Sir Elton John has pulled out of a series of concerts in Las Vegas due to an “unusual bacterial infection” he contracted in South America, which left him in intensive care.
The singer announced he was pulling out of the shows on Monday in a statement that explained that he spent two nights in intensive care and was released on 22 April after becoming ill on a flight to the UK from Chile.
“During a recent, successful tour of South America, Elton contracted a harmful and unusual bacterial infection,” the statement read.
“During his return flight home from Santiago, Chile he became violently ill. Upon returning to the UK, Elton’s doctors admitted him to hospital, where he underwent immediate treatment to remove the infection. After spending two nights in intensive care followed by an extended stay in hospital, Elton was released from hospital.”
It added that the infection was “rare and potentially deadly” but that the star’s medical team identified it quickly and that he is expected to make a full and complete recovery.
Elton John also added: “I am so fortunate to have the most incredible and loyal fans and apologise for disappointing them. I am extremely grateful to the medical team for their excellence in looking after me so well.”
The affected shows were part of the Million Dollar Piano show and were due to take place at Caesars Palace in April and May, while another gig in Bakersfield, California, on 6 May was also cancelled.
The singer is expected to return for his scheduled gigs at Twickenham, in London on 3 June.
So far, we know of 54 babies whose parents say wouldn’t be alive today if it wasn’t for The Chokeables, St John Ambulance’s first aid film teaching people how to save a choking baby in just 40 seconds.
We’re delighted our film has won charity film of the year, announced at Bafta on 15 March. So what’s the secret of its success?
Before making the film, we carried out research that revealed parents are the people most interested in first aid and what they worry about most is their baby choking. Over 40% of parents had seen it happen, 58% said it was a serious concern and yet 79% didn’t know what to do.
Our previous campaigns had been aimed at getting people to take first aid seriously but our audiences just weren’t taking the next step and learning it.
We realised we needed to teach directly – beam the advice into parents’ lives in a way they couldn’t ignore. And the tone needed to be spot on. Parents don’t want to be browbeaten and made to feel guilty. It’s hard enough being a parent. What we needed was an upbeat, engaging, shareable lesson.
Enter the geniuses at Bartle Bogle Hegarty. They realised that the lesson would come across best if taught by common household items that could potentially choke babies – the kind of things most parents would find under their sofas, like a toy or a pen lid. They crafted a script around the idea that these characters were so fed up with babies choking on them that they have decided to teach parents what to do.
We used animation to make the topic less scary, and pulled in the big guns with David Walliams and Johnny Vegas voicing the characters.
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This was all quite a feat considering the film needed to be 40 seconds long. Our tip with charity films is the shorter the better, to get as many people as possible watching to the end, but also to air it on TV in a cost-effective way.
I wanted a name for the campaign to help parents connect with the characters, and identify the campaign easily so it could trend on social media. Heaps of chocolate and one brainstorm later, The Chokeables was born.
When it came to sharing and promoting the film, we developed close relationships with key media to help create a buzz before we released the video. We focused in particular on those who could help us reach a high proportion of parents, such as ITV’s Good Morning Britain and Mumsnet, as well as nationals like MailOnline and the Mail on Sunday. Facebook was crucial as mums use it to share parenting tips, and we also worked with the mums who’d saved their babies so that even more parents could find out what to do.
Social media was key and we created a Thunderclap so people could mass share the video, flashmob style, as well as social media competitions to increase further engagement, such as a messy baby photo competition with first aid kit prizes. We also produced a whole suite of baby first aid advice videos to inspire further learning.
We entered The Chokeables into the inaugural Charity Film Awards, when entries opened in 2015. The awards have been set up to recognise the best videos created by or on behalf of UK charities, whether for raising awareness, changing attitudes and behaviours or fundraising.
Over 375 charities entered for the first round of public voting. More than 43,000 people voted and the resulting shortlist went to a panel of judges. They whittled it down to the finalists, including household names such as the RSPCA, Barnardo’s, the RNLI, Alzheimer’s Society and Great Ormond Street children’s hospital.
A second round of public voting for the people’s choice award has seen more than 66,000 people vote for the winner – the Soi Dog Foundation’s film about Cola the dog, who was given custom-made prosthetics after his front legs were amputated.
To win the overall award for film of the year for The Chokeables is just incredible. We’d put everything into this and hoped it would make an impact, but the success has knocked us sideways. Not only have we taught millions of people how to help a choking baby but it’s helped people feel that St John Ambulance is relevant to their lives.
The video continues to receive millions of views whenever it’s re-posted on social media. I love these stats but nothing beats getting a message from a mum who has saved their baby thanks to our video. There’s no greater reward than knowing we’ve reassured parents and helped all those babies.
Emma Sheppard is head of communications, St John Ambulance. The Chokeables won film of the year at the 2016 Charity Film Awards.
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John Oliver has criticized the latest healthcare reform, referring to it as “shitty Obamacare”.
On Last Week Tonight, the comic took apart the American Health Care Act, championed by the House speaker, Paul Ryan, saying: “You may not have wanted it, it looks awful but it’s here anyway” which he likened to “Pirates of the Caribbean 5: The Curse of Johnny Depp Getting Divorced & Needing the Money.”
He then discussed the negative reaction the bill has already encountered, even from many Republicans. “Much like the life behind Melania’s eyes, the AHCA looks dead by the time it was introduced in Washington,” he said.
Oliver called it “shitty Obamacare, the way Old Navy is a shitty version of the Gap” before talking about the mechanics of the plan. Older people will get more money towards their healthcare leading him to joke: “The older you get, the more money you get. Think of it as the exact opposite of being a woman in Hollywood.”
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Despite all of the negativity, Ryan has been doing the publicity circuit, explaining why the bill is so great. Oliver joked during one of his TV calls-ins that “somehow you can almost hear his erection during that”.
He then played the much-criticized clip of congressman Jason Chaffetz recommending that people should reconsider buying an iPhone if they plan to need any form of healthcare.
“It’s frankly a little hard to take a lecture on good choices from a man who presumably entered a barbershop and said give me the wet poodle pubes,” Oliver said.
He then highlighted that the people who will be most affected by the reform will be poorer Americans who voted for Trump. “It’s like if the people in Pompeii voted for the volcano,” he said.
When asking who exactly will benefit from the plan, Oliver showed stats that prove richer Americans will receive major tax cuts as a result. “So this plan is literally taking money from the poor and giving it to the very rich,” he said. “It’s essentially a reverse Bernie Sanders which is also the name of a sex act which consists of very aggressive fingering.”
In discussing the response, Oliver referred to it as “almost universally hated in Washington” and “truly the Ted Cruz of healthcare legislation”.
He also played footage from Sean Spicer’s press briefing where he used two different paper stacks to somehow prove the new bill is better. “That is the most aggressively stupid thing I have ever seen and I just saw Jason Chaffetz suggest paying for health insurance by retroactively not buying an iPhone,” he said.
Trump has spoken this week about how no one knew how difficult and complicated healthcare was until now. “It’s like saying ‘who knew King Tut was dead’ – everybody did!” Oliver said.
The president is also not attaching his name to it or talking about it at great length. “Trump is not clamoring to put his name on this bill and he has put his name on some of the shittiest products in human history,” he said.
Oliver ended by talking about his plan to get a message to Trump about how awful the new plan is: he’s bought ad time on Fox & Friends, a show the president clearly watches. The ad will feature an older actor explain in detail how his life will be harder from now on. It will air in the DC area on Wednesday morning.
One night in May, my wife sat up in bed and said, “I’ve got this awful pain just here.” She prodded her abdomen and made a face. “It feels like something’s really wrong.” Woozily noting that it was 2am, I asked what kind of pain it was. “Like something’s biting into me and won’t stop,” she said.
