UK eats almost four times more packaged food than fresh

The UK eats almost four times as much packaged food as it does fresh produce, according to new data, with most of western Europe and north America following a similar pattern.

The packaged food revolution – which includes ready meals and calorific cakes and biscuits – is held at least partly to blame for the rise in obesity in the US and Europe. Fresh food has played a smaller and smaller part in some families’ lives as the pace of life has speeded up over recent decades, working hours have increased and more women have entered the workplace. Set against this is the rise of ever more tasty instant meals.

Euromonitor has analysed data from 54 countries and shown that the balance has shifted from fresh to packaged food in the most developed. In some of the other populous but less developed nations – China, India and Vietnam – the nutrition transition, as obesity experts term it, has not yet reached tipping point and they are still getting most of their calories from fresh food.

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In 2015, the data shows, 85% of the countries Euromonitor looked at consume more calories from packaged food than from fresh. The data relates to sales, but there is an assumption that most food that is bought is also eaten.

Brazil’s population consumed the highest number of calories per person per day as fresh food, out of the nine major countries in the survey, at 1,065 calories. The UK was second to bottom, at 405, above Japan which consumed just 247 calories from fresh food.

The UK bought the second highest calorific load of packaged food – 1,547 per person per day in 2015. Belgium was top, on 1,670 calories. China, Vietnam and India bought the least, with India buying just 164 calories in the form of packaged food.

Taking packaged and fresh food together, Belgium’s population buys the most calories per head, at nearly 2,600. India buys the least, at just over 760 calories per head in 2015.

Sara Petersson, nutrition analyst at Euromonitor International, said that the rise of packaged food was not necessarily all bad. “It is kind of the way we are today. The food we eat today is convenient. It is fast to consume and we don’t have to prepare it. Much of it is high in salt, sugar and fat but there are so many healthier packaged foods coming out all the time,” she said.

Food companies are now looking at reformulating food, to reduce the salt, sugar and fat content, reducing the pack size – which in the case of confectionery will probably result in smaller chocolate bars – and they can direct their customers to healthier lines, such as reduced sugar soft drinks.

But the rise of packaged food is cause for concern among obesity experts.

“Sadly, processed, packaged foods tend to be less healthy,” said Dr Tim Lobstein, director of policy at the World Obesity Federation.

“Better profits can be made from products with a long shelf-life and that can be formulated and branded as a commercial commodity. Fresh and perishable foods have a tough time competing with processed, additive-laden, brightly-packaged products. The logic of mass production means that the least healthy foods will often be the cheapest, and will be widely promoted in lower-income urban areas.”

Last month a professor of neuroscience who won an award for his work on the brain’s reward system advocated that high calorie food should be sold in plain packaging to be less attractive to shoppers.

“Colourful wrapping of high energy foods of course makes you buy more of that stuff and once you have it in your fridge, it’s in front of you every time you open the fridge and ultimately you’re going to eat it and eat too much,” said Wolfram Schultz, of the University of Cambridge.

Euromonitor also reveals that in many countries – 28 of the 54 its analysts examined, including the UK – more calories are bought in the form of alcohol than soft drinks.

“With the current obesity crisis, a lot of bad press has surrounded soft drinks, especially sugar-sweetened beverages,” said Petersson. The government’s proposed sugary drinks tax is aimed at reducing child obesity. However, she said, the data on alcoholic drinks suggests that sugar-sweetened drinks are not the only problem when it comes to adults.

“Of course, the relationship between sugar consumption and obesity/diseases is still crucial,” she said. “However, given the even stronger evidence for the relationship between alcohol consumption and morbidity, this data cannot be disregarded. Instead, this data could be used by soft drinks companies to argue against statements such as ‘soft drinks are primarily to blame for the obesity crisis’ or by policy makers/public health organisations to strengthen incentives against alcohol consumption.”

UK eats almost four times more packaged food than fresh

Paramedic stress: "We"re micro-managed by people checking response times"

Peter (not his real name) has been a paramedic with an NHS regional ambulance service in the south of England for almost 20 years. He took two months’ sick leave because of stress in 2015.

