China on my mind

I haven’t written for a long time.  There are multiple and complex reasons for this including family illnesses (too difficult and not appropriate to write about), my injuries (running and bicycle induced (too boring to write about)) and work issues (also inappropriate to write about).  My recent trip to China, however, has provoked my return.

In the last 12 months I have travelled a lot (too much if I am honest) and I fell into a trap, beautifully described by a wise friend of mine at the NIH, whereby everywhere you go you are looked after and you almost forgot where you are!  I agree with a lot of this, especially when at different London airports and one day I was not entirely sure which one I was sitting in, but once you get to your location the experience is usually brilliant.  I am often blown away by the beauty of my location (Strasburg (left) and Trondheim (right) for example)

and always by the great science I am seeing (such as at the EMBO Munich Inflammasome meeting, or the Cytokine meeting in Boston).

2019 arrived with fear and excitement gripping me with equal measure.  The fear is that I know we have to get our papers in as early as possible in 2019 (May is already getting a bit late), so that they are published by the end of this year or the beginning of 2020, in order that we can get our work funded next year. The excitement is that in Jan I realised that we have at least 3 really exciting pieces of work nearly finalised which are really interesting.  Getting them over the line to submission is taking longer than I had hoped and I am finding this decidedly stressful, as it is my job to deliver the papers to as good a journal as possible, so my lab get the credit for all their hard work.  The paper-funding cycle does not get any less stressful for me with increasing experience, unfortunately.

In the midst of this perfect storm of paper-funding fear comes a trip to China for the Cold Spring Harbour Asia conference in the beautiful Suzhou City, not far from Shanghai.

It’s been a while since I went to a conference with a bacterial pathogen focus, not least because my key collaborator and friend Duncan left Cambridge to head up Melbourne University in Australia.  CSHA is an excellent conference with wonderful science from China, Asia, Europe and the USA.  I learnt an enormous amount and it reminded me of the bacterial pathogen biology that I love and miss.   It’s time, therefore, to make new collaborations and get my pathogen research back on track.  I got excellent questions on my own talk which was very helpful.  My favourite presentation had to be the beautiful structural biology shown by my Chinese colleague Feng ,who is an outstanding researcher in host-pathogen biology, and a scientific rock star in China.

The best thing about the travelling, as always however, is making new friends or catching up with old ones including Si Ming (past PhD student and rising star, below middle), Jay, Liz, Bin, Anne and Jorg.  We had a little time to sight see, including visiting the beautiful Humble Ambassador’s Garden (one of the great Chinese gardens) and shopping in old Suzhou City with Si Ming and his lovely PhD students.  I didn’t pay full price for anything, because Si Ming haggled.  He has clearly learnt well from Pani the Greek postdoc in my lab, who won’t pay in full for anything on principle, which keeps our research costs in good health!  On my last day I visited Bin and his wife in Shanghai and gave a talk at the University.  His super PhD students took me to see the lights!!

 

It’s clear Chinese science is rocking and the distracting politics in the west, particularly in the UK, left me feeling we have to wake up before we get left too badly behind.   Next week I am off to San Diego and San Francisco (my second home), then Boston at the end of the month before I settle in for a summer of writing and cycling.  This year I am cycling to raise money for the hospice association so all donations welcome and very gratefully received: it’s a lot of miles and a lot of training for a great cause!!

https://www.justgiving.com/fundraising/ceb27

The long ride home….

I left Australia on Thursday for the exceptionally long flight home (30h in total).  I remain in awe of my Australian colleagues who make these mammoth trips to Europe or the USA at least once a year to attend science meetings (an essential part of our job when you are in science).  On the other hand Australia (certainly the parts I have visited so far) is magical, so it’s well worth the long trip even though the jet lag is horrible.

I went from Melbourne to a conference in Lorne, on the Great Coast Road, which is spectacularly beautiful.  Ash took me in his car to Lorne so I spent the whole time either laughing, talking science or both!  His story about being a victim of road rage, and the driver coming at him with a chain saw could only happen to Ash!   The views from my hotel room, especially at sunrise, were magnificent and the noise from the cockatoos incredible.

On a free afternoon Jac kindly took me to the Kennett River, on the Great Ocean Road, to try and see my second marsupial species: the koala.  Koalas are herbivores who live on a specific type of eucalyptus tree and they sleep about 20h a day.  We saw loads of them and, luckily for me, lots were moving including one who was jumping between branches.  They are beautiful creatures, much bigger than I realized with enormous claws!  We also saw King Parrots, Kookaburras and other spectacular birds in vivid colors.  The bird noise is phenomenal and completely different to anywhere I have ever been.  The musical magpies need to be heard to be believed.