“Hold on,” I said blearily, “help is at hand.” I brought her a couple of ibuprofen with some water, which she downed, clutching my hand and waiting for the ache to subside.
An hour later, she was sitting up in bed again, in real distress. “It’s worse now,” she said, “really nasty. Can you phone the doctor?” Miraculously, the family doctor answered the phone at 3am, listened to her recital of symptoms and concluded, “It might be your appendix. Have you had yours taken out?” No, she hadn’t. “It could be appendicitis,” he surmised, “but if it was dangerous you’d be in much worse pain than you’re in. Go to the hospital in the morning, but for now, take some paracetamol and try to sleep.”
Barely half an hour later, the balloon went up. She was awakened for the third time, but now with a pain so savage and uncontainable it made her howl. The time for murmured assurances and spousal procrastination was over. I rang a local minicab, struggled into my clothes, bundled her into a dressing gown, and we sped to St Mary’s Paddington at just before 4am.
The flurry of action made the pain subside, if only through distraction, and we sat for hours while doctors brought forms to be filled, took her blood pressure and ran tests. A registrar poked a needle into my wife’s wrist and said, “Does that hurt? Does that? How about that?” before concluding: “Impressive. You have a very high pain threshold.”
The pain was from pancreatitis, brought on by rogue gallstones that had escaped from her gall bladder and made their way, like fleeing convicts, to a refuge in her pancreas, causing agony. She was given a course of antibiotics and, a month later, had an operation to remove her gall bladder.
“It’s keyhole surgery,” said the surgeon breezily, “so you’ll be back to normal very soon. Some people feel well enough to take the bus home after the operation.” His optimism was misplaced. My wife came home the following day filled with painkillers. When they wore off, she writhed with suffering. After three days she rang the specialist, only to be told: “It’s not the operation that’s causing discomfort – it’s the air that was pumped inside you to separate the organs before surgery.” Once the operation had proved a success, the surgeons had apparently lost interest in the fallout.
During that period of convalescence, as I watched her grimace and clench her teeth and let slip little cries of anguish until a long regimen of combined ibuprofen and codeine finally conquered the pain, several questions came into my head. Chief among them was: “Can anyone in the medical profession talk about pain with any authority?” From the family doctor to the surgeon, their remarks and suggestions seemed tentative, generalised, unknowing – and potentially dangerous: Was it right for the doctor to tell my wife that her level of pain didn’t sound like appendicitis when the doctor didn’t know whether she had a high or low pain threshold? Should he have advised her to stay in bed and risk her appendix exploding into peritonitis? How could surgeons predict that patients would feel only “discomfort” after such an operation when she felt agony – an agony that was aggravated by fear that the operation had been a failure?
I also wondered if there were any agreed words that would help a doctor understand the pain felt by a patient. I thought of my father, a GP in the 1960s with an NHS practice in south London, who used to marvel at the colourful pain symptoms he heard: “It’s like I’ve been attacked with a stapler”; “Like having rabbits running up and down my spine”; “It’s like someone’s opened a cocktail umbrella in my penis …” Few of them, he told me, corresponded to the symptoms listed in a medical textbook. So how should he proceed? By guesswork and aspirin?
There seemed to be a chasm of understanding in human discussions of pain. I wanted to find out how the medical profession apprehends pain – the language it uses for something that’s invisible to the naked eye, that can’t be measured except by asking for the sufferer’s subjective description, and that can be treated only by the use of opium derivatives that go back to the middle ages.
When investigating pain, the basic procedure for clinics everywhere is to give a patient the McGill pain questionnaire. Developed in the 1970s by two scientists, Dr Ronald Melzack and Dr Warren Torgerson, both of McGill University in Montreal, it is still the main tool for measuring pain in clinics worldwide.
Melzack and his colleague Dr Patrick Wall of St Thomas’ Hospital in London had already galvanised the field of pain research in 1965 with their seminal “gate control theory”, a ground-breaking explanation of how psychology can affect the body’s perception of pain. In 1984, the pair went on to write Wall and Melzack’s Textbook of Pain, the most comprehensive reference work in pain medicine. It has gone through five editions and is currently more than 1,000 pages long.
In the early 1970s, Melzack began to list the words patients used to describe their pain and classified them into three categories: sensory (which included heat, pressure, “throbbing” or “pounding” sensations), affective (which related to emotional effects, such as “tiring”, “sickening”, “gruelling” or “frightful”) and lastly evaluative (evocative of an experience – from “annoying” and “troublesome” to “horrible”, “unbearable” and “excruciating”).
You don’t have to be a linguistic genius to see there are shortcomings in this range of terms. For one thing, some words in the affective and evaluative categories seem interchangeable – there’s no difference between “frightful” in the former and “horrible” in the latter, or between “tiring” and “annoying” – and all the words share an unfortunate quality of sounding like a duchess complaining about a ball that didn’t meet her standards.
But Melzack’s grid of suffering formed the basis of what became the McGill pain questionnaire. The patient listens as a list of “pain descriptors” is read out and has to say whether each word describes their pain – and, if so, to rate the intensity of the feeling. The clinicians then look at the questionnaire and put check marks in the appropriate places. This gives the clinician a number, or a percentage figure, to work with in assessing, later, whether a treatment has brought the patient’s pain down (or up).
Some men may find it hard to imagine anything more agonising than toothache or a tennis injury
A more recent variant is the National Initiative on Pain Control’s pain quality assessment scale (PQAS), in which patients are asked to indicate, on a scale of 1 to 10, how “intense” – or “sharp”, “hot”, “dull”, “cold”, “sensitive”, “tender”, “itchy”, etc – their pain has been over the past week.
The trouble with this approach is the imprecision of that scale of 1 to 10, where a 10 would be “the most intense pain sensation imaginable”. How does a patient “imagine” the worst pain ever and give their own pain a number? Some men may find it hard to imagine anything more agonising than toothache or a tennis injury. Women who have experienced childbirth may, after that experience, rate everything else as a 3 or 4.
I asked some friends what they thought the worst physical pain might be. Inevitably, they just described nasty things that had happened to them. One man nominated gout. He recalled lying on a sofa, with his gouty foot resting on a pillow, when a visiting aunt passed by; the chiffon scarf she was wearing slipped from her neck and lightly touched his foot. It was “unbearable agony”.
A brother-in-law nominated post-root-canal toothache – unlike muscular or back pain, he said, it couldn’t be alleviated by shifting your posture. It was “relentless”. A male friend confided that a haemorrhoidectomy had left him with irritable bowel syndrome, in which a daily spasm made him feel “as if somebody had shoved a stirrup pump up my arse and was pumping furiously”. The pain was, he said, “boundless, as if it wouldn’t stop until I exploded”. A woman friend recalled the moment the hem of her husband’s trouser leg snagged on her big toe, ripping the nail clean off. She used a musical analogy to explain the effect: “I’d been through childbirth, I’d broken my leg – and I recalled them both as low moaning noises, like cellos; the ripped-off nail was excruciating, a great, high, deafening shriek of psychopathic violins, like nothing I’d heard – or felt – before.”
It seems a shame that these eloquent descriptions are reduced by the McGill questionnaire to words like “throbbing” or “sharp”, but its function is simply to give pain a number – a number that will, with luck, be decreased after treatment, when the patient is reassessed.