I once turned up at a house where a woman and her daughter were crying hysterically because her husband – a man in his 30s – had passed away from a heart attack. And then the couple’s son came home from school to find his dad lying there and his mum and sister in that state. It was awful. I ended up crying with the family while we waited an hour for the police to arrive.

You do become emotionally involved. You end up putting things like that, which you have witnessed or dealt with, into a filing cabinet in your head, but over the course of a career that filing cabinet fills up.

Paramedics get stressed for many reasons and the dramatically increased demands on NHS ambulance services in the last four or five years have only made that worse.

The job can be stressful and upsetting anyway, given you’re treating an injury or illness or dealing with someone who might die. You’ve got to treat the patient, and deal with anxious relatives. That’s all very tiring and pressurising and very stressful.

And we’re under growing stress because there are too few paramedics to deal properly with the number of people calling 999 and then being sent an ambulance. We’re busy all the time. The response times we’re meant to stick to are a big part of that.

The bosses transfer the pressure they’re under to meet those performance targets on to us. We’re micro-managed by people who spend all day looking at computer screens, checking how response times are going.

We’re supposed to answer Red 1 and Red 2 calls – the most urgent ones – within eight minutes. But the reality of an understaffed service that hasn’t invested in more staff to keep up with growing demand means that that can take 20-30 minutes.

My ambulance service covers a rural part of the country. I’ve ended up driving 50-60 miles to respond to an urgent call, because there was no one else nearer to attend. Driving all that way at high speed, with a blue light on, is very stressful, believe me.

Then there’s the hours. We’re meant to work 12-hour shifts. But it’s never just 12 hours; it’s usually 13, 14 or 15. And we do four shifts in a row. The closure of ambulance stations is a massive issue too. Traditionally paramedics have seen them as almost their homes and the other people working there as like their family, but closures mean we have fewer and fewer of such places that we can come back to and discuss the ups and downs of the day with people who understand.

Stress is very common, especially among those who’ve been on the job for 15-20 years; their coping mechanisms aren’t as fresh as among the younger paramedics. Four of the 30 paramedics at my ambulance station have been off with stress over the last few years. They just couldn’t face coming in for another run of 14- or 15-hour shifts.

I’ve had time off myself for that reason. Two years ago I needed almost two months off because I was so stressed from the demands of the job. The pressure on me had become unreasonable. My stress was quite severe and I’ve never fully recovered, to be honest. My family say it’s really aged me. It’s taken a massive toll.

I’ve seen colleagues with 30 years in the service suddenly decide that they can’t do the job any longer because they can’t cope with all the different demands on us. I’ve got to the point where I don’t want to put my green uniform on any more.

Paramedic stress: "We"re micro-managed by people checking response times"

Labour challenges Hunt over dropping NHS waiting times target

Labour has challenged the health secretary over the legal basis for dropping a commitment on NHS waiting times.

The shadow health secretary, Jon Ashworth, wrote to Jeremy Hunt claiming the government and NHS England were acting unlawfully by accepting that the 18-week target would be missed.

NHS England’s chief executive, Simon Stevens, said he expected waiting times to rise slightly as a “trade-off” for improvement in other areas such as hitting the four-hour A&E target and better cancer care.

Longer waits can be expected for planned operationssuch as hip and knee replacements, cataract removal, hernia operations and laparoscopies.

The NHS target is for 92% of patients to be treated within 18 weeks of referra. Ashworth said: “The absolute nature of this legal duty to meet the 92% is reflected in the NHS constitution.

“The NHS constitution isn’t just a pledge by politicians; it’s a legal guarantee about the standards of care that patients can expect to receive in the English NHS. That includes a guarantee to treatment within 18 weeks, which NHS England have now said they can no longer provide because the government has denied them the funding they need.

“Government ministers need to urgently clarify they are not breaching the NHS constitution and must outline the consequences of denying patients their legal right to treatment within 18 weeks.

“As a first step, the secretary of state must publish his department’s legal advice urgently.

“Earlier this week NHS chiefs announced – without any public consultation or changes to the law – that the NHS will no longer be required to meet the 18-week treatment target because the financial crisis has got so bad. It’s utterly unacceptable and a striking admission of how badly the Tories are running the NHS.

“Since Theresa May became prime minister standards of care for NHS patients have been in a rapid downward spiral. She might be prepared to ignore NHS staff and the public but she can’t just ignore the NHS constitution based on legislation voted upon by parliament.”