By the time I left Lorne I had given 3 talks as part of my Australasian Society of Immunology traveling lectureship, and had 2 more to go.  I spent the weekend in beautiful Apollo Bay with Paul, Bernie and Paul’s sister Jude whose incredible cooking was fabulous.  We went to the Apollo Bay seafood festival which was particularly good and I reached the point of never wanting to eat again!  In Jude’s garden there were two visiting koalas, which was just magical for me.  There is an element of sadness, though, to this as it illustrated some of the plight of the wildlife. Four of the eucalypt trees, that were the koalas home, had been chopped down so they were looking for a new home and food, as were some of the bird life too.  Just as the change in environmental policies proposed by Trump threaten the marine life on the west coast of the states, and the poachers threaten the African wild life, the koalas of Apollo Bay show how very small environmental changes can cause major upheavals to the wild life.  My travels over the last 5 years have reconnected me with wild animals at home and abroad, especially the problems they encounter in the current world order.  So much of it is under threat, despite the fantastic conservation work happening everywhere.

From Apollo Bay I travelled to carry on the lecture tour in Canberra (catching up with Si Ming) and Brisbane (catching up with the two Kates, David and Matt).  The hospitality of everyone was fabulous, I got brilliant input from all my colleagues into our science and I finished my tour really scientifically reinvigorated (especially when combined with my US trip).  It was time to get back to the lab! My cunning plan, however, of timing my arrival back for the UK spring failed miserably as the arctic winter descended and the snow fell.  California and Australia are now just a distant dream, but what a fantastic trip it was both scientifically and socially.  I love my job: being a geek definitely has its compensations!

Good bye SF hello Melbourne

Its been a very full on few days.  I finished up at Genentech having learnt a massive amount in a short time.  I always gain so much from my research trips away and this time was no exception.  We have hopefully solved a few technical issues, have accelerated projects in the lab and I have been reminded again of how much work we must do if we want to remain competitive in an international scientific environment.  Having arrived in Australia this message has just been re-inforced after giving the first of 5 talks (in 10 days) on my Australia Society of Immunology travelling lectureship.  Its so interesting giving talks and meeting people in different labs.  With things moving so fast both technically and scientifically around the world its a sobering reminder of how much work I will need to do just to try and keep up.  My colleagues are truly amazing in SF and Australia and the feedback I am getting on our work is fantastically helpful.

Mike and I did have a few days holiday last week in CA, based mostly around SF.  We caught up with friends, visited Mendocino (saw lots of whales), tasted wine in the Andersen Valley and walked around the city taking in the magnificent views: it really is quite a place and more than lives up to the tourist ads!

I left for Melbourne, Australia on Fri (I am not a fan of long flights so it was not a lot of fun), but on arrival I was met by my great friends Paul and Bernie.  I stayed with them in their lovely home and was treated to a day of wine tasting (I am now totally confused of course as 5 days before I was in Anderson Valley and the vines were in winter mode, in the Yarra valley the grapes are nearly ready for harvest) and wild life watching (magpies (which make a wonderful noise), kookaburra, cockatoo and my first marsupial).

My first talk is done, I have 4 more to go and as I log into Facebook I find my friends Duncan and Sarah are here so we go out to dinner tonight: it is indeed a very small world!

The final week looms

I can’t believe it I have been here 3 weeks already and my last week in Genentech is approaching.  I have had an excellent week at work here with a new collaboration made, a catch up on work with a colleague in San Diego and the realization that a reorientation on one project will be needed.  The scientific technology here, and hence the advances that are being made, are breath taking and I am so grateful that I have this collaboration.  This also, though, goes for my other industrial collaborations with GSK and AZ.  I am very lucky that Cambridge University have totally embraced industry partnerships and facilitate in any way they can our collaborative work.  The opportunities are incredible and I have learnt so much.  It is also (hopefully) a two way process and I hope very much I bring something in return to the collaboration.  Anything that can accelerate new drug treatments for human and animal diseases has got to be a good thing.