This procedure doesn’t impress Professor Stephen McMahon of the London Pain Consortium, an organisation formed in 2002 to promote internationally competitive research into pain. “There are lots of problems that come with trying to measure pain,” he says. “I think the obsession with numbers is an oversimplification. Pain is not unidimensional. It doesn’t just come with scale – a lot or a little – it comes with other baggage: how threatening it is, how emotionally disturbing, how it affects your ability to concentrate. The measuring obsession probably comes from the regulators who think that, to understand drugs, you have to show efficacy. And the American Food and Drug Administration don’t like quality-of-life assessments; they like hard numbers. So we’re thrown back on giving it a number and scoring it. It’s a bit of a wasted exercise because it’s only one dimension of pain that we’re capturing.”
Illustration: Matthew Richardson
Pain can be either acute or chronic, and the words do not (as some people think) mean “bad” and “very bad”. “Acute” pain means a temporary or one-off feeling of discomfort, which is usually treated with drugs; “chronic” pain persists over time and has to be lived with as a malevolent everyday companion. But because patients build up a resistance to drugs, other forms of treatment must be found for it.
The Pain Management and Neuromodulation Centre at Guy’s and St Thomas’ Hospital in central London is the biggest pain centre in Europe. Heading the team there is Dr Adnan Al-Kaisy, who studied medicine at the University of Basrah, Iraq, and later worked in anaesthetics at specialist centres in England, the US and Canada.
“I’d say that 55 to 60% of our patients suffer from lower back pain,” he says. “The reason is, simply, that we don’t pay attention to the demands life makes on us, the way we sit, stand, walk and so on. We sit for hours in front of a computer, with the body putting heavy pressure on small joints in the back.” Al-Kaisy reckons that in the UK the incidence of chronic lower back pain has increased substantially in the last 15 to 20 years, and that “the cost in lost working days is about £6 to 7 billion”.
Elsewhere the clinic treats those suffering from severe chronic headaches and injuries from accidents that affect the nervous system.
Do they still use the McGill questionnaire? “Unfortunately yes,” says Al-Kaisy. “It’s a subjective measurement. But pain can be magnified by a domestic argument or trouble at work, so we try to find out about the patient’s life – their sleeping patterns, their ability to walk and stand, their appetite. It’s not just the patient’s condition, it’s also their environment.”
The challenge is to transform this information into scientific data. “We’re working with Professor Raymond Lee, chair of Biomechanics at the South Bank University, to see if there can be objective measurement of a patient’s disability due to pain,” he says. “They’re trying to develop a tool, rather like an accelerometer, which will give an accurate impression of how active or disabled they are, and tell us the cause of their pain from the way they sit or stand. We’re really keen to get away from just asking the patient how bad their pain is.”
Some patients arrive with pains that are far worse than backache and require special treatment. Al-Kaisy describes one patient – let us call him Carter – who suffered from a terrible condition called ilioinguinal neuralgia, a disorder that produces a severe burning and stabbing pain in the groin. “He’d had an operation in the testicular area, and the inguinal nerve had been cut. The pain was excruciating: when he came to us, he was on four or five different medications, opiates with very high dosages, anticonvulsive medication, opioid patches, paracetamol and ibuprofen on top of that. His life was turned upside down, his job was on the line.” The utterly stricken Carter was to become one of Al-Kaisy’s big successes.
Since 2010, Guy’s and St Thomas’ has offered a residential programme for adults whose chronic pain hasn’t responded to treatment at other clinics. The patients come in for four weeks, away from their normal environment, and are seen by a motley crew of psychologists, physiotherapists, occupational health specialists and nursing physicians who between them devise a programme to teach them strategies for managing their pain.
Many of these strategies come under the heading of “neuromodulation”, a term you hear a lot in pain management circles. In simple terms, it means distracting the brain from constantly brooding on the pain signals it is getting from the body’s periphery. Sometimes the distraction is a cunningly deployed electric shock.
“We were the first centre in the world to pioneer spinal cord stimulation,” says Al-Kaisy. “In pain occasions, overactive nerves send impulses from the periphery to the spinal cord and from there to the brain, which starts to register pain. We try to send small bolts of electricity to the spinal cord by inserting a wire in the epidural area. It’s only one or two volts, so the patient feels just a tingling sensation over where the pain is, instead of feeling the actual pain. After two weeks, we give the patient an internal power battery with a remote control, so he can switch it on whenever he feels pain and carry on with his life. It’s essentially a pacemaker that suppresses the hyperexcitability of nerves by delivering subthreshold stimulation. The patient feels nothing except his pain going down. It’s not invasive – we usually send patients home the same day.”
When Carter, suffering from agonising pain in the groin, had failed to respond to any other treatments, Al-Kaisy tried his new combination of therapies. “We gave him something called a dorsal root ganglion stimulation. It’s like a small junction-box, placed just underneath one of the bones of the spine. It makes the spine hyperexcited, and sends impulses to the spinal cord and the brain. I pioneered a new technique to put a small wire into the ganglion, connected to an external power battery. Over 10 days the intensity of pain went down by 70% – by the patient’s own assessment. He wrote me a very nice email saying I had changed his life, that the pain had just stopped completely, and that he was coming back to normality. He said his job was saved, as was his marriage, and he wanted to go back to playing sport. I told him, ‘Take it easy. You mustn’t start climbing the Himalayas just yet.’” Al-Kaisy beams. “This is a remarkable outcome. You cannot get it from any other therapies.”
The greatest recent breakthrough in assessing pain, according to Professor Irene Tracey, head of the University of Oxford’s Nuffield Department of Clinical Neurosciences, has been the understanding that chronic pain is a thing in its own right. She explains: “We always thought of it as acute pain that just goes on and on – and if chronic pain is just a continuation of acute pain, let’s fix the thing that caused the acute and the chronic should go away. That has spectacularly failed. Now we think of chronic pain as a shift to another place, with different mechanisms, such as changes in genetic expression, chemical release, neurophysiology and wiring. We’ve got all these completely new ways of thinking about chronic pain. That’s the paradigm shift in the pain field.”
Tracey has been called the “Queen of Pain” by some media commentators. She was, until recently, the Nuffield Professor of anaesthetic science and is an expert in neuroimaging techniques that explore the brain’s responses to pain. Despite her nickname, in person she is far from alarming: a bright-eyed, enthusiastic, welcoming and hectically fluent woman of 50, she talks about pain at a personal level. She has no problem defining the “ultimate pain” that scores 10 on the McGill questionnaire: “I’ve been through childbirth three times, and my 10 is a very different 10 from before I had kids. I’ve got a whole new calibration on that scale.” But how does she explain the ultimate pain to people who haven’t experienced childbirth? “I say, ‘Imagine you’ve slammed your hand in a car door – that’s 10.’”
She uses a personal example to explain the way perception and circumstance can alter the way we experience pain, as well as the phenomenon of “hedonic flipping”, which can convert pain from an unpleasant sensation into something you don’t mind. “I did the London Marathon this year. It needs a lot of training and running and your muscles ache, and next day you’re really in pain, but it’s a nice pain. I’m no masochist, but I associate the muscle pain with thoughts like, ‘I did something healthy with my body,’ ‘I’m training,’ and ‘It’s all going well.’”
I ask her why there seems to be a gap between doctors’ and patients’ apprehension of pain. “It’s very hard to understand, because the system goes wrong from the point of injury, along the nerve that’s taken the signal into the spinal cord, which sends signals to the brain, which sends signals back, and it all unravels with terrible consequential changes. So my patient may be saying, ‘I’ve got this excruciating pain here,’ and I’m trying to see where it’s coming from, and there’s a mismatch here because you can’t see any damage or any oozing blood. So we say, ‘Oh come now, you’re obviously exaggerating, it can’t be as bad as that.’ That’s wrong – it’s a cultural bias we grew up with, without realising.”
Recently, she says, there has been a breakthrough in understanding about how the brain is involved in pain. Neuroimaging, she explains, helps to connect the subjective pain with the objective perception of it. “It fills that space between what you can see and what’s being reported. We can plug that gap and explain why the patient is in pain even though you can’t see it on your x-ray or whatever. You’re helping to bring truth and validity to these poor people who are in pain but not believed.”
