Dr Phil Hammond, broadcaster and GP returner in Bristol

After dinner speaking is a bit like doctoring. You're never quite sure who's going to turn up next. My last three gigs have been funeral directors, biotechnology entrepreneurs, and insurance brokers.

The undertakers were the most riotous. Largely composed of family firms, they told great stories. Apparently, one couple, keen clay pigeon shooters, died together and chose to have their ashes put into a clay and cartridge, and then fired at each other.

Another family insisted on doing all the pallbearing without any expert guidance. Three pallbearers faced in the wrong direction and one caught his jacket in the door of the hearse, causing the coffin to be juggled like a hot potato.

They had their gripes too. Corpses are often so obese that it's easier to get a piano down the stairs. And the organ retention scandal has meant they have to scrape up every last scrap of tissue, even if the deceased has been putrefying in the living room for a month.

The biotechnology pioneers were equally reductionist and very inventive. It's always a pleasure to meet proper scientists, but they rarely get the chance to see their inventions through.

Small biotech firms take big risks, often putting their own money and family home on the line to start up, but if any new drug shows promise, big pharmaceutical companies step in to buy them out.

They remained optimistic until I showed them examples of the adverts drug companies use to market their drugs. You spend your life pioneering a new cancer drug that stands up to rigorous scrutiny for it to appear in the medical press as a leprechaun riding a unicorn under a golden fountain.

Insurance brokers, like doctors, live their lives predicting risk and then take the consequences when it goes pear-shaped.

There were brokers who insured against terrorism and natural disasters, and their approach was refreshingly frank: 'You need a few bombs and the odd cyclone to remind people why they need insurance. When nothing happens for a while, people get complacent and don't renew their premiums; but if there are too many payouts, the underwriters get upset. And there are some religions who just won't insure because everything is God's will, so there's no point.'

I sat next to a broker who dealt in health insurance, but he didn't think the NHS would ever switch to such a system: 'I was in America recently and no-one could explain the health system there. The idea is that patients are informed consumers who shop around for the best insurance deal, but the system is so complex that it's almost impossible to decide what's best for you.'

So 40 million Americans opt out of health insurance not just because they can't afford it, but because they can't understand it.

He also met Alan Greenspan, who was Chair of the Board of Governors of the Federal Reserve and is now on secondment to Her Majesty's Treasury. So what did he see as the biggest threat to the US economy? Homeland terror? Wars abroad? Unemployment? Cyclones?

No, it's the 2003 Medicare reform package in which the government promised to fund prescription charges for the over 65s by guaranteeing $400 billion to drug companies.1,2

The NHS can't afford the drugs either, but at least they have NICE to pin the blame on.

Guidelines in Practice, November 2006, Volume 9(11)
© 2006MGP Ltd
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  1. www.federalreserve.gov/boarddocs/testimony/2004/20040225/default.htm
  2. www.nybooks.com/articles/17244