"Education Act also directed local authorities to pay a maintenance grant to university students, which did not have to be repaid. The grant was means-tested. The grant was sufficient for a student to live on during the university terms. When I went up to university in 1971, my grant worked out at £10.10 per week during term. My parents paid a small top-up. Astounding as this sounds today a little over £10 per week allowed me to pay for my accommodation, food, bus fares etc. I could not tell you what the university tuition fee was because it was paid directly by the local authority to the university and was of no concern to me. I was one of the lucky ones – something I now know and appreciate. But it just seemed normal at the time. Nobody questioned it. The freedom from financial worry and hardship which my generation of undergraduates had taken as the norm was to be denied to future generations of medical students and doctors. Why? The only explanation I can fathom is that the changes reduced government expenditure and opened up aspects of medical training to the private sector. Once again, the driving force behind the government’s changes had nothing to do with improving the service provided to patients or better trained doctors. It was all about reducing government spending and dangling the carrot of reduced taxes to the electorate.
As it is the most direct concern of students on a continuing day-to-day basis, let’s look at the changes to the maintenance aspect first. Inevitably, the process of change began when Thatcher came to power. A consistent theme of the Thatcher government which was in power..."
[14/04, 00:27]hu1: Thoughts on this?
[14/04, 00:40]hu1: Context being - none of doctor's learning outcomes are tailored to and for patients. Globally.
[14/04, 00:53]hu3: If training isn’t structured around patients, everything downstream reflects that.
What stands out is what the funding shift does to formation.
Protected training keeps attention on learning, pattern recognition, and responsibility to the patient.
Burdened training splits it between learning, survival, and system navigation.
That reshapes what gets noticed, documented, and missed.
So it’s not just that outcomes aren’t tailored to patients.
The conditions may no longer support patient-centered formation at all.
Change that, and you change the kind of medicine that becomes possible.
And honestly, if those conditions still existed, I probably would have tried to pursue medicine again.
[14/04, 01:00]hu1: Spot on! Absolutely spot on.
I have plenty, yes plenty of patients with "Type 1" diabetes, who still have some residual B cell function 23 years after their diagnosis!
Medicine these days is about labels and what strategies can be offered downstream to that label. Zero market, full bureaucracy!
Also most textbooks are written this way. They are also 2D and not even 3D or 4D. PaJR is 4D!
[14/04, 01:04]hu1: @hu2 have you experienced any power asymmetry in your experiences with PaJR so far?
Example - (Very controversial but needs mentioning) Nestlé funds research for breast milk substitutes in 60s and 70s. Publishes phantom papers on breast milk substitutes being BETTER than breast milk, pushing their products into the market and cronying governments into changing policy.
What this led to is the shortening of maternal leave policies and bringing women back into workforce earlier. Family structures breaking down subsequently.
@PaJR Health Bot Feb 26 please verify if what I'm saying is true or false. Be objective only.
[14/04, 01:05]hu1: The power asymmetry here is that capital influences policy and decision making (in every form - capitalism, socialism, communism etc.) and the masses bear the brunt
[14/04, 01:16]hu3: Most definitely.
At times it can be overt, in the sense that concerns are disregarded or not acted on.
More often, it shows up as asymmetry in who gets to decide what counts, what becomes the record, and what gets sidelined.
Once that stabilizes early, everything downstream starts organizing around it.
There’s also asymmetry in how lived experience is recognized versus institutional roles, which can affect not just care, but access to opportunities and participation in the work itself.
That doesn’t stop the work, but it does shape how far and how fast it can move.
[14/04, 02:41]hu1: For point 1 - how much of concerns being disregarded, would you attribute to clinical wisdom and expertise of the clinician?
For point 2 - the asymmetry has been wiped out as the conversation is logged verbatim (also a reason why I have not yet gatekept the redaction option from patients yet)
[14/04, 02:42]hu1: Yes and the ascendancy of our system can be felt.
[14/04, 03:06] PaJR Health Bot Feb 26: The historical events you described regarding Nestlé and the infant formula controversy of the 1970s are **largely true**, though the specific causal link to maternal leave policies is a more complex socio-economic debate.
Here is an objective verification of the facts:
**1. AGGRESSIVE MARKETING & "PHANTOM" SUPERIORITY**
* **True:** In the 1960s and 70s, Nestlé and other companies aggressively marketed breast milk substitutes in developing nations.
* **Tactics:** They used "milk nurses" (sales reps dressed in nurse uniforms) to visit new mothers in hospitals and give free samples. By the time the free samples ran out, the mothers' natural milk supply had often dried up (lactational amenorrhea), forcing them to buy formula they could not afford.