But you can’t simply “see” pain glowing and throbbing on the screen in front of you. “Brain imaging has taught us about the networks of the brain and how they work,” she says. “It’s not a pain-measuring device. It’s a tool that gives you fantastic insight into the anatomy, the physiology and the neurochemistry of your body and can tell us why you have pain, and where we should go in and try to fix it.”
Some of the ways in, she says, are remarkably direct and mechanical – like Al-Kaisy’s spinal cord stimulation wire. “There are now devices you can attach to your head and allow you to manipulate bits of the brain. You can wear them like bathing caps. They’re portable, ethically allowed brain-simulation devices. They’re easy for patients to use and evidence is coming, in clinical trials, that they are good for strokes and rehabilitation. There’s a parallel with the games industry, where they’re making devices you can put on your head so kids can use thought to move balls around. The games industry is, for fun, driving this idea that when you use your brain, you generate electrical activities. They’re developing the technology really fast, and we can use it in medical applications.”
Illustration: Matthew Richardson
Pain has become a huge area of medical research in the US, for a simple reason. Chronic pain affects over 100 million Americans and costs the country more than half a trillion dollars a year in lost working hours, which is why it has become a magnet for funding by big business and government.
Researchers at the Human Pain Research Laboratory at Stanford University, California, are working to gain a better understanding of individual responses to pain so that treatments can be more targeted. The laboratory has several study initiatives on the go – into migraine, fibromyalgia, facial pain and other conditions – but its largest is into back pain. It has been endowed with a $ 10m grant from the National Institutes of Health to study non-drug alternative treatments for lower back pain. The specific treatments are mindfulness, acupuncture, cognitive behavioural therapy and real-time neural feedback.
They plan to inspect the pain tolerance of 400 people over five years of study, ranging from pain-free volunteers to the most wretched chronic sufferers who have been to other specialists but found no relief. The idea is to find people’s mid-range tolerance (they’re asked to rate their pain while they are experiencing it), to establish a usable baseline. They then are given the non-invasive treatments – such as mindfulness and acupuncture – and are subjected afterwards to the same pain stimuli, to see how their pain tolerance has changed from their baseline reading. MRI scanning is used on the patients in both laboratory sessions, so that clinicians can see and draw inferences from the visible differences in blood flow to different parts of the brain.
A remarkable feature of the assessment process is that patients are also given scores for psychological states: a scale measures their level of depression, anxiety, anger, physical functioning, pain behaviour and how much pain interferes with their lives. This should allow physicians to use the information to target specific treatments. All these findings are stored in an “informatics platform” called Choir, which stands for the Collaborative Health Outcomes Information Registry. It has files on 15,000 patients, 54,000 unique clinic visits and 40,000 follow-up meetings.
The big chief at the Human Pain Research Laboratory is Dr Sean Mackey, Redlich professor of anaesthesiology, perioperative and pain medicine, neurosciences and neurology at Stanford. His background is in bioengineering, and under his governance the Stanford Pain Management Center has twice been designated a centre of excellence by the American Pain Society. A tall, genial, easy-going man, he is sometimes approached by legal firms who want him to appear in court to state definitively whether their client is or is not in chronic pain (and therefore justified in claiming absentee benefit). His response is surprising.
“In 2008, I was asked by a law firm to speak in an industrial injury case in Arizona. This poor guy got hot burning asphalt sprayed on his arm at work; he had a claim of burning neuropathic pain. The plaintiff’s side brought in a cognitive scientist, who scanned his brain and said there was conclusive evidence that he had chronic pain. The defence asked me to comment, and I said, ‘That’s hogwash, we cannot use this technology for that purpose.’
“Shortly afterwards, I gave a talk on pain, neuroimaging and the law, explaining why you can’t do this – because there’s too much individual variability in pain, and the technology isn’t sensor-specific enough. But I concluded by saying, ‘If you were to do this, you’d use modern machine-learning approaches, like those used for satellite reconnaissance to determine whether a satellite is seeing a tank or a civilian truck.’ Some of my students said, ‘Can you give us some money to try this?’ I said, ‘Yes, but it can’t be done.’ But they designed the experiment – and discovered that, using brain imagery, they could predict with 80% accuracy whether someone was feeling heat pain or not.”
Mackey finally published a paper about the experiment. So did his findings influence any court decisions? “No. I get asked by attorneys, and I always say, ‘There is no place for this in the courtroom in 2016 and there won’t be in 2020. People want to push us into saying this is an objective biomarker for detecting that someone’s in pain. But the research is in carefully controlled laboratory conditions. You cannot generalise about the population as a whole. I told the attorneys, ‘This is too much of a leap.’ I don’t think there’s a lot of clinical utility in having a pain-o-meter in a court or in most clinical situations.”
Mackey explains the latest thinking about what pain actually is. “Now we understand that pain is a balance between ascending information coming from our bodies and descending inhibitory systems from our brains. We call the ascending information “nociception” – from the Latin nocere, to harm or hurt – meaning the response of the sensory nervous system to potentially harmful stimuli coming from our periphery, sending signals to the spinal cord and hitting the brain with the perception of pain. The descending systems are inhibitory, or filtering, neurons, which exist to filter out information that’s not important, to “turn down” the ascending signals of hurt. The main purpose of pain is to be the great motivator, to tell you to pay attention, to focus. When the pain lab was started, we had no way of addressing these two dynamic systems, and now we can.”
Mackey is immensely proud of his massive CHOIR database – which records people’s pain tolerance levels and how they are affected by treatment – and has made it freely available to other pain clinics as a “community source platform”, collaborating with academic medical centres nationwide “so that a rising tide elevates all boats”. But he is also humble enough to admit that science cannot tell us which are the sites of the body’s worst pains.
“Back pain is the most reported pain at 28%, but I know there’s a higher density of nerve fibres in the hands, face, genitals and feet than in other areas,” Mackey says, “and there are conditions where the sufferer has committed suicide to get away from the pain. Things like post-herpetic neuralgia, that burning nerve pain that occurs after an outbreak of shingles and is horrific; another is cluster headaches – some patients have thought about taking a drill to their heads to make it stop.”
Like Irene Tracey, Mackey is enthusiastic about the rise of transcranial magnetic stimulation (“Imagine hooking a nine-volt battery across your scalp”) but, when asked about his particular successes, he talks about simple solutions. “Early on in my career, I used to be very focused on the peripheral, the apparent site of the pain. I was doing interventions, and some people would get better but a lot wouldn’t. So I started listening to their fears and anxieties and working on those, and became very brain-focused. I noticed that if you have a nerve trapped in your knee, your whole leg could be on fire, but if you apply a local anaesthetic there, it could abolish it.
“This young woman came to me with a terrible burning sensation in her hand. It was always swollen; she couldn’t stand anyone touching it because it felt like a blowtorch.” Mackey noticed that she had a post-operative scar from prior surgery for carpal-tunnel syndrome. Speculating that this was at the root of her problem, he injected botulinum toxin, a muscle relaxant, at the site of the scar. “A week later, she came up and gave me this huge hug and said, ‘I was able to pick up my child for the first time in two years. I haven’t been able to since she was born.’ All the swelling was gone. It taught me that it’s not all about the body part, and not all about the brain. It’s about both.”
Main illustration by Matthew Richardson
This is an edited version of an article that appears on Mosaic. It is republished here under a Creative Commons licence.
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NHS funding levels should be checked by the government’s budget watchdog amid public distrust of the figures and a worsening winter crisis in hospitals, John McDonnell has said.
