James Le Fanu 31 January 2023 12:48pm GMT Pointless bureaucracy is weighing heavily on the NHS, as covered in this newspaper. This is not just bad for staff morale but, as neurologist Peter

Nestor observes, can result in a recognisable psychological syndrome. Its cause lies in the ever increasing range of obligatory tasks required - mandatory online and in-person training,

form-filling, appraisals, setting of "key performance indicators" etc - leading to a feeling of not being trusted to do one's job or at risk of some kind of punitive action.

Those afflicted by the syndrome become overwhelmed with feelings of helplessness and frustration at which point, as with other forms of extreme psychological stress, the brain's ability

employees," Nestor writes in the journal _Brain_. He suspects the response to its identification will be some additional mandatory online training modules on mental health. "A

better approach would be to dismantle this bureaucratic system - which simply did not exist 25 years ago - that gives rise to it." A BITTER PILL A constant topic of conversation in

communities of older people is "that dreadful tablet", a medicine that many people need, and many absolutely loathe taking. These are the bone-strengthening class of drugs, the

bisphosphonates, for the prevention of fractures. A while ago the late _Telegraph_ journalist Cherrill Hicks wrote of how she had come to dread the ritual of taking her weekly osteoporosis

pill - which was necessary in order to avoid its tendency to cause severe pain and inflammation on passing down the oesophagus. This entails swallowing the tablet, of alendronic acid, with a

large glass of tap water on an empty stomach first thing in the morning, then standing fully upright and not eating or drinking for at least 30 minutes. "It may sound feeble," she

wrote, "but I remain ambivalent, every week wondering whether or not to take my tablet" - and others feel the same way. The alternative is an annual infusion directly into a vein

of a different form of the drug, Zoledronate. This too, however, has its drawbacks as it is more expensive and requires a visit to hospital. Still it is perhaps no surprise to learn that

when, in a recent study, patients on one of these drugs were asked about their experience, the Zoledronate proved to be considerably "more acceptable". Or as one woman who had

switched to Zoledronate put it: "I am so pleased I don't still have to take those wretched tablets!" WASP THERAPY Finally, reports of sudden unexpected cures are always a bit

suspect - but consider the following. Ami Schattner, professor of medicine at the Hebrew University in Jerusalem, describes how a patient with raised blood pressure told him that she had

been much distressed by the unsightly silvery plaques of psoriasis covering two thirds of her body. Then, five years previously, within a couple of days of being badly stung by a hornet, the

plaques started to regress before clearing completely - never to return. There is no way of telling which of the complex chemicals in insect venom might account for this effect, but Prof

Schattner suggests it is worth investigating further, given the precedents where chance observations have led to major therapeutic breakthroughs. Meanwhile, it would be interesting to hear

from anyone who might similarly have benefitted from an insect sting in this, or other, ways. _E-mail queries and comments confidentially to [email protected]_