on some scales to weigh it and fill the system with the right amount, ideally with some leak check dye as well. Then you just seal off the filling valve, run the unit up and check the pipe joints for leaks with the UV light.

If you have a house with a large central space, and that's reasonably well insulated, with only modest amounts of uncontrolled solar gain, I'm sure 3.5 kW of cooling would be pretty effective for the whole house. I thought about fitting one very high up in the very top of our entrance hall, which is right in the centre of the house and around 6m high, as I'm sure that would have provided more than enough cooling on even the hottest days, and I doubt it would use more than around 1 kW of our generated PV power.

All our openings were larger than a standard wide (33") door frame, so I just packed them all out. IIRC, I had to add an additional bit of stud at the top of every frame to get the height down.

Not really, as the MVHR air flow rate is a great deal lower than a typical air-to-air heat pump. Our Genvex MVHR does have a tiny air-to-air heat pump built in, but it will only provide around 1.5 kW of cooling, which isn't a lot if you've got any large, unshaded, glazed areas facing the sun. The limit on the Genvex is really imposed by the low air flow rate, as even a cheap split air-to-air unit like this: https://www.appliancesdirect.co.uk/p/tcl-12wminv/tcl-tcl12wminv will provide around 3.5 kW of cooling for less than £400.

One idea I had was to turn a boost timer on using a PIR switch. That way the MVHR would boost whenever someone went into the bathroom. Not ideal if you get up in the middle of the night to use the bathroom, but a time switch to disable boost at night would solve that problem.