The shadow chancellor wrote to Robert Chote, head of the Office for Budget Responsibility (OBR), asking him to look at NHS funding levels, as doctors warned that the shortage of resources in health and social care has created a crisis.
There have been a number of calls from Labour and the Liberal Democrats for an independent auditor for the NHS. But McDonnell called on the existing OBR to see if it could establish the truth about public spending on the NHS.
The level of NHS funding has become hotly contested amid claims that cuts to social care have been causing unprecedented pressure on hospitals and further controversy over the government’s claims to be putting in another £10bn a year into the health service by the end of this parliament.
“It has become clear that Labour’s warnings of a looming winter crisis in the NHS were not heeded,” McDonnell wrote to Chote. “And we have seen in recent days that the British Red Cross has now had to describe the ongoing situation as a humanitarian crisis. The response from the prime minister at the weekend was to play down this situation despite the volume of continued complaints from frontline NHS staff.
“I strongly believe that this is leading to widespread public distrust in the government’s presentation of the level of funding and support for the NHS and social care. Therefore, it seems that now is the time to assess further enhancing the role of the OBR, and add additional responsibilities to your organisation.”
John McDonnell Photograph: Danny Lawson/PA
He suggested there should be an “annual standalone report that assesses short-medium term policy decisions made on health spending by the government, that takes into account the analysis you already do on the long-term trends and drivers of health spending.”
On Monday night, frontline doctors issued an unprecedented warning that patient safety was at risk at many A&E units across the NHS because hospitals are overwhelmed.
The health secretary, Jeremy Hunt, told the Commons in an emergency statement that hospitals may have to cancel operations and outpatient appointments so that staff can concentrate on the sickest patients.
GPs may also be drafted in to help hospitals cope with record demand for medical care. He also provoked controversy by suggesting the four-hour treatment target should exclude people who waste time by presenting with minor ailments.
The Royal College of Emergency Medicine said a substantial number of A&E departments were falling significantly short of the four-hour standard – but Hunt said that as many as 30% of those turning up were neither an urgent case nor a genuine emergency.
The college, which represents doctors in emergency care, warned: “In our expert opinion, when an emergency department falls below 75% against the four-hour standard, it shows a significant level of overcrowding and begins to put safety at risk. Present figures suggest a substantial number of departments are falling below this level.”
The college believes that one in four A&E units are at risk of offering poor care, citing delays in assessing patients and administering pain relief.
In an emergency statement prompted by reports of intense pressure at A&E units around the NHS in England, Hunt said that the four-hour waiting time had to be revised to remove non-urgent cases.
“This government is committed to maintaining and delivering that vital four-hour commitment to patients,” Hunt said. “But since it was announced in 2000 there are nearly 9m more visits to our A&Es, up to 30% of whom NHS England estimate do not need to be there. And the tide is continuing to rise.
“So, if we are to protect our four-hour standard, we need to be clear it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.”
NHS Providers, which represents hospital bosses, welcomed the change as “potentially helpful” in relieving the strain on A&Es.
But Jonathan Ashworth, the shadow health secretary, said: “Is he now really telling patients that rather than trying to hit the four-hour target, the government is now rewriting and downgrading it?”
John McDonnell describes the last six years of economic policy as an ‘abject failure’ in the House of Commons on Wednesday. The shadow minister accuses Philip Hammond of failing the sick and elderly after his autumn statement gave no additional money to the NHS or social care
The inadequacy of competition and the profit motive in the provision human services like education and health has been established by harsh experience with consistent failures like PFI hospitals, for-profit schools and private prisons. This failure presents a puzzle: how is it that (assuming we have an adequate income) we can rely on for-profit corporations to put food on our tables and clothes on our backs, but not to educate our children or preserve our health.
In the hands of many advocates of privatisation, this puzzle is turned into a knock-down refutation: if the profit motive works well in providing something as vital as food, it must work well everywhere. The latest instance of this naive faith in the market is the Australian Productivity Commission’s call to privatise public health and housing.
In fact, there is no puzzle here: economists and public policy scholars worked out decades ago how to answer this question in principle, and solved many of the issues in detail. The problem is that the political class, along with much of the economics profession, have done worse than the Bourbons, of whom Talleyrand observed “they have learned nothing, and forgotten nothing”. Leading economist Paul Romer recently observed, echoing earlier comments by Robert Gordon, that macroeconomics has been going backwards since the early 1980s.
The same is true of the regressive microeconomics underlying the dogma that privatisation and market competition are always and everywhere beneficial. Our leaders, and the economists who advise them, have shown themselves incapable of learning from experience, but they have forgotten much that we once knew. In this case, what we once knew was the analysis of market failure that supported the successful mixed economy that came into being in the mid-20th century.
The basic analytical framework was set out in Francis Bator’s 1958 article, “The anatomy of market failure”, (itself drawing on earlier work by the great British economist AC Pigou). It was developed further by a string of contributions from economists like Kenneth Arrow, Joseph Stiglitz and George Akerlof, all of whom received the Nobel Memorial Prize in Economic Sciences for their work.
Taken together with Keynesian macroeconomic theory, this body of work explained why a properly functioning modern economy must be one in which some goods and services are provided by firms competing for profit and others by governments or publicly-funded non-profit organisations. The result is the “mixed economy”, political and social aspects of which were analysed by scholars such as Karl Mannheim and Andrew Shonfield.
Human services are among the sectors of the economy where markets and competition perform badly. The central problems related to human services involve information and finance. These are most obvious in relation to education. Education is for most of us, a once-only experience, and its value is hard to assess, except in retrospect. To some extent, we can make choices on the basis of the reputation of schools and universities. However, these reputations change only slowly over decades, so slowly that no rational for-profit firm would invest in maintaining them.
Moreover, education is hugely expensive, so that most families can’t afford it in the absence of public provision or a public subsidy. The experience of for-profit education in Australia and the US has been that it is far easier to extract public subsidies through scams of various kinds than to compete on the basis of high-quality education.
Many of the same issues arise in healthcare. Obviously, if we knew what was wrong with our health and how to fix it, we wouldn’t need doctors to tell us. As it is, we need to rely on the judgment of our doctors to give us the right treatment and, equally importantly, to tell us when we will get better without treatment. The greater the role of profit in the system, the greater the incentive to provide unnecessary or overpriced services. The example of the United States, which spends more on healthcare than any other country, with worse results, is an illustration.
Information isn’t a problem, or not much of one, in the case of food supply. We buy food on a weekly or even daily basis and have plenty of chances to determine what we like, and which suppliers offer good value for our money. There are things we can’t easily observe, like the cleanliness of food preparation, but these can be dealt with through regulation rather than through governments getting into the food supply business themselves.
Of course, none of this helps if you don’t have enough money to afford the food you need. But long experience has shown that the best way to help poor people afford necessities like food is to give them more money. Neither general food subsidies nor welfare payments tied to food purchases (food stamps) have ever worked as well as income redistribution.
If markets and profits don’t work well in the provision of human services, why should we expect governments and non-profit organisations to do any better? The answer is that that non-profit provision relies on professionalism and a service ethos. These can’t be combined with reliance on direct financial incentives and managerial control.
The Bourbons who have dominated public policy for the past few decades are resolutely hostile to any kind of professional or service ethos. They take for granted the most simplistic versions of textbook economics, in which only monetary incentives matter. On a more sophisticated view of the question, people care just as much about the respect of their peers and belief in the value of their work as they do about the size of their pay packet.
This is ultimately an empirical question, and after 30 years of failure we have more than enough evidence to reach a conclusion. Across the human services sector, markets, incentives and competition rarely work better than non-profit provision and frequently lead to disastrous failure.
