I almost didn’t write this. It wasn’t from not wanting to. I cradled my head in my hands, desperate to contribute to the reams of social media positivity I had seen surrounding Mental Health Awareness Week.
I almost didn’t – couldn’t – because I was depressed.
There came a certain point in my experience of being LGBT where I accepted that I had to be strong and uncompromising in the face of disapproving glances and withering remarks. I made a pact to throw myself into my community with zeal, no matter how exhausting, and to make full use of the privileges I was afforded in the tolerant metropolis I’d landed in.
And yet, for some reason, I find this an incredibly difficult attitude to transfer over to my struggle with depression. I will share with my co-workers that I am going on a date with a man or going to an LGBT-themed event with an almost belligerent pride, but am overwhelmed with fear in having to admit to those same people that I’m leaving slightly early to see my therapist or that I need to take some time off due to another episode.
Indeed, the word “depression” still has a bite to it, in the way that the word “gay” did when I first dared to say it to someone else in reference to myself. The tone of my voice takes on an odd quality as I approach it in a sentence, to the point where I sound intolerably meek by the time “depression” tumbles out.
The thing is, in many cases, mental illness and being queer go hand in hand. It’s an uncomfortable but important reality that LGBT youth are four times more likely to kill themselves than their heterosexual counterparts. More than half of individuals who identify as transgender experience depression or anxiety. Even among Stonewall’s own staff, people who dedicate themselves to the betterment and improved health of our community, 86% have experienced mental health issues first-hand. It’s a morbid point to make, but it makes perfect sense that we, as a community, struggle disproportionately.
At a recent event I attended, set up to train LGBT role models to visit schools and teach children about homophobia, no one explicitly mentioned their struggles with mental illness. We told one another stories of how we had come to accept ourselves in the face of adversity, talking in riddles about “dark times” or “feeling down” or being a “bit too much of a party animal”. But these problems have other names – depression, anxiety, addiction – that we consistently avoid, despite being in a community in which a large percentage of us will have undergone similar experiences.
And this phenomenon replays itself over and over. Despite there being a common understanding between me and my queer friends that we’ve probably all been vilified in the same way and made to feel a similar flavour of inadequate, we will rarely acknowledge, even within the safe boundaries of friendship, that this has had a lasting impact on our ability to maintain a healthy self-image.
But part of being proud of who we are as LGBT people is being able to be open about the struggles we’ve faced. It’s in naming and wearing the uncomfortable badges of anxiety, depression and addiction that we take the first step towards fully accepting mental illness as an important part of our collective identity. After all, how can we be true role models to the next generation if we refuse to tell the whole story?
And so, this Mental Health Awareness Week, I’m issuing a challenge to my community. If you are LGBT and suffer from a mental illness, be defiant in your acceptance of it in the same way that you would about your sexuality or gender identity. Bring it up, speak it out and feel sure that your voice, however seemingly small or insignificant, is a valid one. After all, we have been, and will always be, a community of fighters – it’s about time we dared to show our battle scars.
The death of a man after prolonged restraint by police on a mental health ward was caused in part by “disproportionate and unreasonable” use of force, pain compliance techniques and multiple mechanical restraints, an inquest has found.
The narrative conclusion, which came after the coroner ruled out a verdict of unlawful killing, found fault with both police officers and medics involved in the death of Olaseni Lewis at Bethlem Royal hospital in south London in 2010.
Lewis, 23, an IT graduate with no prior history of mental illness, collapsed at the hospital after being taken there by relatives on 31 August 2010. He never regained consciousness and was pronounced dead at Croydon University hospital on 4 September.
A postmortem examination found he had suffered a hypoxic brain injury, which occurs when the brain is starved of oxygen, jurors heard on the second day of the inquest.
Early in the inquest, Lewis’s mother, Ajibola Lewis, recalled how a nurse at the Maudsley hospital in south London, had warned her not to allow him to be transferred to Bethlem, where the incident occurred.
“She said to me, ‘Look, don’t let him go to the Bethlem, don’t let him go there,’” Ajibola Lewis said. However, she took the decision, on the advice of doctors, that her son should attend the mental health hospital as a voluntary patient.
The case only came to inquest after years of investigations into who should be held responsible for Lewis’s death. In 2015, following an investigation by the Independent Police Complaints Commission, the Crown Prosecution Service determined that the officers involved had no criminal case to answer.
Last year, it was decided that no charges of corporate homicide would be brought against the South London and Maudsley NHS foundation trust, which manages Bethlem, after it was investigated by Devon and Cornwall police.
A Health and Safety Executive investigation into Lewis’s death is pending following the conclusion of the inquest.
Hundreds of private patients of a surgeon convicted of carrying out needless breast operations are seeking compensation after nearly £18m worth of claims were made against the NHS.
Ian Paterson, 59, was convicted on Friday of 17 counts of wounding with intent and three counts of unlawful wounding against 10 patients, upon whom he conducted “extensive, life-changing operations for no medically justifiable reason”.
More than 250 NHS patients have received payouts after being treated by the surgeon and it has now emerged that around 350 patients who underwent treatment privately at clinics owned by Spire Healthcare in the West Midlands are also taking civil action against Paterson and the firm.
Paterson, described in court by one victim as being “like God”, lied to patients and exaggerated or invented the risk of cancer to convince them to go under his knife.
Thompsons Solicitors, a firm representing the private patients, said the Spire Healthcare’s treatment of those who complained was “shabby”.
“We are determined to secure appropriate compensation for every single one of our clients, some of whom found the courage to come forward only as recently as four weeks ago,” said Linda Millband, lead national lawyer at the firm.
“Spire needs to face up to its responsibilities, because they let him operate well after he was suspended by the NHS.”
A freedom of information request revealed the NHS has resolved 256 cases, paying out £9.5m in compensation and £8.2m in costs, while a further 25 cases are still to be heard.
Paterson, who was suspended by the General Medical Council in 2012, lied to patients and exaggerated or invented the risk of cancer in order to convince them to go under the knife.