On Sky News’ Sophy Ridge on Sunday Ashworth said he thought the NHS needed up to £5bn extra funding this year, suggesting the government should scrap tax cuts in order to pay for the health service.

“We can afford the NHS if the government is prepared to put the money in and make different decisions on tax,” he said.

Asked if he was prepared to consider tax increases to fund the NHS, he said: “I am ready to have that discussion with people about how we fund the NHS.”

But he added that money was being wasted because of the “privatisation agenda” and a failure to deal with public health problems such as obesity.

Labour challenges Hunt over dropping NHS waiting times target

The return of the MMR charlatan fits with our times | Nick Cohen

If you are unlucky, and all of us are unlucky in the end, you will visit a doctor in the confident expectation that they can fix any illness as a mechanic fixes a car and learn of the vast areas of ignorance on the map of medical science. If you are very unlucky, you will take an autistic child to a doctor and learn that “autism” is a vague and flabby label. There isn’t even agreement on what causes it, let alone on what, if anything, might alleviate or cure it.

Into the gap, between inexplicable suffering and the inability to relieve it, pour the conmen. Last week, Andrew Wakefield, the most contemptible of the charlatans, arrived in Britain to exploit the false hopes and fill the nightmares of his native land.

That he is a fraud has been established beyond reasonable doubt. The General Medical Council struck him off in 2010 after, in a superb example of journalism at its best, Brian Deer showed how Wakefield had manipulated research to make a non-existent link between the measles, mumps and rubella vaccine and autism.

Not content with lying, Wakefield exploited his voodoo science for financial gain. The money was not the worst of it. The MMR conspiracy theory sent vaccination rates below the level of herd immunity. As unvaccinated children become teenagers, we are yet to see whether they will pay a price in blood for Wakefield’s fraudulence. Given the threat to public health, the personal enrichment and the neglected fact that Wakefield’s malign fantasy has led parents who vaccinated autistic children needlessly blaming themselves, in my eyes he appears to be a criminal.

If you want to know what is wrong with a country, look at the criminals its courts cannot punish. Just as it was impossible to prosecute bankers after the crash of 2008, so it is impossible now to arrest Wakefield. Rob an old lady of her savings and you go to prison. Rob millions of children of protection against preventable illness and you are endorsed by the Trump administration, which has, inevitably, made its support for the MMR con explicit.

The one good thing Andrew Wakefield has done in his worthless life is show that sick societies are like sick people. They, too, face suffering without relief or prospect of a cure. They, too, are open to exploitation by every variety of crank and fanatic. Nowhere more so than in Trump’s America. At a personal level, Trump’s wife, Melania, promises to sue anyone who says their son, Barron, may be autistic. Her threat suggests the couple have feared, however fleetingly, that they might learn of the pain of the parents of autistic children and of autistic people themselves.

Whatever twinge of sympathy I felt, vanished, however, when I saw that at the political level Trump had said that “doctors lied” about vaccination and has given every indication of pursuing the Wakefield conspiracy theory in office. If he does, it will be a disaster for autistic people. In America, as in the UK, they fall over a cliff edge when they move from child to adulthood. So bad are the services, the US does not know how many autistic adults live in its borders.

Hillary Clinton, who actually talked to autistic people, something vaccination conspirators neglect to do, promised a census. She lost. And now, as Steve Silberman, the author of the magnificent Neurotribes tells me, the Trump administration can indulge in junk science, safe in the knowledge that its billionaire friends will never need public assistance to provide for their autistic children.

The “doctors lied” is the first link between MMR and so many other modern manias. Climate change deniers have to maintain that 97% or more of the world’s scientists are lying. It is easier to believe an unbelievable fiction than contemplate the vast and wrenching changes manmade climate change must bring to our lives. Rather than face them, say Trump and the Anglo-Saxon right, we can retreat into a surprisingly comfortable state of paranoid delusion.

Second, and this point needs emphasising when elements on the right claims to be the champions of the working class (and let us see how long that lasts) and elements on the left blame it for Trump’s victory: conspiracy theories always begin with pseudo-intellectuals.