I have not cycled much this week with colleagues either being away or sick (colds/flu), but I have run a lot.  I had forgotten how nice it was to run along the bay and the sunrises have been spectacular.   On my Thursday run the noise over my headphones was drowned out by what I realized was frogs!  I think they are Chorus frogs (according to Vanessa)

San Francisco’s Chorus Frogs Nearly Disappeared. People Helped Them Return. Then The Frogs Got Noisy.

They are certainly noisy and I had to smile.  By the time I returned the sun was fully up and the frogs were quiet.  We have had quite a bit of rain by SF standards so I guess this is keeping them happy.  So I have enjoyed another Jan in SF apart from the odd day of rain that was worse than a British rain storm (5 mins on the bike and I was drenched despite my rain wear)!  Time for lunch in the back yard then off for a hike: whats not to like?

Next stop is Australia to see my great friends and collaborators there.  I have an Australian Society for Immunology Lectureship so thats 6 lectures in 10 days (gulp) in Melbourne, Lorne, Brisbane and Canberra.  I am very much looking forward to seeing everyone.  Kate, Matt and Ash were so kind to me last time I was “down under” and this time I am catching up with other great friends including Paul, Andreas, Si Ming and Ranja.  I think one of the best things about being an academic is having great friends all around the world along with the fact you get to travel to wonderful places.  I am not sure whether this is true in any career other than an academic one because it is so dependent upon collaboration (so travel is absolutely critical for my job), but its such a privilege.

 

A very worthy holiday

Last Monday was a holiday in the USA in memory of the great Martin Luther King.  This came in the same week as America has gone into shut down as the budget cannot be agreed by the senate.  This is not the first time the government has gone into shut down but it usually happens when the president is from one party and the senate has a majority of members in the other party.  Currently the president and the senate are from the same party (Republicans) so this situation is somewhat unusual!  To say the current political situation is perplexing would be an understatement.

In California, however, because the state is so rich it does not actually need to take a lot of notice of government politics.  Much of how the USA works is run at the state, rather than national, level so San Francisco and the vibrant Californian economy carries on regardless.  Monday for myself was spent on the bicycle cycling up two climbs I did very early on in my first trip, Old La Honda and Tunitas which have 3 and 8 miles of climbs respectively.  This time Eddy and I climbed both with a considerable effort on my part, but with a great sense of achievement.  I has forgotten about the magic of Redwood trees and the amazing smell of the Eucalyptus trees (which are obviously not native and are a source of controversy here https://www.theatlantic.com/science/archive/2016/11/the-great-eucalyptus-debate/509069/).  The weather at the moment is glorious and as I sat in the sun refueling I did spare a thought for the climate back home!!!

Scientifically I have had a great week.  A couple of things I didnt finish the last time I was here are being done now (by me and I am so out of practice in the lab its embarrassing), new projects are under way and I am getting a fresh perspective on some of our on going work.  A change of environment and travel always helps me to clarify my thoughts as well as reinvigorate my scientific excitement even if it is hard to uproot myself from everyone at home to do this.

This weekend Cedar took me to see a 2000 year Redwood tree which is not far from Tunitas I realised as we drove up Kings Mountain which I recognised from having descended and climbed on Eddy at various times.  On driving it I did start to wonder how I had managed to cycle this road.  The tree was absolutely enormous!  I never thought of myself as a tree hugger, but sometimes these things are necessary.

 

Return to San Francisco: the city is playing with my mind

I am back!  Its been a bit like entering a time warp as I am staying in the same apartment, going to the same local coffee shop in Noe and cycling in from the same coffee shop on Valencia with the Genentech crew.  Of course there have been some changes: the building work around my apartment has progressed and people have come and gone from the cycling crew, but Folsome hill on Bernal Heights still remains as brutal as ever!  In the immortal words of Chris Froome “no one likes cycling up 20% hills”  and that definitely includes me!

I am back in the same lab again with most of the same people and it is really good to be there especially seeing how the collaborative work has progressed (very well) and setting up new collaborative studies.  I am excited about the research prospects ahead and its a valuable opportunity to talk over what we are doing in Cambridge with my expert colleagues here (its always good to find out whether what you have been really excited about is actually interesting rather than just a figment of my fevered scientific imagination).  It is also fabulous to catch up with the really good friends I made when I was last here (Eddy’s rebuild at Veloro with James and Geb; lunch with Vanessa and Shirley; all at Genentech) and also to see friends (Susan, Andy, Hilary and Cedar) from much further back who have relocated to California.