He sobbed as the jury returned the guilty verdicts on Friday at Nottingham crown court. The surgeon was released on conditional bail ahead of sentencing in May, when he faces a custodial sentence.
One patient who gave evidence in the trial had 27 biopsy cores taken from her healthy right breast and had “absolutely not” received medical best practice.
A Spire Healthcare spokesman said: “What Mr Paterson did in our hospitals, in other private hospitals and in the NHS, absolutely should not have happened and today justice has been done.
“We would like to reiterate how truly sorry we are for the distress experienced by any patients affected by this case. We can say unequivocally that we have learned the lessons from these events.
“We commissioned a thorough independent investigation and have fully implemented all of the recommendations.”
Mental health experts have praised Prince Harry for revealing that he sought counselling after 20 years of bottling up his grief over his mother’s death.
The prince said he had suppressed his emotions after losing his mother, Princess Diana, when he was 12. He took up boxing to help cope with feelings of aggression before finally seeking counselling.
“I have probably been very close to a complete breakdown on numerous occasions when all sorts of grief and all sorts of lies and misconceptions and everything are coming to you from every angle,” he said in an interview with the Telegraph.
Sir Simon Wessely, the president of the Royal College of Psychiatrists, said the prince had achieved more in terms of communicating mental health issues in a 25-minute interview than he had in a 25-year career.
“He has a reach across the world that people like me can only dream – he will have communicated in a way that I have been working all my life to achieve,” he said.
Wessely said grief – “though raw, painful and uncomfortable” – should not be viewed as a mental health problem and, for some, coping with it in silence could be the right approach.
“It’s not rocket science, and we should be wary of applying an orthodox approach to the individual experience of grief,” he said. “However there are times when prolonged grief can become a barrier, preventing us from moving on in life, and then it can become a problem which may perhaps need help.”
Marjorie Wallace, founder of the mental health charity Sane, said: “It’s done more good than many many campaigns. It’s given a message of hope that feelings left for too long can become malignant – but that it is never too late to seek help.”
Paul Farmer, chief executive of the Mind, said the interview would have a huge impact. “It’s inspiring to see Prince Harry speaking out about his experiences. It shows how far we have come in changing public attitudes to mental health that someone so high-profile can open up about something so difficult and personal,” he said.
“We know that this will have a huge impact on people who are still struggling in silence with their mental health – every time someone in the public eye speaks up we know that it encourages ordinary members of the public to do the same.
“Prince Harry speaking so candidly is a true turning point that shows that as a society we must no longer adopt a ‘stiff upper lip’ attitude and that we need to talk openly about mental health, something that affects us all directly.”
Sue Baker, director of the Time to Change mental health charity, said research showed that speaking out helps overturn stigma.
“Prince Harry sharing his experiences of mental health issues and the counselling he sought as a result of losing his mother will have helped change attitudes, not just at home but also overseas. It was a dream of mine 20 years ago that we’d see the royal family join sports people, music stars, politicians and business leaders as well as everyday people in sharing their mental health experiences in all sorts of communities,” she said.
On Twitter there was admiration for the prince for breaking the stigma over speaking of mental health and bereavement. Chuka Umunna, the former Labour shadow cabinet member, tweeted:
Chuka Umunna (@ChukaUmunna)
1/2 Big big respect to Prince Harry for opening up about his mental health and grief https://t.co/zXE3mZmyPm
April 17, 2017
Chuka Umunna (@ChukaUmunna)
2/2 Losing a parent so young is v.tough. I lost my Dad at 13 -doing so in the public eye wld have been harder still https://t.co/zXE3mZmyPm
April 17, 2017
Bryony Gordon, who interviewed the prince, told the BBC: “To hear someone of his profile talking so candidly about the stuff in his head, it’s a watershed moment, it’s so important.”
Gordon, who has had mental health problems, said if when she first became ill aged 12, a member of “the most famous family in the world” had spoken about it, the ensuing decades might have been very different.
“He has taken something massively negative and he’s turning it into a positive,” she said.
Michael Bublé’s wife, Luisana Lopilato, has said their son is recovering and well in her first public comments since the couple announced last year that the three-year-old had cancer.
The Canadian singer and Lopilato, an Argentinian actor, have returned to her home country after Noah, their eldest son, had medical treatment in Los Angeles.
Speaking at a press conference in Buenos Aires for her latest film on Monday, Lopilato, 29, thanked those who had offered their support to the family.
She told reporters: “When things like those that happened to us occur, your take on life changes. It happened to us. Now I value life much more, the now and the today. Thank God, my son is well.”
She went on: “It’s difficult for me to speak about this. It’s very recent and I’m still a bit sensitive about the subject. But the love is daily, when people stop me in the street. It’s wonderful to know that you’re accompanied in life and that people love you.”
Bublé, 41, and Lopilato put their careers on hold following the diagnosis, but she said seeing Noah “grow and being happy” gave her the strength to finish her forthcoming film, Those Who Love, Hate.
Noah was diagnosed in November 2016. Earlier this year the couple released a statement on Facebook saying he was “progressing well” and doctors were optimistic about his future.
When Aino Korhonen*, 69, saw an advert for online mental health therapy in a newspaper, she went to her GP and asked if she could be referred to try it.
The lifelong Helsinki resident had been diagnosed with depression and had attended a few sessions with a psychologist but the two didn’t get along. She remembers: “We didn’t [seem to] talk the same language. I went a couple of times and it didn’t help me at all.”
Korhonen knew it was time to try something different when she turned up for an appointment only to sit and wait until she was informed that the psychologist was ill. “I was shocked. Somehow they hadn’t managed to contact me. I decided this wasn’t working. I couldn’t come here and not see anybody. I needed something else.” she says. Her GP agreed.
While online therapy is viewed with some scepticism in the UK, in Finland the service, Mental Health Hub, is used by every hospital district in the country. It was first set up 10 years ago by Prof Grigori Joffe and Dr Matti Holi at Helsinki University Central hospital in response to fragmented mental health services and because it is hard for patients in rural areas of the sparsely-populated country to get help.
