After this I promise to stop obsessing about mad people running the world. But really. Today’s Guardian reports that Richard Granger, architect of the world’s biggest imploding IT project, compared the NHS project to a sled being pulled by huskies. “When one of the dogs goes lame, and begins to slow the others down, they are shot. They are then chopped up and fed to the other dogs”.

The twisted macho mindset of some IT ‘experts’ is not uncommon in the health sector.

One of the more extraordinary books I found during research for In the bubble was the 1,276-page Telemedicine Glossary.This hefty tome listed 13,500 organizations and projects involved with health telematics, plus six hundred telemedicine research projects with witty acronyms like KISS (Knowledge-Based Interactive Signal Monitoring System), CONQUEST (Clinical Oncology Network for Quality Standards of Treatment), CLIFF (Cluster Initiative for Flood and Fire Emergencies), and HUMAN (Health Through Telematics for Inmates) as titles. The last of these is about treating prisoners remotely.

But back to the NHS. The disaster scenario (says the Guardian today) is that iSoft’s problems will eventually trigger a domino collapse among other firms, halting the transformation of the NHS or postponing completion for yet more years.

This disaster is surely inevitable given the way it was set up. People close to the project, that I’ve talked to, were appalled from the beginning by its top-down architecture. And as usability expert Ann Light spotted more than two years ago, doctors and NHS IT workers had “no confidence in the ability of the national programme for IT to improve patient care because of the impossible timescales and lack of engagement of clinicians”.