Are things much changed?  Politically, of course, there has been major change.  SF is relatively protected against this being an incredibly rich and powerful state.  The city remains bewitching and beautiful to me so my love affair with it continues.  Despite all this there are still things that shock me especially sick people lying in the street amidst the astonishing wealth I am surrounded by.  It reminds me how lucky the UK is to have the NHS.  Much remains unchanged here and the feeling of being in a time warp is unmistakable (and very nice!).  Having said that one of my colleagues here did say to me “Time warp in SF?  It can’t compare to the time warp of being in Cambridge” which is totally fair.

The major thing I had forgotten about was the flowers blooming in winter (noticed during a beautiful, warm sunny weekend in January (sorry UK folks I couldn’t resist saying this)) and this is really how the city plays with my mind.  We have magnolia,

irises, roses, jasmine, lilies and agapanthus all out at the same time before the daffodils.   I am surrounded by summer scent in winter!   So is it good to be back: yes, definitely, both professionally and personally, but it was very hard to leave home this time, much tougher than any time I have travelled like this before.

 

A Thriller in Manilla (and other stories)

I have been remiss and not written for too long.  There is, however, a reason for this.  I have been applying for a visa to go back to San Francisco for January (returning to Genentech to follow up on some exciting research) and the immigration officers are now advised to read people’s social media sites.  As a consequence I have kept my head down and not written anything!  I have my visa and will now escape the UK winter (January in San Francisco; a lot of February in Australia giving talks) so, with luck, by the time I am back at the end of February I will have jump-started my cycling training (Eddy is on his way back to SF) and seen the sun.  I am so much looking forward to returning to SF and seeing all my really good friends.  I am even returning to the same apartment (home from home on Douglass St).

I have missed everyone immensely and the city has got under my skin.  A particular treat, though, will be that since being in SF I have had my cataract done and I now realize how much my vision was affected so I can’t wait to see the scenery and wild-life through genuinely fresh eyes.

What have I been doing with my time since June?  Work, travel, work, travel, work, travel: there appears to be a pattern here!  Work first then.  Our research is going well with a flood of exciting results from everyone working in my research group.  We are all beginning to process these results into cohesive blocks of work to form the basis of several papers (we need a big year of papers in 2018).  Publication has been a trial for me this year and I have been fighting to get an important paper into press.  Writing papers is not something I find easy, but I am working hard to improve my written skills.  The challenge for me with writing papers is primarily because of my obsessively through nature trying to make sure we get everything right such that we don’t make any mistakes and our research will be repeatable.  The majority of our work seems to be answering difficult questions often requiring development of new techniques which means the research can move more slowly than I would like.

I seem to have travelled a lot this year, but perhaps not as much as last year.  I have had a lot of fun catching up with friends in the UK including visiting beautiful Jersey (staying with Budds and David)

I had my first trip to Dartmouth (for my godfather’s 80th birthday): a very beautiful and ancient port which makes it a very interesting place (even when visited with a touch of a hangover because the party was fun!)

Time off was also spent in Southwold (Suffolk), Cromer (Norfolk), Oxford, Rome and Boston, whereas work trips included Dublin, Manchester, Philadelphia (twice), Boston (work as well as fun), Dresden and Manilla.  The trip to Manilla (which came just before one of the Philadelphia trips) was for a scientific review.  I learnt some new travel lessons.  I did not feel safe in Manilla because of problems with my airport pick up and the massive amount of security at the hotel all of which left me feeling nervous.  I am not a brave solo traveller (given I travel a lot on my own I feel its important to realize my limitations).  I now know that if I don’t feel safe I don’t want to be somewhere so that will be upper most in my mind in the future when I agree to travel for work.  Of course no where is ever safe, but there are ways of mitigating risk.  It was a shame I felt unsafe in Manilla because I met wonderful people who were kind and so generous.  They were sad about my airport experience and, one day if the political system is more clement, I would like to go back and see the sights my new friends showed me on their phones: the Philippines is clearly a spectacularly beautiful country which is much threatened by global warming (approximately 900 islands at low tide, 700 at high tide)

There was also a spot of building work at home (which took an age, but the end result of an extension with a new kitchen was worth the wait) and a new car (which some idiot drove into the back of by driving too close to me such that when I stopped at a roundabout he couldn’t stop).