It’s a win-win for patients, for professionals, for [hospital] management and for the taxpayer.
The online portal includes a questionnaire to determine whether users have mental health problems, along with a signposting service to show people where to go for help. The hub also provides self-help tools for those who don’t need professional help. Three years ago, it started offering therapy courses with qualified mental health professionals for people with mild to moderate mood disorders. Anyone can access it but a referral is needed for therapy. The hub also offers education, training, advice and consultation opportunities for mental healthcare professionals, as well as various tools for measuring mental health.
Patients can access computer-assisted cognitive behavioural online therapies for depression, alcohol misuse and a wide rage of anxiety disorders. They log on to watch videos and complete written exercises designed to highlight destructive behaviour and how to avoid it. If they have questions or worries, they can message a mental health professional who will reply to them with advice or encouragement.
It has proved popular. Funded by the hospital district in Helsinki, HUS and the government, in November 2016 the hub had 80,000 unique users, compared with 53,0000 in November 2015 – a rise of 70% year on year. The total number of unique users in 2016 was 545,000, equal to roughly 10% of the Finnish population; this has grown from 218,000 users in 2014 and 400,000 in 2015, the year the hub became available nationwide.
For Korhonen the service was invaluable. She remembers: “I started doing it and good heavens this was very good for me. I could do it very early in the morning because I normally wake up early. I could do it last thing in the evening. The exercises were very versatile. It really worked for me. I started appreciating myself. I changed my harmful beliefs into something creative. I got rid of my automatic negative thoughts. I changed them into positive ones.”
Preliminary evidence shows that the therapy provided works as well as that provided in a more traditional face-to-face setting, according to HUS director of strategy, Dr Visa Honkanen. Research shows that over a three month period, patients’ depression levels reduced by 10 points, as measured by Beck Depression Inventory, a widely-used instrument for measuring the illness. If someone were to have moderate depression and their BDI score dropped 10 points, they would be left with very mild or no depression.
Mental Health Hub was set up partly because it is hard for patients in rural areas to get help. Photograph: Alamy
Honkanen adds, however, that the idea of Mental Health Hub is not failsafe. He asks: “What if we have cases where self help tools say that everything is OK and then a young person harms him/herself. Who is responsible? Of course we would be.” This situation has not arisen yet in Finland but Honkanen recognises that as digital services develop, it is an issue that will come more to the fore. Of course, this situation could occur with face-to-face therapy as well.
The service has been somewhat of a revolution for the healthcare professionals involved. Eero Matti Kovisto, a psychologist based at HUS who does part of his work online, was sceptical at first about whether Mental Health Hub would be effective. “It was scary [to start with], I was just wondering: ‘Does this help anybody?’ I had the feeling that something was missing [from the therapy].”
He recognises that online therapy is not for everyone and Mental Health Hub is only effective for certain mental health problems which don’t require intensive treatment, but he has seen firsthand how it can transform lives. He also sees that it creates a more equal relationship between the professional and the patient and gives more responsibility to the latter for their care. He sees his role as more like that of a coach: “I give my patients comments and they do the therapy independently. It’s a whole different role [for a healthcare professional] and internet therapy is a whole different thing.’
The service is also much cheaper than traditional treatment; the professionals providing therapy can take on a bigger caseload. Kovisto has 20 people he helps online, which just takes up one day a week. Joffe adds: “It’s a win-win for patients, for professionals, for [hospital] management and for the taxpayer.”
As for Korhonen, whose depression almost entirely disappeared after taking the course, she knew it had helped when in November she lost a close family member. “This was a real shock. I had just finished my depression treatment and I felt quite terrible about it. I still grieve but somehow I feel that because of this therapy I was able to manage. I can remember all the good things and be grateful for them. Without the therapy, I don’t know what I would have done.”
*Not her real name
Sarah Johnson was in Finland to learn about what health initiatives are running in the country. The trip was supported by Finpro and Tekes, who had no say in the content of this article.
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Parents who oppose vaccinations on conscientious grounds won’t allowed to enrol their children at New South Wales childcare centres under legislation to be introduced by the state opposition.
Labor leader Luke Foley announced the policy on Sunday and said the legislation, set to be introduced this week, would plug the loophole which had allowed specialist anti-vaccination childcare centres to be set up.
The changes won’t affect children who can’t be vaccinated for medical reasons, such as a specialised cancer treatment.
“We need to be encouraging vaccinations not discouraging them,” Foley said in a statement.
“Vaccinations are the only way to protect against serious diseases like polio, mumps, whooping cough, meningococcal, diphtheria and tetanus.”
Foley said his plan would also cover family day care operations.
The announcement comes after an unvaccinated NSW girl was diagnosed with tetanus earlier this month. It’s believed the seven-year-old picked up the disease through an open wound on her foot while playing in the garden of her northern NSW home.
The case prompted renewed debate in the north coast region, which has some of the lowest immunisation rates in Australia.
The Conservative government is once again aiming to take more from the poor (GPs ordered to stop prescribing some drugs to save cash, 28 March). These treatments will effectively be removed from those currently entitled to free prescriptions (eg recipients of income support or pension guaranteed credit, those having a long-term disability, holding a valid medical exemption certificate or maternity exemption certificate). Doctors have long been advising those who pay for their prescription to buy these over-the-counter medicines at retail price, rather than pay the £8.40 prescription charge. Nothing changes here; it is those who cannot otherwise afford these medicines who will go without. Aidan Shanks Eastry, Kent
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The NHS is to stop giving patients travel vaccinations, gluten-free foods and some drugs that can be bought over the counter in an effort to rescue its ailing finances.
Simon Stevens, the chief executive of NHS England, announced the changes in an interview with the Daily Mail in which he detailed new efforts to get better value for money so that money saved could instead be spent on promising therapies that have recently been developed.