Following a long series of unsuccessful attempts at developing a workable lightbulb, Thomas Edison is supposed to have said, “I’ve not failed. I’ve just found 10,000 ways that won’t work.” This quote comes irresistibly to mind when thinking about Tony Blair’s famous commitment to “what works”, as opposed to ideology, in public policy.
In retrospect, it seems that Blair, and like-minded reformers throughout the English-speaking world, have delivered an Edison in reverse. Edison experimented with many things that didn’t work, but ended up with a light bulb. Market-oriented reforms, particularly in the provision of human services like health, education and public safety, have begun with a working system and replaced it with a string of failed experiments.
Here are a few examples from recent news stories around the English-speaking world
These examples could be multiplied endlessly, and not as the result of a selective choice of reports. A Google search on terms like “PFI hospital” or “private vocational training” will produce dozens more reports, nearly all describing financial and human disasters.
Yet despite this string of disasters, the push for market-oriented reform goes on. In the US, the Obama administration continues to promote the failed idea of charter schools, and Obama allies like Rahm Emanuel have carried on the war against teacher unions. The conservatives in Britain have backed away from the worst failures of the PFI. However, they are still enamoured of other Blair ideas like converting local authority schools into “academies” despite the absence of any evidence of improved performance.
Even by comparison with these examples, the Baird government in NSW stands out. It is pushing ahead with the privatisation agenda in Tafe, despite the obviously disastrous nature of the results. It has outsourced teaching in prisons to companies whose staff lack teaching degrees.
Not content with that, the Baird government is outsourcing the provision of public housing. The likely winner, despite its failures here and abroad, is Serco, a firm prominent as both a beneficiary of, and advocate for, outsourcing of human services.
The Australian policy elite seem immune to evidence on the failures of markets in human services. The recent Harper review of competition policy in Australia suggested that, “Consumer choice should be placed at the heart of government service delivery, through policies to encourage diverse and competitive markets populated with innovative and responsive providers.”
But it is precisely the firms lauded as “innovative” and “responsive”, from the University of Phoenix to the shonky builders of PFI schools and hospitals, that have done most to hurt government service programs.
Sooner or later the advocates of reform will have to answer the Edison-Blair question: “What works?” And what works is traditional public provision. Through all of these failed experiments, the public sector, much-maligned and chronically underfunded, has carried on with the hard work of educating young people, treating the sick and providing the vast range of services needed in a modern society, on a the basis of an ethic of service to the entire community, and not merely those who can pay for premium service.
The only other model with comparable success is not-for-profit provision by organisations with a charitable or service mission. Church-run schools and hospitals, and activist-run services like women’s shelters and services for the unemployed and homeless, have complemented the public sector, meeting needs that have been unrecognised or underserved.
The issue is not, in the end, one of public versus private. Rather it is the fact that market competition and the profit motive inevitably associated with it is antithetical to the professional and service orientation that is central to human services of all kinds.
No matter how cleverly market reformers design incentive schemes, competition for profits will always find a way to subvert them. It is time we as a society recognised this, and returned to what actually works.
Franco Basaglia is nevertheless a household identify in Italy. His name is always connected to Law 180 (“Basaglia’s law”), promulgated in 1978. It was a rushed compromise of legislation that properly ended the era of detention and repression for the mentally unwell. Basaglia knew it was imperfect, warning that “we ought to keep away from a sense of euphoria”, but it was the culmination of a career on the health-related barricades. In the phrases of the Italian philosopher, Norberto Bobbio, it was “the only genuine reform” in Italian historical past. Basaglia died just two many years later on, aged only 56.
Born into a relaxed family in Venice in 1924, Basaglia (who occurs to be my wife’s fantastic-uncle), was an instinctive anti-fascist, covering the blackboards of his university in 1944 with the slogan: “Death to the Fascists, Freedom for the People”. Then a medical pupil, he was arrested and invested 6 months in prison. He grew to become element of a popular uprising in April 1945 when he and fellow prisoners broke out and led an insurrection across the city. His encounter in prison was formative: when he grew to become director of a psychological asylum in Gorizia, near the Yugoslavian border in the early 60s, he said: “It took me straight back to the war and the prison.” Primo Levi, as well, was a large influence, as Basaglia would regularly draw comparisons in between concentration camps and the asylum technique. He felt that psychiatrists had been closer to repressive prison guards than humane medics, and became fascinated by the so-referred to as “anti-pyschiatrists” in Britain: RD Laing, Maxwell Jones and David Cooper. In experimental settings like the “Rumpus Room”, Villa 21, Dingleton and Kingsley Hall, they had been trying not to demonise and medicalise psychological sickness, but to understand its existential and social aspects, and to permit sufferers the dangerous freedom to investigate, rather than repress, their crises. They wished, in Cooper’s words, to realize no matter whether invalids were really unwell, or had basically been invalidated.
On his 1st day in charge in Gorizia, Basaglia refused to indicator the permits for the restraint of prisoners, and from then on his aim was to introduce democracy inside of the asylum. At one point there were more than 50 meetings a week. Physicians didn’t put on white coats and mingled freely with individuals. A magazine was produced. Visits and outings had been encouraged. Locked wards have been opened, bars, shackles and strait-jackets eliminated.
Basaglia gathered close to himself an “équipe” of like-minded pioneers. The atmosphere Foot describes is one of outstanding energy and enthusiasm, with virtually no time left for loved ones or even sleep. Physicians were anticipated to be ever-existing and offered. The group was faced, inevitably, with opposition from the previous guard of asylum workers and, specifically, by traditionalist elements outside. But time was on Basaglia’s side: the anti-institutionalism of 1968 coincided with the publication of L’Istituzione Negata, a collective operate (edited by Basaglia) that described the radicalism of the Gorizia experiment. It became an instantaneous bestseller and, along with a successful Tv documentary, manufactured him famous.
There were, though, tragic incidents. Giovanni Miklus was launched for a day in September 1968 and, that same afternoon, killed his wife with a hammer. Basaglia and 1 of his colleagues had been accused of manslaughter, even though each had been at some point cleared. In February 1972, when Basaglia was director of the asylum in Trieste, a guy called Giordano Savarin was released and duly murdered both his mother and father. Basaglia and another colleague had been once again experimented with for manslaughter and, once again, each had been cleared.
In 1977, a lady who had been turned down for treatment method at Gorizia drowned her four 12 months-old son, Paolo, in the bath. These deaths reminded everybody that psychiatrists have been taking significant risks, and gave ample ammunition to those who desired the experimentation to quit.
In Italy, the literature on Basaglia tends in direction of either idealisation or demonisation – he’s regarded both a secular saint or a dangerous radical. John Foot provides a significantly much more rounded, and fair, portrait of a challenging, committed man: a medical professional who was a hefty smoker, a guy who distrusted energy but knew how to operate with it, somebody whose jacket pockets have been total of notes and numbers, who had the power to remain up all evening speaking but may fall asleep mid-conversation. His workplace door was often open. One buddy remembered that he utilised to reply the telephone in other people’s houses. He was driven, but often, it seems, grounded.
What’s interesting is that for all the adulation, Basaglia was circumspect about what he’d accomplished. He desired not to reform the institution of the asylum, but to abolish it. He didn’t want to produce a “golden cage”, but to do away with the cage altogether (one thing he later accomplished in Trieste). He recognised that he, himself, had become an institution, and was acutely mindful of the likelihood of getting co-opted. A single of his favourite lines, borrowed from Sartre, was that “Ideologies are freedom even though they are in growth, oppression when they are formed.”