Christmas has now arrived already.  I have finished work for 2017 (well traveling to work rather than the process of work) and I am once more packing my bags (along with Eddy) for another voyage.  I am frantically trying to get bike fit (a lot of sessions on the turbo trainer with Zwift will happen over my Christmas break) as the fear of Fulsome is already looming large on my horizon.  The Christmas tree is up and Speed has taken to a new mode of being “cat hunter gatherer” by taking decorations off the tree and delivering them to everyone as presents!

 

 

 

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Eddy goes to Majorca

So much has happened since the last blog, but taking Eddy to Majorca has prompted an update!  I have been cycling like crazy for months because I had a 4 day trip to Majorca with my buddies from Respiratory Medicine in Addenbrookes Hospital.  The cycling trip, organised by the ever patient Jurgen, has been an annual adventure for us for the last 4 years (year 1 London to Paris, year 2 The Loire Valley and last year around the Dordogne).  We are usually a mixed ability group (this year was no exception), but in 2017 the self-imposed ban on climbing was lifted and we were to tackle some pretty serious climbs in the hills of Majorca.  Now had this been last year, after the San Francisco hills, I would have been well trained.  Finding sufficient hills around Essex, however, has been more of a challenge!  I have spent every weekend trying to find as many hills to cycle as possible.  As it turns out all was well, the hills didn’t kill me (my obsessive training helped as my hill speed is faster), no one was injured and everyone enjoyed themselves.

I had a close encounter with a goat (no captions please): suffice to say it shouldn’t happen to a vet but it usually does and at least she only got my banana skin.  She ate everyones food so no wonder she was in such good health.

One of our team (Tim) races and did the iconic Sa Calobra in 31 mins (in my dreams!).  A good trip was had by all and my California cycling arm and leg tan lines are back!

I was at a conference in Dublin the week before and in my time away much has happened.  We had two horrible terrorist attacks.  We also had an incredible general election campaign where the young finally turned out to vote due to a remarkable Labour Party campaign. Theresa May’s dream of an enhanced majority was lost and now we have a hung parliament. Interesting times ahead…..

Hard science, soft science or no science at all……

I have been meaning to write for a while, and I don’t know where the time goes, then just as I sit down to do so Theresa May announces an election, and the world gets even madder than it is already.   As the election campaign gets underway I can only feel depressed: the conservative policies are frankly frightening: a hard Brexit will be a killer for British science unless something radical happens to improve the funding system.  Labour is still imploding, and the current leadership policies whilst idealistically laudable are unlikely to attract enough support to stop a conservative landslide.  I am reminded of the horrors of the last time Labour tried this with Michael Foot…….

What I was going to talk about was science: the good, the bad and the ugly.  I have been to a conference in Banff in Canada, came back and had gastric flu, recovered then spent a lot of time training for my up and coming Mallorca cycle trip.  I am trying to improve my climbing speed, although I have cheated a little by buying new wheels for Eddy; which are fabulous!  The issue that prompted me to write came up during a BA flight.  I was bored reading the BA business magazine (for once I got an upgrade to business to Canada, so I guess all those airmiles last year and reaching BA silver does occasionally pay off) and I nearly choaked reading about a Silcon Valley tech company called Vinome.  Last year I learn’t a lot about the excellence, but also the pitfalls of Silicon Valley companies.  It’s full of remarkable, and brilliant, people generating a bewildering array of ideas and I have a huge respect for many of them.  Some are less remarkable though and Vinome is one of them.

To put this is context I have just been to a Keystone meeting (in Banff).  This is one of the the best conference programs in biological sciences and attracts top speakers from around the world.  It lived up to my expectations with some inspiring work being shown, and I returned fizzing with ideas.  On our one afternoon off we had a lot of fun in the beautiful Banff country side with the huskies and a sledge!  I am reminded that this is the one winter sport, as a vet, I am seriously cut out for!!  I was not able to learn to ski as a child so that passed me by (although I have had a go a couple of times and I totally get it, but I am too scared of getting injured and not being able to run/cycle on my return)!