GPs will be told to not prescribe medications such as those for upset stomachs, travel sickness and haemorrhoids in a new drive to eliminate waste from the NHS’s £120bn annual budget.
Stevens said: “We’ve got to tackle some of the waste which is still in the system. The NHS is a very efficient health service but like every country’s health service there is inefficiency and waste.
“There’s £114m being spent on medicine for upset tummies, haemorrhoids, travel sickness, indigestion, [and] and that’s before you get to the £22m-plus on gluten-free that you can also now get at Morrison’s, Lidl or Tescos.
“Part of what we are trying to do is make sure that we make enough headroom to spend money on innovative new drugs by not wasting it on these kind of items.”
Next month, NHS England will start reviewing 10 items which it says are “ineffective, unnecessary [and] inappropriate for prescription on the NHS, or indeed unsafe”, which together cost the service £128m a year. The Department of Health is expected to then issue new guidance advising GPs that they are not prescribed.
They include omega 3 and fish oils; the painkiller fentanyl: lidocaine medicated plasters; a tablet used to treat high blood pressure called doxazosin MR; and a drug called tadalafil, which is used to treat erectile dysfunction, along with gluten-free foods and travel vaccines.
NHS Clinical Commissioners, which represents England’s 209 NHS clinical commissioning groups (CCGs) – the GP-led bodies which hold health budgets locally – has asked NHS England to look into whether the 10 itemsare a good use of scarce cash when the NHS is undergoing the tightest budgetary squeeze in its 69-year history.
Many other common medications could soon be added to the banned list. NHS Englandsaid: “In light of the financial challenges faced by the NHS, further work will consider other medicines which are of relatively low clinical value or priority or are readily available over the counter and in some instances, at far lower cost, such as treatment for coughs and colds, antihistamines, indigestion and heartburn medication and suncream. Guidance will support clinical commissioning groups in making decisions locally about what is prescribed on the NHS.”
NHS bosses hope the moves could ultimately save as much as £400m a year. The service is facing serious financial problems. NHS trusts in England recorded a deficit of £2.45bn last year and are expected to end this financial year almost £1bn in the red again, despite repeated warnings to get their finances in order.
An NHS spokesman said: “New guidelines will advise CCGs on the commissioning of medicines generally assessed as low priority and will provide support to clinical commissioning groups, prescribers and dispensers.
“The increasing demand for prescriptions for medication that can be bought over the counter at relatively low cost, often for self-limiting or minor conditions, underlines the need for all healthcare professionals to work even closer with patients to ensure the best possible value from NHS resources, whilst eliminating wastage and improving patient outcomes.”
Stevens’s money-saving initiative is a foretaste of a major initiative he will unveil on Friday. He will announce details of his long-awaited “delivery plan” to fulfil his pledge, first made in October 2014 in his Five Year Forward View modernisation blueprint, to radically transform how the health service works by 2020 so that it delivers better care and closes the £22bn gap which is expected to open up in its own finances by then in order to remain sustainable.
He will give the go-ahead to between six and 10 of the 44 sustainability and transformation plans (STP), one covering each part of England, which are intended to implement his ideas, which centre on moving a lot of care out of hospitals and treating patients closer to home and keeping them healthier so that they avoid expensive £400-a-night unnecessary stays in hospital.
The STP plans have proved very controversial because they could see dozens of hospitals lose key services, such as their A&E or maternity unit.
Who is suggesting that the pill might protect women from cancer as well as from pregnancy?
The University of Aberdeen, which has been analysing results from the Oral Contraception Study set up by the UK Royal College of General Practitioners more than 40 years ago. There have always been concerns about the mass medication of healthy women, and it has more often been the risks and harms of the pill, rather than its benefits, that have been trumpeted.
So which cancers does the pill protect women from?
The pill protects women from endometrial cancer – cancer of the womb – ovarian and bowel cancer. That had been established. But this, the longest-ever study, says that protection lasts up to 35 years after women stop taking it, and that there are no other cancers connected to it in the long-term.
But doesn’t the pill increase the risk of breast cancer?
Yes, while taking it, but women on the pill are generally young and have a low risk of breast cancer, unless they have a family history. A small increase on a small risk is not much to worry about, and the increased risk disappears within five years of coming off the pill. There is also a small increased risk of cervical cancer, but that also disappears within five years of stopping.
Did the study discover anything else?
Yes. It found that women who take the pill are no more likely to get other sorts of cancers in later life than women who don’t. So, in relation to cancer, researchers say the pill is very safe in the long term.
What have other researchers found?
Researchers at Oxford University published a major review in 2008, which showed that the pill reduced the risk of ovarian cancer by 20% for every five years that a woman took it. Those on it for 15 years cut their risk in half. That’s an attractive idea, because ovarian cancer is not easily detected at an early stage, and kills two-thirds of those who get it. The Oxford scientists published in the Lancet, which ran an editorial calling for the pill to be available over the counter, as opposed to prescription-only, thereby “removing a huge and unnecessary barrier to a potentially powerful cancer-preventing agent”.
In 2015, the same team published a further review on the protection the pill provided against endometrial cancer. Protection lasted for at least 30 years, said Prof Valerie Beral. Women in their 70s were still being protected due to taking the pill earlier in life. “It is time to start saying that not only does it prevent pregnancy, which is why people take it, but you should know you are less likely to get cancer than women who don’t take the pill,” Beral said.
Why would the pill protect from cancer?
Female hormones are implicated in a number of cancers. The pill contains a low dose of the hormone oestrogen, which is linked to breast and cervical cancer, so it raises these risks, as does HRT (hormone-replacement therapy), which is given to women dealing with menopausal symptoms. But it also contains progesterone, which is known to be protective against endometrial cancer.
Aren’t there other risks involved in taking the pill?