Foot exhibits very plainly that Basaglia was component of a nationwide motion, rather than a lone idealist. There were several other psychiatrists and politicians struggling to do equivalent factors in other components of the country – in Parma, Reggio Emilia, Perugia and Arezzo – and the interaction in between the politicians and medics, among the outdoors and the within of the asylums, is constantly intriguing. Mario Tommasini, a crusader towards the horrors of the asylum in Colorno, is brilliantly portrayed. Basaglia’s wife, Franca, is shown to be an integral contributor to all the debates and books. Theéquipe in Gorizia is depicted not as some monolithic, united crew, but as a conflicted group attempting to accommodate various ideas and egos.
In numerous ways, the true story is what occurred soon after Basaglia’s law was passed: how households and communities did or didn’t cope with those launched sufferers, and how individuals sufferers themselves fared. The fates of individuals pioneering psychiatrists is also telling. Clancy Sigal, who with Laing aided set up Kingsley Hall and the Philadelphia Association, is quoted in a footnote observing that “many physicians and nurses” were burnt out by “too-near proximity to the fierce heat of schizophrenia”: the expense of changing aloofness with solidarity was typically incredibly higher. It all helps make for a fascinating, nuanced narrative in which the lines between the sick and the nicely, amongst the democratic free planet and a violent, repressive 1, are repeatedly blurred.
Tobias Jones’s A Spot of Refuge is published by Quercus.
• To purchase The Guy Who Closed the Asylums for £16 go to bookshop.theguardian.com or phone 0330 333 6846. Free United kingdom p&p in excess of £10, online orders only. Cellphone orders min p&p of £1.99.
When the British Healthcare Journal recently asked John Ashton to describe himself in three phrases, the president of the Uk Faculty of Public Overall health, chose “visionary, outspoken, impatient”. An hour in his organization confirms all 3 traits, and “loquacious” and “political” have to have been close contenders for inclusion also. If garrulousness was an Olympic sport, he would have a gold medal. His solutions routinely but engagingly veer way off-subject, and grow to be element historical past tutorial, element individual story and portion refreshingly authentic diagnosis of the nation’s most pressing overall health ills – many of which, in his view, are not healthcare in origin.
Asked to determine the country’s most significant public well being difficulties Ashton does not cite obesity, smoking or alcohol. “One is the increasing inequalities in people’s position, income and manage in excess of their lives more than the last twenty or thirty many years. Tons of individuals are becoming left behind. Outside the wealthy parts of the country people are living miserable, quick lives, with a good deal more sick-wellness than men and women in the far more advantaged components of the country.
“Becoming a northerner, I am aware that a lot of individuals in the more advantaged components of the south-east have no awareness at all of what individuals are up against in some other components of the country. I’m speaking about men and women on the west coast of Cumbria or in parts of north Liverpool or east Manchester where nobody’s worked for two or 3 generations, they can’t put meals on the table and the youngsters can not take element in school trips, so individuals young children are expanding up as 2nd-class citizens relative to other young folks”, he stresses. All this matters, he adds, because of the massive distinctions in daily life expectancy among rich and bad up to a decade among Glasgow and Surrey, for example.
Ashton’s instruction in psychiatry before he turned to public overall health emerges when he talks, with the two passion and disappointment, about what he says is the expanding burden of mental sick-well being. He blames that on a disparate list including the “intransigent” epidemic of obesity that can be each a result in of and impact of depression, addictive behaviours, the changing roles in male-female relationships and the escalating sexualisation of young people, particularly girls.
“The condition of grownup males is of increasing concern due to the fact suicide has been going up in working-age men, specially the below-40s. There is something in the dramatically changed place of males in society vis-a-vis females and vis-a-vis the labour marketplace that is affecting men’s self-esteem and self-self-confidence as a consequence of this dislocation, with the reduction in their traditional role as breadwinners”, he says.
His main worry, although, is young individuals. Rising divorce costs, residing away from your loved ones, a lack of help for parents, widespread youth unemployment, and fact that “bringing up young children is a really lonely business” are all creating young children and younger men and women who, uncertain of their location in the globe, are increasingly troubled, he says.
“We’ve acquired youthful men and women who are self-harming, whose lifestyles will consequence in troubles later on in life – the alcohol, the drugs, the lack of self-esteem – but our kid and adolescent mental well being solutions are a disgrace. They are in crisis. We’re not stopping difficulties in young individuals and we’re not responding to them when they get them. Folks can not get witnessed, even when they are genuinely sick”.
The FPH’s annual conference, which commences nowadays in Manchester, involves a debate on what public wellness experts can do to tackle the objectification of youthful men and females, notably the latter, by means of clothes, music, specially promotional video clips, the pornography industry and the media.
“The fact that a third of ladies have now had sex by the time they are 13 is element of a sexualised culture that can often be adverse in final result, such as pregnancy and disease, but can also be measured in its impact on psychological health”, says Ashton.
He bemoans that National Institute for Overall health and Clinical Excellence tips on sex schooling for youthful men and women have gathered dust on schooling secretary Michael Gove’s desk given that 2010.
“Classroom teachers will tell you that boys are hunting at pornography on their iPhones at the age of eleven,twelve and 13. This is where they are receiving their intercourse data from, because we’re not offering them correct intercourse and relationships education.”
If only credit card companies this kind of as Visa would, on ethical grounds, cease allowing clients to shell out for porn with their cards, the multibillion pound business would no longer be so capable to do its damage, Ashton suggests.
He is effortlessly the most colourful of the senior physicians at the helm of the health care royal colleges and their constituent groups. (The FPH represents 3,300 public wellness specialists across the Uk operating in the NHS, academia, NGOs and English neighborhood government). That’s partly because no other health care large cheese would ever dress in a pink shirt, pink stripy tie and cream jacket, but also because he speaks his thoughts to a degree his peers may take into account reckless.
The Liverpool-born Labour party stalwart is an virtually identikit leftwing public wellness physician, describing his politics as “pragmatically radical”, although he surprisingly names Denis Healey alongside Tony Benn and Ken Livingstone as politicians he admires.
The Sunday Occasions was wrong to report last 12 months that he supports reducing the age of consent from 16 to 15, he insists. What he actually stated, he maintains, is that if Britain does not tackle the roots of “early sexualisation”, then legalising intercourse at 15 might be needed.
Ashton is not shy about detailing unconventional suggestions. “When you search at the way we lead our lives, the anxiety folks are underneath, the strain on time and sickness absence, mental health is plainly a significant situation. We ought to be moving in the direction of a four-day week simply because you have acquired a proportion of men and women who are functioning too challenging and a proportion that haven’t acquired jobs. The lunch-hour has gone individuals just have a sandwich at their desk and carry on functioning”, he explains.
“So we want a four-day week so that folks can take pleasure in their lives, have more time with their families, and maybe minimize high blood stress simply because folks might commence doing exercises on that further day. It would suggest that men and women may well smile a lot more and be happier and increase general overall health.”
Age 67.
Lives Cumbria.
Household Married 4 sons, two stepsons.
Education Quarry Financial institution large college, Liverpool Newcastle-upon-Tyne healthcare college London College of Hygiene and Tropical Medication (LSHTM).
Job 2013-current: president, Faculty of Public Health 2006 -13: director, public health (PH)/county healthcare officer (MO), Cumbria 1993-2006: North West regional director, PH/MO 1993-94: regional director, PH/MO, Mersey Regional Health Authority 1990-93: director, Liverpool Public Overall health Observatory 1983-93: senior lecturer/professor, public overall health, University of Liverpool 1980-82: senior lecturer, LSHTM 1975-79: senior registrar, lecturer, University of Southampton 1971-75: principal/registrar/SHO, Newcastle on Tyne & Northumberland 1970-71: property surgeon, Newcastle hospitals.
Public life Chairs in various health-related colleges and universities. CBE for outstanding services to the NHS.
Interests Smallholding, walking, cycling, Liverpool FC.