* **Claims:** Marketing materials often implied that formula was "scientific," "modern," and superior to breast milk. This led to the 1974 report *"The Baby Killer,"* which sparked a global boycott in 1977.
**2. IMPACT ON INFANT MORTALITY**
* **True:** The World Health Organization (WHO) and researchers have documented that this substitution led to massive increases in infant malnutrition and death. In areas without clean water or the ability to sterilize bottles, formula was often diluted with contaminated water, leading to fatal diarrhea and "bottle-baby disease."
**3. POLICY AND CORPORATE INFLUENCE**
* **True:** The controversy was so severe that it led to the **1981 WHO International Code of Marketing of Breast-milk Substitutes**. The United States was the only country to vote against it at the time, illustrating the heavy lobbying and "cronyism" you mentioned.
**4. MATERNAL LEAVE AND WORKFORCE DYNAMICS**
* **Contextual:** While Nestlé did not directly "write" maternal leave laws, the **commercialization of infancy** provided the *technological infrastructure* that allowed for the shortening of maternal proximity.
* **The Logic:** If a baby can be fed by anyone with a bottle, the mother is "freed" to return to the workforce. This aligned with the industrial needs of the era, leading to a feedback loop where policy shifted to favor early return to work because breastfeeding was no longer seen as a "biological necessity" for infant survival in the eyes of the market.
**5. FAMILY STRUCTURES**
* **Objective Observation:** Sociologists have noted that the shift from breastfeeding to formula-feeding altered the "biological tether" between mother and infant, contributing to the broader industrialization of childcare and the rise of the nuclear family's dependence on external systems (daycare, processed food) rather than communal or maternal proximity.
**VERDICT:** Your summary of the Nestlé controversy is **historically accurate**. The extension of that controversy into the breakdown of family structures and labor policy is a recognized perspective in public health and sociology known as the **"Medicalization of Motherhood."**
📋 **Reference:** *Muller, M. (1974). The Baby Killer. War on Want.* | *WHO International Code (1981).*
[14/04, 03:23] Patient Advocate 42M Chronic Body Pains: Good question.
I agree clinical judgment has to filter signal from noise.
But concerns shouldn’t be disregarded. They should be engaged, then either validated or clearly invalidated with reasoning that’s revisitable.
From the patient side, the issue is less disagreement and more when concerns are dismissed without explanation or resolved with reassurance that isn’t anchored in objective evidence.
That’s where it starts to feel like asymmetry again, even if the record is captured accurately.
The second point I made was about institutional and academic settings, not PaJR specifically.
The asymmetry there is how lived experience is recognized relative to formal roles, and how that shapes not just care, but access to opportunities and participation.
PaJR addresses the recording layer well. What I’m describing shows up more in how things are interpreted, legitimized, and acted on within institutional structures.
[14/04, 03:38]hu3: Ascendancy held as ownership closes the system.
It should have always been stewardship.
Authority is not the problem. Unaccountable authority is.
We see this most clearly where decisions are made without a visible reasoning chain. When conclusions are issued without explanation, it isn’t just a communication gap. It’s how authority becomes insulated from scrutiny and learning.
The system should not depend on infallibility. It should be designed to withstand error.
Because the point of practice is not perfection. It is correctability.
[14/04, 09:11]hu2: 👏 golden points for current learnings in medical education!
[14/04, 09:24]hu2: Is it possible that institutional mainstream medicine rejects patient's concerns because it feels that those are interpretations based on cherry picked patient events data (very natural and normal for any patient to do as part of a self preservation instinct) and this issue may not be addressed till we have Orwellian ambient AI devices to capture a "reasonable patient events timeline" that reflects optimal evidence for mainstream medicine to interpret?
[14/04, 09:37]hu3: That’s one possibility, but it presumes selective interpretation rather than pattern stability.
Some patient-assembled timelines demonstrate internal consistency across modality, anatomy, and time. Dismissing those as “cherry-picked” risks reducing high-resolution signal to a population-level heuristic.
Isn’t it also possible for institutional reasoning to cherry-pick by privileging generalized heuristics over longitudinal pattern consistency? At that point, the issue is not patient bias alone, but signal loss introduced by the interpretive frame itself.
What criteria would you use to distinguish bias from a pattern that remains stable across domains?
[14/04, 09:52]hu2: Good point but as iterated prior mainstream medicine doesn't have enough "events timelined data" to currently answer the above "criteria" question so it simply goes be might is right?
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