Yes, although the NHS says they are small and that “for most women, the benefits of the pill outweigh the risks”. There is a slight increased risk of stroke because oestrogen can cause blood to clot more readily. In the leg, that can cause deep-vein thrombosis. Clots can also form in the lung or cause a stroke or heart attack. The NHS has a list of conditions that make taking the pill more risky, and says that if women have more than one of them, they should find another form of contraception. They include being over 35, being a smoker, being very overweight and having high blood pressure.
So does this mean most women should take the pill for a while in their youth?
If women want to use the pill to prevent pregnancy, the anti-cancer effect is an added bonus, and might make it a more attractive form of contraception. But no medicine is without any side effects at all, and for a small number of people, the pill is a more risky option.
The moderation-better-than-dry theory is built on a fallacious interpretation of statistics (Drinking can be good for the heart – but only in moderation, 23 March). A significant proportion of those over 30 who are absolute abstainers are former alcoholics – many having quit drinking on the basis of urgent medical advice. Though “former and occasional drinkers” were separated from the non-drinkers in the study, the dead former drinkers are notably absent from it. The drinks industry will no doubt be delighted with the apparent results. Kevin Bannon London
• Ian Mitchell’s GP doesn’t need to read the Guardian (Letters, 25 March). If he is like most doctors, he routinely upwardly adjusts patient-reported alcohol consumption by a factor of two, or three, or four. Dr George Rylance Bexhill-on-Sea, East Sussex
• Colin Dexter was apparently of the opinion that had he moved to Rotherham, rather than Oxford, he would never have become a writer (Obituary, 23 March). This may well be true. But, if like Anthony Trollope, he had married a woman from Rotherham, he might have been still more prolific. Martin Brayne Chinley, Derbyshire
• Not only has “anent” (Letters, 24 March) survived in Scotland: it has undergone mutation. Some years ago in the Scottish Office I was asked to clear a draft beginning “I have received your comments on my letter of … , and note your comments thereanent”. Sebastian Robinson Glasgow
• Re the letters about encouraging new cartoonists (15 March and 24 March), before this all goes any further can I just say how much I enjoy the Doonesbury classic cartoons? New cartoonists, yes, but please not at the expense of what seems like an old friend rejuvenated. Bernadette Crowley Wallasey, Merseyside
• I can’t understand why the Scandinavian and Nordic nations are so happy, given the price of their beer (Report, 21 March). Michael Cunningham Wolverhampton
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The best way to protect yourself from any virus is to arm yourself with knowledge of how they operate inside you. Learn their survival mechanisms and vulnerabilities. There are more than 4000 known viruses. Scientists have argued whether viruses are even living beings.
From conception to death, proteins (amino acids) play a huge role in cellular health. Every living being is endowed with both external and innate protective mechanisms to ward off bacteria, viruses, fungi, and intruders. Indeed, pay attention to the protective protein coat that surrounds individual cells. And pay special attention to the enzymes that break down and repair amino acids. This is the key to all disease and a vibrant life.
Viruses invade a cell by changing the structure and permeability of the cell wall. Viruses can’t survive on their own—they must hijack a host cell, inject their own nucleic acid, and replicate themselves like an out of control copy machine. Viruses use a type of agglutinin (big word meaning a substance that glues things to itself) called hemagglutinin to bind themselves to sialic acid links on the surface of epithelial host cells. Once attached, the virus begins to alter the permeability of the host cell wall—it makes the cell wall soft, causes it to bend apart, and creates holes (pores) in the sialic acid links on the surface. Viruses enter the host through these pores to hide inside and evade the immune system. They do this by using an enzyme called neuraminidase. This particular enzyme can catalyze (break apart) sialic acid links on the host cell surface. These two important molecules classify viruses: Hemagglutinin (H) and Neuraminidase (N). Each virus has one type of H and one type of N. H1N1 for example, was responsible for the pandemic of 1918 while the swine flu pandemic was H2N2. As a virus mutates or jumps species, the H and N numbers change to reflect the shift. As newer, more virulent strains of viruses are formed, human antibodies against the older ones no longer recognize them and reinfection can occur.
Neuraminidase is a key player in the ability of the virus to enter and exit the host cell. This enzyme breaks apart chains of sugars and other glycoproteins. Mucin is a protective glycoprotein secreted in the mucus of the respiratory and digestive tract. The sugar molecules attached to mucins give them increased water holding capacity and make them resistant to digestive enzymes. The disruption or pore created in the chain allows the virus to escape the protective mucus fluid in the respiratory tract and travel via the spleen to the brain and other tissues. Viruses have evolved to use this enzyme to their advantage—neuraminidase prevents them from aggregating (sticking) to each other and being trapped in protective mucous.
A key player in virus prevention is the “Aquaporin.” Defined by the Farlex Medical Dictionary (link below): “A member of a family of trans-membrane channel proteins found in epithelial membranes that serve to regulate trans-epithelial water movement in tissues involved in body fluid homeostasis.” In other words, essential membrane proteins that tunnel into every cell, bring essential nutrients into every cell, and carry toxins out of every cell.
Ever heard of them? Doubtful. Are they important? Critical. Aquaporins are essential for cellular hydration and oxygenation. Hydrated cells protect against and remove toxins. Viruses in dehydrated cells have more time to multiply. And so it is with cancer. An external acidic pH, along with cellular dehydration, increased metabolism of sugar, and poor water perfusion—allow cancer cell invasion, replication, and metastasis. (Viral Infections are pH Sensitive; link below)
Neuraminidase inhibitors are effective treatments that work by reducing the fluidity of both the host and virus cell membrane; making it rigid and inhibiting the ability of the virus to enter the host cell. There are several herbal antivirals that are known to do this. Ginger, Rhodiola, Elder, Chinese Skullcap, and Licorice are neuraminidase inhibitors effective against both influenza A and B strains. (Buhner, link below)
A large part of your immune system is located in the gut—so proper digestion is critical. Digestive enzymes, hydrochloric acid, probiotics, and fermented foods are essential for gut health. Viruses, bacteria, fungi, and parasites are all made of protein. Protease enzymes digest protein membranes surrounding viruses, leaving them unprotected and vulnerable to destruction. The Herpes Zoster virus has been successfully treated since 1968 with enzymes and no side effects. The Medical Enzyme Research Institute found that enzymes significantly limit the progression of early stage HIV. In HIV positive patients— enzyme therapy can delay onset of the disease—sometimes permanently. (Enzymes for Life, link below)
Hydrochloric (stomach) acid not only breaks down food, but also kills pretty much every pathogen known to man. Proton pump inhibitors like “the purple pill” inhibit the production of stomach acid. This is counterproductive. Hydrochloric acid supplementation is necessary. Probiotics and fermented foods like kefir, Kombucha, and fermented vegetables contain live cultures that repopulate your gut with beneficial bacteria that restore a healthy microbial balance. Healthy digestion means your immune system can spend less time breaking down food for energy, and more time identifying and destroying pathogens.