Is it time to refer to the baseball elbow injury that outcomes in Tommy John surgeries as an epidemic? There have been approximately fifty Tommy John surgeries on expert baseball players in 2013. The number of specialist baseball players opting for Tommy John surgical procedure in 2014 is at forty-5. The impact of that variety is felt when it is regarded that Key League Baseball has not even reached the midpoint in the 2014 championship season.
“Tommy John surgical treatment is on a record speed this 12 months for elite degree pitchers,” said Dr. John Knight of The Hand and Wrist Institute. ”This damage is quite possibly a profession ender at any level. The age for UCL injuries is dropping as pitchers are throwing as well hard and also many pitches. The dilemma is the culture of growing competition to get to the pro degree requiring pitchers at an early age to throw with maximum work.”
UCL is quick for ulnar collateral ligament, and injuries to that ligament are identified to trigger an early termination to a baseball player’s profession. The truth that Main League Baseball will soon have as several gamers struggling from this kind of injuries and opting for Tommy John surgical treatment before the 2014 All-Star break as the league had in the entirety of the 2013 championship season leaves a lot of concerned about the tension becoming positioned on baseball gamers.
MLB pitcher Dustin McGowan had Tommy John surgical treatment right after six commences in Double-A (Photo credit score: Wikipedia)
The American Sports activities Medication Institute (ASMI) is not frightened to label the proliferation of Tommy John injuries as an epidemic. In a position statement launched in Could 2014, the ASMI implies that the epidemic is largely connected to UCL issues in gamers that arose when they have been adolescent amateurs.
“To have a opportunity of stemming the tide of Tommy John injuries, one has to start off with youngsters initial touching a baseball,” added Dr. Knight. ”Children as early as four years old are throwing a hefty baseball. They are throwing too much. They are throwing with greatest velocity as there has been an more than emphasis on far more is far better. All of this leads to enhance stress and torque across the development plates and ligaments in a establishing elbow, likely setting up the elbow for greatest weakening of the soft tissues and inability to hold up more than time. The prevention should begin in the establishing years with specific attention to pitch counts in innings and video games, limiting the variety of innings pitched and higher attention to appropriate biomechanics.”
The ASMI offers a record of 9 suggestions for specialist pitchers to minimize the risk of possessing to undergo Tommy John injury. The suggestions contain not constantly pitching with one hundred% energy and becoming wary of pitching in winter league baseball.
A Tommy John surgery epidemic is not only devastating from a healthcare-relevant place, but also can serve as a main setback for specialist baseball organizations. Despite some who declare that going under the knife truly improves the performance of baseball players, it at least serves as a short-term setback for teams that need to have their best prospective customers to perform these days. Further, the studies that declare Tommy John surgical procedure improves functionality in excess of time might be heavily flawed.
Darren Heitner is a attorney and the Founder of South Florida-based HEITNER LEGAL, P.L.L.C., which has a target on Sports activities Law and Contracts.
Wonderful proposals recommend placing five million added individuals on statins to avert fewer than 500 deaths a year. Photograph: Alamy
Public well being is by no means far from the information in any week. Let’s commence this ’round up’ with the ‘Roundup-ready’ soya bean.
The Chinese army is banning genetically modified food items like Roundup prepared soybeans.
The Roundup prepared soya bean is not far more nutritious, even though – it can survive in a swamp of glyphosate (or Roundup, the weed killer). The Chinese are concerned that pesticide residues are leading to birth defects, depression, infertility and other afflictions.
The harms from each new fantastic factor consider time to appear, but the positive aspects are obvious, up-front and overstated. This was a key theme of the second science and technological innovation decide on committee inquiry on NHS screening programmes. Health-related innovation outstrips the potential of communicators to help patients and the public with ample info to make informed choices. Public wellness practitioners, myself integrated, have been guilty of not communicating the full information, fearful that these may well reduce screening coverage and not deliver the advantage we anticipate. Availability of very good clear information, to inform option and consent is the new critical.
NHS well being checks came under scrutiny by the decide on committee. The Danish randomised controlled Inter-99 trial in the BMJ advised there was no life conserving from common wellness checks. NHS checks don’t meet screening criteria and had been railroaded into the NHS constitution with out the usual evaluation by the National Screening Committee. Margaret McCartney, GP and broadcaster, advised the pick committee screening inquiry that the tests represented hidden harms to people but also meant money was not invested on other preventive measures.
Lower off factors of clinical exams, informed selection and population overall health advantage have been also newsworthy in the debate above who should get a statin. According to Nice’s Prof Mark Baker, the proposals are an provide of therapy, not a necessity, and assistance informed decision. The Good proposals suggest placing 5 million further men and women on statins to avert fewer than 500 deaths a yr. For each death postponed, 10,000 people will have to take a statin to no objective. I am with the dissenters on this: it truly is above-medicalisation.
1 of the nationwide screening criteria says do not go to screening right up until you have exhausted all preventive measures. Need to we actually display for lung cancer? Are we positive we have carried out every thing we can to avoid smoking? Our well being leaders, like John Ashton, president of the Faculty of Public Well being, don’t consider so: they have written this week to the BMJ and the health secretary to velocity up standardised cigarette packaging.
The pre-diabetes prevalence in Uk adults has improved to a terrifying 35%, as Coca-Cola launches a new decrease sugar merchandise alongside fiscal assistance for three nearby authority “park-life” initiatives. Is this accountable advertising of a more healthy item? Aseem Malhotra from Action on Sugar isn’t going to consider so:
Fundamentally, this is about a business launching a sugary solution to motivate more men and women to consume a substance that contributes to a assortment of dietary and overall health-relevant troubles, including diabetes. Coca-Cola seems to be utilizing the cover of the government’s discredited duty deal to seek acclaim for bringing out a item that nonetheless contains in excess of four teaspoons of sugar per 330ml can, which equates to 1-quarter of a child’s daily suggested greatest consumption of sugar.
It truly is nevertheless peddling a lot more sugar than we need if we need to have to have any.
The nationwide abortion statistics appeared with no a lot fanfare displaying a continued fall in abortion rates but worrying trends in abortion for girls who have had kids. Here once more public knowledge and selection comes into question – inadequate contraceptive solutions for older women? Males not taking the snip?
There is also a public overall health nutrition angle, as the British Pregnancy Advisory Service pointed out:
Neural tube defects (NTDs) this kind of as spina bifida and anencephaly are prevalent as conditions underneath which Ground E abortions are carried out. BPAS is saddened that the government continues to delay the mandatory fortification of flour with folic acid, which would markedly decrease the incidence of NTDs and the variety of couples needing to make the difficult choice to end what is usually a significantly desired pregnancy.
Amen to that.
So there it is, we are above-reliant on technologies that make someone an extraordinary revenue and hold the masses dependent and largely ignorant of harm. There are no technological fixes that come with out unintended harms.
Prevention is better than remedy, especially as there is no remedy. Prevention is also much better than early detection of illness, specially the place finding it early signifies residing with a daily life of ineffective treatment method, anxiety, or worse, a lifetime lower short. Far more public advantage comes about, for less price, via nationwide action, legislation, regulation and taxation. Reducing that pre-diabetic condition of the British public, alongside minimizing weight problems, will come about by way of the largely unsexy, largely unprofitable, fundamental public overall health tips to consume much less and move far more, cease smoking and lower out sugar. The suggestions on that is the exact same whether or not you have a wellness verify or not.
These themes will be talked about at the forthcoming Well being+Care conference. Overall health+Care 2014 will take place on 25-26 June at ExCel, London. Passes are free for NHS and public sector teams, but you do require to register in advance.
Dr John Middleton is vice president of the UK’s Faculty of Public Wellness
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