Compare and contrast then with Vinome.  This is the company that leads with this headline “What if boutique bottles, perfectly matched to you, could be delivered right to your doorstep?  Life Uncorked: Vinome brings you the ultimate personalized wine experience! Harnessing the science of taste, we analyze your DNA to match you to wines you will love, then deliver them right to your doorstep ($65 per bottle); Vino + Genome = Vinome“.   This irritated me on several counts.  Firstly the genetics of taste are poorly understood.  There is a link between a gene and liking red or white wine, but that’s about it, and the studies have relative small numbers of people (4000).  Vinome analysed the genome of 500 wine lovers and performed a survey on their tastes then “bingo”: they have cracked how to work out what wines people like.  Really?!??!??!?!?!  We barely understand how genetics impact on disease so this claim is, at best, unlikely!  Needless to say it is not just me who is skeptical, but  apparently “I hear the skepticism,” Vinome CEO Ronnie Andrews said, “but those people just aren’t wine fans.”  So for those of you who don’t know one of my part time jobs is to help manage a very big wine cellar, but clearly I cannot be a wine fan!  Finally their plan takes all the fun out of wine: the trial and error of tasting, seeing how it matches with food and how it changes with the environment in which you find yourself.  This appears to be poor science (nothing has been published in peer review journals so its hard to argue otherwise with no evidence) which in the current political climate is not something any of us need.  My advice: save your money on signing up and use it to buy some wonderful bottles of wine!

 

Time with the NHS

This week I have, hopefully, reached the end of relatively long eye saga which gives me the perfect opportunity to sing the praises of the NHS, which is currently under massive financial pressure after repeated brutal attacks from the politicians (predominantly the Conservatives).  In 1948 Bevan helped the Attlee Labour government established a free health service (the National Health Service (NHS)) for the people of Britain.  This is paid for by the UK tax system, but what it means is that if you are ill you get treated properly for free.  Almost from the outset different governments have introduced charges for various aspects of the NHS treatment but, when the chips are down, you get treated.  I have, unfortunately, had various health problems during my life and each time I have been put back together by the NHS.  My latest saga started with a serious retinal tear in Oct 2015, followed by a successful repair and a vitrectomy.  This week I had a cataract repair (which is an expected consequence of the vitrectomy).   These images sum up what it was like for me in my right eye pre surgery (image on the right (to be honest it was much worse)) and how it is now (on the left), the lower images show why!

If I am honest I was terrified prior to surgery: compared to the retinal surgery this was much simpler, but it could still go wrong, I had to have another anaesthetic (the last one was horrible), there is the fear of the pain (hideous last time) and what if I couldn’t see afterwards?  All this was rushing around my brain, particularly the potential risk of blindness in my eye (which is a potential risk) and these fears were what I went through last time after retinal surgery.  On the other hand I might be able to see normally with my new lens for the first time since I was 10.  Pre surgery the arrow drawn by the surgeon marked the spot.  My buddy Edwin passed me in the hospital and insisted on this photo, and its presence either on Facebook or the blog!!!

The cataract surgery is so far fantastic and, so long as there are no complications, it is nothing short of remarkable.  It is, for me, life transforming and I now want to rush back to California and look at everything again (any excuse of course!!!!).

All of this treatment has been free, with a couple of general anaesthetics, two rounds of surgery with one of the top surgeons in the world and multiple appointments with phenomenally caring staff.  You have to wait a bit, but I have no complaints.  What I see in the NHS, though, are staff who are very thinly stretched yet somehow manage to be kind, caring, skilled and compassionate.  My care has been fantastic despite people having to work under very difficult conditions.

The NHS is chronically underfunded and the biggest recent problems were due to Andrew Lansley and his reforms under Cameron’s government followed by continual under investment by the conservatives.  The Andrew Lansley Rap beautifully sums this up (https://youtu.be/Dl1jPqqTdNo (this is not for those who are offended by swearing)).   I have been stunned by how much more difficult things have become for the NHS in the 9 months I was in the USA.  We have to put in more money and presumably we will have to have some sort of insurance system similar to France or Holland as the Conservatives refuse to contemplate tax increases.  I do often argue with some of my very dear friends who do not understand why I am a socialist (be it champagne or otherwise), but I just don’t understand what is wrong with paying taxes to have a caring compassionate state where health care is free and we have outstanding medical clinicians wanting to work in the NHS.  We are already loosing brilliant clinicians, who have left to work elsewhere in the world: is this really what we want to happen?  This is why I am a socialist and why I am so sad at the current state of our Labour Party.  No one is opposing the Conservatives which can only mean even more problems for the NHS.  Irrespective of your political leanings its important to have a strong opposition to keep the government on its toes. Do we really want a private health system where only the rich get treated and the poor are left to die?  This used to be the reality for the poor and, pre-Obama care, this is how it was for some people in the USA.  Is it really more important to have an extra pound in your pocket (particularly if you have lots of money already), than to pay a bit of extra tax to ensure free health for all?