Finally—one absolute superstar—Colloidal Silver. Colloidal silver was considered an essential part of the human immune system until the late 1930’s. Ancient Greeks lined water and wine urns with silver. The Romans made poultices for burns. American settlers put silver coins in milk and water to keep it fresh and kill germs. The expression “born with a silver spoon in their mouth” came from the time when wealthy people put silver spoons and silver pacifiers in their children’s mouth to protect them from the germs of commoners. In the bubonic plague of the 1400’s—wealthy people remained mostly unaffected. In 1920, Alfred Searle wrote a book, “The Use of Colloids in Health and Disease,” designed to help doctors understand the healing properties of colloidal silver. Good old Louie Pasteur turned humans against the essential protective innate mechanisms, and critically essential microbes that will soon be our only hope against mutant resistant pathogens.
We’re poised to come full circle. Everything new is simply well forgotten old.
Thomasina Copenhaver is a naturopathic doctor and registered nurse with over 30 years experience in the healthcare profession. Her passion is writing, researching, and empowering all humans with knowledge of healing at the cellular level; to enable them to make educated and informed choices regarding their health. For more information visit her website www.notesfromanaturopath.com or to buy her book, “Notes from a Naturopath” visit Amazon or Barnes and Noble.
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Last year, around 3,500 organs were transplanted into patients in the UK alone. That said, a large number of organs were also discarded because the moment a donor dies, doctors have only eight or so hours to find a patient on the organ register who is a match and can be almost immediately ready for surgery. One recent estimate suggested that as many as 60% of the hearts and lungs donated for transplantation are discarded each year. But a new technology could be about to change this: whole-organ cryopreservation.
This week, Hannah Devlin looks at the past, present, and future of these technologies with University College London’s Professor Barry Fuller. We also hear from Newcastle University bioethicist Dr Simon Woods about some of the ethical issues that arise with any biotechnology, including cryopreservation.
Women who have taken the contraceptive pill are protected from some types of cancer for as long as 30 years after they stopped taking it, according to new research.
Those who have used the pill “during their reproductive years” are less likely to have bowel cancer, endometrial cancer or ovarian cancer than women who had never taken it, a study at the University of Aberdeen found.
Researchers also looked at the risk of all types of cancer in women who have taken the pill during their reproductive years and found it does not lead to new cancer risks later in life.
The results are the latest published from the longest-running study in the world into the effects of taking the contraceptive pill.
Established by the Royal College of General Practitioners in 1968, the Oral Contraception Study was set up to look at the long-term health effects of oral contraceptives.
The latest study, led by Dr Lisa Iversen, relates to 46,000 women followed for up to 44 years.
Iversen, research fellow in the Institute of Applied Health Sciences at the university, said: “Because the study has been going for such a long time we are able to look at the very long-term effects, if there are any, associated with the pill.
“What we found from looking at up to 44 years’ worth of data was that having ever used the pill, women are less likely to get colorectal, endometrial and ovarian cancer.
“So, the protective benefits from using the pill during their reproductive years are lasting for at least 30 years after women have stopped using the pill.
“We were also interested in what the overall balance of all types of cancer is amongst women who have used the pill as they enter the later stages of their life. We did not find any evidence of new cancer risks appearing later in life as women get older.
“These results from the longest-running study in the world into oral contraceptive use are reassuring. Specifically, pill users don’t have an overall increased risk of cancer over their lifetime and that the protective effects of some specific cancers last for at least 30 years.”
The study, which has received funding from bodies including the Medical Research Council, Imperial Cancer Research Fund and the British Heart Foundation, published its latest findings in the American Journal of Obstetrics and Gynaecology.
The ceilings soar impressively high, the stained glass windows are exquisite, and the satin-adorned pews stretch majestically to the dignified altar. Amid the silence punctuated by the barest of sobs, I spot doctors whom I have long lost track of. And row upon row of nurses, still tight years later. As we wait for the service to begin, we imagine we are all silently interrogating our memories about each other. Time parted us for decades before we have gathered in such dreadful circumstances.
“I wanted you to hear it from me,” a colleague had said, audibly upset on the phone. I nearly collided with the pavement when I heard.
She was wonderful, the speakers confirm that morning. Her boss delivers an impassioned eulogy about an inspired clinician and a devoted mother to the children who sometimes tagged along on weekend rounds. Her best friend recalls their last conversation that ended with the doctor saying to the nurse, “Go home, don’t work so hard.”
Her husband quietly expresses gratitude for their years together and grief for the stolen ones. Her parents sit mutely, heads hung low, suddenly and irrevocably aged. A slideshow of pictures, depicting ordinary things – licking ice cream, dropping of the kids, medical graduation, the first day of internship – suddenly turned unmistakably poignant. The audience is frozen in a horrible dream.
Outside, there is more heartbreak. “We have to say goodbye to Mummy, just us,” the children’s father says softly. We, the gathered, hold our breath lest it makes a sound. Gently, under the flowers she so loved, she is lifted into the car. It’s soon a mere dot on the road. There are refreshments but the crowd disperses awkwardly, wordlessly, not trusting ourselves to speak.
