It sounds to me that the London GP Manish Shah not only sexually assaulted female patients, but that he despised them too.

Shah has been given three life sentences for committing a total of 90 sexual assaults on 24 female patients at Mawney medical centre in Romford, east London, between 2009 and 2013. Claiming he was practising “defensive medicine”, he gave healthy women under 25 smear tests (generally performed by a nurse) and performed unnecessary breast examinations on women under 50. Shah breached NHS guidelines by not offering a chaperone for intimate examinations and didn’t always wear gloves. He left one patient entirely naked on the table. The youngest of his victims was 15, and her experiences left her “anxious, fearful and shaking” and afraid of visiting doctors.

In some ways, this case serves as a masterclass in determined and manipulative abuse. Shah would frighten patients about their family medical history. At other times, he’d mention celebrities such as Angelina Jolie (who underwent a preventive double mastectomy after testing positive for the BRCA gene mutation) and Jade Goody (who died in 2009 from cervical cancer). There it is – the contempt. And not just for those patients, for all women – including Jolie and Goody, whose suffering he so cynically exploited.

Here, you could make a guess at Shah’s thought processes – dazzle patients with celebrity names and they’ll let you do anything you want. What rot. Those patients would have instinctively trusted Shah, not because he bandied around famous names, but because he was a doctor.

Who are these people who put themselves in positions of trust but can’t be trusted? Maybe that’s part of the problem – the automatic deference given to medical professionals leading, in some, to a weaponised sense of entitlement. Characters such as Ian Paterson, the breast surgeon given 20 years in 2017, who subjected more than 1,000 patients to unnecessary and damaging surgery, an inquiry last week citing “a culture of avoidance and denial” in a “dysfunctional” healthcare system.

Such cases shatter trust in the medical profession, just as trust has been destroyed in myriad other areas, from the clergy to the care system to education. Now, it seems, women aren’t even able to walk into their GP surgery to normally, routinely, discuss their health. They have to be wary and alert and, if they require an intimate examination by a male GP, should seriously consider the option of a chaperone and fight against that all-powerful female urge not to be “demanding”, not to make a “fuss”.

Is this the future – mandatory chaperoned medicine between the sexes? All that extra expense for the NHS, and pressure on patients, just because some men abuse their power? Well, if that’s what it takes… People see medics when they’re at their most vulnerable – they need to feel safe. Now women know that their GP surgery could be just another unsafe space to deal with.

When the going gets tough, the desperate start growing beards

Facebook Twitter Pinterest Prince Harry: taking it on the chin/ Photograph: POOL/Reuters

It seems that men who suddenly sport beards may be trying to tell us something and it’s not just: “I can’t find the razor.”

The US website Vox coined the phrase “crisis beard” for face-fluff that sprouts under extreme pressure. For instance, the Canadian prime minister, Justin Trudeau, has been getting hairier with each new political crisis.

Al Gore grew a beard after losing the presidency to George W Bush. David Letterman morphed into Grizzly Adams when he stopped doing his chatshow. Prince Harry also has a beard: he had it before he married Meghan Markle, but don’t be alarmed – this doesn’t mean you can’t blame her for it.

Crisis beards are thought to be about rebellion, individualism and deep, existential despair. Respect to men. Women also express themselves via hair, but only men can cover two-thirds of their faces with anguished cries for help from their very souls.

It’s also interesting to see politicos go this route. The crisis beard could be the chic new way to express political anxiety, sorrow and humility. Which is all very timely, after just reading that the former prime minister David Cameron has made £1.6m (at least!) since his Brexit resignation. Why is this man still clean shaven? Mr Cameron, you owe the UK a beard. Make it a big one.

Computer-generated porn is as degrading as the real thing

Facebook Twitter Pinterest Deepfaked visuals wouldn’t render porn ethical. Photograph: gremlin/Getty Images/iStockphoto

Are women meant to cheer because the violent porn of the future may be computer-generated?

An algorithm has been developed to produce deep-fake images that could replace performers in porn. While deepfakes already exist in porn, often that is to humiliate real people, grafting their heads on to bodies. This would be about replacing humans altogether, stopping the exploitation and degradation of real-life porn workers, the rationale being that, whatever happens during porn wouldn’t matter because the women wouldn’t exist.

This is being viewed as a Good Thing, but is it really? Women already don’t exist in any valid way in porn. They may be there bodily; otherwise, they’re mere ciphers for an increasingly normalised hardcore roster of male sexual demands. Female behaviour, language and reactions are performed to order for the exclusive satisfaction of men. Female sexual autonomy is nowhere to be found: desire is faked, or explicitly unwanted, such as in hugely popular rape porn, where female fear and distress are the chief erotic components.

Deepfaked visuals wouldn’t render porn ethical, because the mentality would still be there. While you could fake the imagery, it would be impossible to computer-generate away the violent and misogynistic mindset that drives porn. You would not stop porn warping and damaging male minds in the real world, where all the real women live.

If realistic deepfake “men” could be depicted gang-raping a realistic deepfake “woman”, how does this improve anything for real women? If nothing is real, and anything goes, porn imagery could even become worse, further sexualising and trivialising the rape, battery and murder of women. The safety and wellbeing of vulnerable porn-workers is extremely important, but how porn is made is not the end of the story. It’s also about the harmful messages and imagery it sends out into the world, and the damage that wreaks, however it’s produced.

• Barbara Ellen is an Observer columnist