We had known each other well enough in our early days, biding time on endless night shifts, watching dawn break, praying that the nurses would save the next page for the day crew. Later, our lives diverged, each assuming the other was successful, busy and content. The final time I saw her was shortly before she died.
It had been a fractious day; I felt brittle, from a distance she looked happy. What would have happened if we had stopped to talk?
If she had asked, “How are you?” I’d almost certainly have smiled, “Fine.”
And if I had asked, “How are you?”
Could she conceivably have replied, “Suicidal”?
After the gut-wrenching news of her suicide starts the inevitable soul-searching. It was a bad boss. No, a troubled marriage. Parenting had taken its toll. Or her disagreeable colleagues. She seemed so normal in the days leading up to it. No, far from it. She was upset, anxious, disillusioned. The only thing you learn is that for someone who was surrounded by observant and intelligent people, no one really knew much at all. No one knew what went through the mind of a vibrant and capable doctor in the prime of her life, who one day decided that life wasn’t worth living anymore.
Unfortunately, this isn’t the first time I have encountered the suicide of a colleague. Some I had known personally; others were brought close through mutual patients, and still others I would never get to meet because they had ended their life before starting a new rotation. In every instance, other doctors did not realise the depth of their colleague’s mental anguish. “I wondered about her but didn’t want to intrude,” someone ruefully recalled. “I didn’t think it was possible,” reflected another.
Four junior doctors have taken their lives in the past six months in Australia.In my busy hospital, I observe a roundabout of students, residents and specialists in difficulty. But how much difficulty? When they say they’re having a bad time, is it a bad week, a dreadful year, or a tortured life? Are they upset about a rejected grant or do they deem their very existence worthless? Forced smiles and tough hides abound in the workplace, where always being “fine” is a badge of honour. This is why it can be so difficult to distinguish doctors who will indeed be fine from those who need help.
There is ample evidence for the high rates of mental illness in doctors, several times greater compared to other professions and the general population. These figures are quoted so frequently at every orientation that awareness should not be an issue. Practically every institution has an employee assistance program that offers confidential help. Some offer free psychiatric evaluation and counselling. And as with other informal medical consults, many psychiatrists will help a colleague in distress, making access to high quality help less of an issue for doctors than many others.
Armed with knowledge and surrounded by advice, why do doctors commit suicide at an alarmingly high rate?
I sometimes fear it may be because as a profession, we are reluctant to swallow the evidence. And if we can’t accept the evidence we can’t help ourselves or others. We can have an intellectual discussion about anxiety, depression or suicide and we can apply the knowledge to our patients but but identifying vulnerability in our own self is altogether different. No matter how many times we hear it, it still doesn’t seem possible that we, or someone like us, could have a mental illness. The consequences seem so vast, the repercussions so numerous that perhaps it’s better to not know the truthful response to “Are you OK?”
Doctors say that the disclosure of mental illness poses a real threat – to license and insurance, career and reputation.
Discrimination, bullying and harassment in medicine are unfortunately never far from the headlines but thanks to brave people who have risked their career, a victimised doctor has more support than ever before. Nonetheless, a career in medicine means always having to keep up with something, whether it’s the latest research, the newest drugs, the next exam or the upcoming promotion. Doctors would like to be perfect at all of these and are genuinely puzzled when life deals them disappointment. It seems ludicrous now but I was dumbfounded when I got my first mark that wasn’t a distinction. Twenty years later, I realised nothing had changed when my registrar failed his specialist exam and told me that “even the walls” were laughing.
When doctors are depressed, their sense of personal failure is compounded by the suspicion that they somehow lack the ability to pull themselves together. The “well” among them can’t understand how the same stressful hospital ward, the same demanding colleagues, the same rocky tenure track can make some of us angry, others sleepless, and yet others suicidal.
In these pressured times, few doctors would be strangers to a variation of the message, “Heard you’re sick. There’s no cover so let us know whether to cancel your patients.” There is no call more disheartening than one that professes to care about the doctor but can seem like a veiled complaint that says, “If you’re sick, we all suffer.” But while it’s quite easy to tell your colleagues that you have pneumonia or a migraine, doctors say that the disclosure of mental illness poses a real threat – to license and insurance, career and reputation. The diagnosis invokes not only sadness but also ignominy, which may be why there are so few well-publicised stories of doctors with mental illness.
For much of my career, I have watched policies, promises and campaigns about combating mental illness and suicide in doctors. Our knowledge is evolving and with it, ways of managing mental illness, but with many lives lost each year, we don’t have the luxury of time.
Since we can’t always read the suffering of our colleagues, humanity in all our professional dealings and concern and compassion for every colleague must be a priority. As well as this, a healthy dose of introspection about how we judge doctors with a mental illness and why we judge them differently, arguably more poorly, than our patients.
When it comes to mental illness, we hear a lot from the experts but not enough from the sufferers. But in fact, nothing would be more welcome than the insights of doctors who have endured mental suffering and worse, been on the brink of suicide. What healed them and who helped them? What could their colleagues have said or done differently at the time? What workplace adjustments would have meant the most? These stories are clearly among us – hearing them could illuminate the dark corners of our understanding and help link theory and practice.
As a profession, we must do more than lament our dead colleagues. Dealing effectively with mental illness and halting suicide among doctors requires curiosity, compassion and practical support. Most importantly, it requires the humility to realise that in the long span of a career, none of us is immune and that those doctors whom we help today could end up saving our life tomorrow.
In Australia, the crisis support service Lifeline is on 13 11 14. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255.
The US Department of Health and Human Services has proposed the elimination of data collection for LGBT seniors from an annual survey that helps determine how billions of dollars are allocated for vital care services.
The National Survey of Older Americans Act Participants (NSOAAP) collects information about services including senior centers, home-delivered meals and transportation. The proposed 2017 survey is missing a question about the sexuality of respondents, which has been included since 2014.
“It’s a very bad sign because to strip LGBT older adults out of the survey suggests that the federal government believes that the needs of this elder population do not matter,” Michael Adams, chief executive officer of Services and Advocacy for LGBT Elders (Sage), told the Guardian.
Alongside basic demographic data, NSOAAP respondents give information as detailed as how many servings of meat they eat per day and what level of help they need for activities such as walking, dressing and eating.
Such information is used to measure the impact of government-funded services and is included in a report in the annual budget.
Adams said it was important to identify LGBT seniors in the survey because they are underserved.
“It doesn’t matter, frankly, whether LGBT elders are eating chicken or steak or fish in a senior center,” he said, “but what does matter is: are they eating in a senior center at all? Are they receiving care management services? Are they receiving caregiver support?”
Sage and other groups lobbied the Obama administration to include a question about sexuality in the survey. One was introduced in 2014.
The surveys from that year, 2015 and 2016 asked: “Which of the following best represents how you think of yourself: lesbian or gay; straight, that is, not lesbian or gay; bisexual; something else [which respondents were asked to clarify later]; refused; and don’t know [which respondents were also asked to clarify].”
A notice to the Federal Register dated 13 March 2017 said “no changes” had been made to survey. However, in its draft form it does not include the sexuality question.
The health department’s Administration for Community Living (ACL) said on a link to the draft that it “does contain modifications from the currently approved collection”. The agency is accepting comments on the proposal until 12 May.
The health department did not immediately respond to a request for comment. Adams said he would welcome a dialogue with the White House.
“In recent years, we have made significant progress in including LGBT elders in federally supported elder services and we will be watching very closely for any efforts to roll that back,” he said.
The disappearance of the sexuality question comes after moves by the White House to eliminate two federal statistical programs, igniting fears among senior statisticians that data that does not fit with administration policy could cease to be collected.
Last month, the Trump administration rescinded an Obama-era protection that allowed students unfettered access to bathrooms and locker rooms that corresponded with their gender identity.
On Monday, Sage launched a campaign to get LGBT supporters to respond to the call for public comments on the survey draft. As of Monday afternoon, nearly 700 people had sent letters opposing the planned change.
Most processed foods will fail to meet salt-reduction targets set this year by Public Health England. This week, research by the Consensus Action on Salt and Health (Cash) showed how out of 28 categories surveyed, only one (bread rolls) will meet the targets. Salt is added to make processed food taste better – 75% of the salt we consume comes from this type of food.
Too much salt, which is linked to heart disease, high blood pressure, strokes and kidney disease, is causing more than 14,000 preventable deaths a year, says Cash. You would expect crisps and ready meals to have a high salt content – and you might also be aware that foods such as bread can contain a lot – but the researchers also found that sweet products, such as Galaxy Ultimate Marshmallow hot chocolate contained salt, with one serving containing 0.8g –more than a typical packet of ready-salted crisps (0.46g). With the current maximum daily recommended intake of salt at 6g – a teaspoon – easily exceeded by many, where else is salt hiding?
Cereal
One 30g serving of Kellogg’s cornflakes contains 0.34g of salt, but even the company’s very sweet cereals, such as Crunchy Nut Cornflakes and Caramel Bites granola, contains the same amount.
Crumpets
Crumpets … 1.55g. Photograph: foodfolio/Alamy
Last year, Cash found that Warburtons liked to use salt in its crumpets, with the highest being its giant crumpet, with 1.55g of salt. Eat two, and you’ve had more than half of your daily salt allowance.
Anchovies
It’s not news that salted fish contain a lot of salt. But the recommended serving size might surprise you. A single fillet is a serving – and contains 9% of your daily salt allowance. Have you seen the size of an anchovy fillet? It’s barely bigger than krill.
Pizza
Tesco Meat Feast pizza … 3.6g Photograph: Tesco
Again, this is about serving size. Do you really only eat half a supermarket pizza? A 290g Pizza Express La Reine pizza, with mushrooms and prosciutto, is supposed to serve two people, according to the manufacturer. Eat the whole thing and you’ll have consumed 3.92g of salt (65% of your RDA). A whole Tesco Meat Feast pizza will deliver 3.6g.
Pre-packed salads
Healthy, yes? It depends what you go for. Waitrose’s hot-smoked salmon and potato salad has 1.6g of salt, more than a quarter of your maximum level; Tesco’s chicken and bacon pasta salad contains two servings, each with 2.3g of salt.
Soup
Soup … 2.6g a can. Photograph: Richard Griffin/Getty Images/iStockphoto
In canned soups, ham or bacon can up the salt content (half a can of pea and ham soup from Crosse & Blackwell contains 1.3g), but many vegetable soups are just as salty. You’ll also get 1.3g of salt in half a can of Heinz vegetable soup and half a carton of New Covent Garden vegetable soup. Hands up if you only eat half a can.
Cheese
Salty cheeses, such as feta (2.51g per 100g) or halloumi (2.71g) have high levels, but other cheeses we might not think of as “salty” also contain a fair bit of salt. A 30g portion of Stilton contains around 10% of your RI, and cheddar doesn’t contain much less.
Hundreds of pregnant women without legal status are avoiding seeking NHS antenatal care because of growing fears that they will be reported to the Home Office or face high medical bills, according to charities that work with vulnerable migrant women.
The Guardian has seen letters from one NHS trust sent to women with complex asylum claims warning they will have their antenatal care cancelled if they fail to bring credit cards to pay fees of more than £5,000 for maternity care. These letters contravene NHS guidelines, which state that maternity care should never be denied.
We’re interested in hearing from other undocumented migrants or people with a complex asylum situation about their difficulties with accessing NHS care.
Please share your experiences in the form below. We understand that this is a sensitive issue and you can respond anonymously if you prefer. We will do our best to keep your responses secure. We will contact you before we publish your responses.
Please share your experiences in the form below and we’ll use a selection in our reporting. We understand that this is a sensitive issue and you can respond anonymously if you prefer. Please do not include any information that you would not want to be published. We will contact you before we publish your responses.