Anyone who has looked at the work of Holocaust, 9/11 or climate change deniers, will see that it is stuffed with footnotes. It was not a tabloid catering for the “left behind” that began the MMR lie, but the learned medical journal, the Lancet. Its editors did not know they were victims of a fraud. But they ought to have seen that Wakefield’s original 1998 paper was “badly written and had no clear statement of its hypothesis or indeed of its conclusions”, as Ben Goldacre, the debunker of scientific fraud, put it.

Last week, Wakefield did not speak at a working men’s club, but at the supposedly reputable Regent’s University in London. To top that, he was invited to the European parliament, not by a neofascist know-nothing, but by an MEP from a Green party, which readers who have not been paying attention may think is filled with decent people.

Third, the MMR scandal rebuts the myth that we are living in a uniquely mendacious era of web-driven “fake news”. Mainstream national newspaper journalists (including here at the Observer, I am afraid) and BBC and Channel 4 broadcasters amplified Wakefield’s message in the last decade without making the most basic checks. There can be no “post-truth age” for the autistic, for they never had an age of truth to begin with. To put the disgrace of my trade as mildly as I can, if Wakefield were put on trial, there would be hundreds of journalists alongside him in the dock.

Finally, ask yourself why Andrew Wakefield does not recant, when every study of autism and vaccination has shown his original claim to be false. Asking that is like asking why Donald Trump does not cut his links with climate change deniers or Jeremy Corbyn cut his links with the Socialist Workers party. Wakefield would lose his support base. More to the point, as I suspect he, Trump and Corbyn know, the very fools he has encouraged would throw the accusations of corruption he has thrown at others back at him.

Whether you are dealing with climate change or MMR, the final lesson is this: you cannot rely on charlatans to expose themselves. You have tune up your bullshit detector and do the exposing yourself.

The return of the MMR charlatan fits with our times | Nick Cohen

How long do you get with your GP? Doctors" consultation times – in data

The doctor will see you now. But for how long? This week the president of the Royal College of General Practitioners, Dr Helen Stokes-Lampard, said GP consultations in the UK are too short for people with complex health needs.

The average consultaton time in the UK is 10.6 minutes. This figure comes from a 2015 survey by the Commonwealth Fund on behalf of the Health Foundation, which surveyed 12,049 doctors in 11 countries. It was the second-lowest: only Germany had shorter consultation periods, at 10.3 minutes. But in Germany 80% of patients get less than 15 minutes with their GP, compared with 92% in the UK.

There is no standard time in the UK: it’s up to GPs to set the duration of appointments. But Stokes-Lampard told the BBC: “We’ve got a crazy situation whereby GPs are ridiculously overworked, there are too few of us and the whole situation is on the brink.”

Methodology: the survey of 12,049 GPs and primary care physicians in 11 countries, including 1,001 GPs in the UK, was carried out between 2 March and 8 June 2015.

GP consultation times – in data

How long do you get with your GP? Doctors" consultation times – in data

Bed-blocking three times worse than NHS figures show – study

The number of patients trapped in hospital despite being fit to leave is three times higher than official data shows, according to a study.

Nuffield Trust, a health thinktank said far more hospital beds were taken up by patients classed as “delayed transfers of care” than NHS England’s counting system detected.

NHS bosses said the findings bore out their own experience and the official figures hugely underestimated how many people had to stay in hospital because of problems elsewhere.

Nigel Edwards, Nuffield Trust’s chief executive, who undertook the research, said: “Our audits show that up to two-thirds of the patients stuck unnecessarily in hospital beds aren’t actually being counted in the official figures.

“That means that a typical 650-bed hospital may actually have only around 250 beds available for all its emergency patients, once you’ve taken out all the people who could go home if they had more support, and discounted maternity, paediatric and cancer beds.”

Delayed transfers – which some call bed-blocking – are running at their highest ever level, with 193,680 bed days lost because of it in November, according to the most recent official NHS figures.

Edwards cited his thinktank’s own research about bed occupancy trends at three small and medium-sized hospitals NHS hospitals and a separate study of 7,500 bed days in a large number of bigger hospitals.

In one small rural hospital, only 40 (24%) of the 277 patients examined were counted as delayed transfers of care (DToCs). However, 80 others (30%) were also fit to leave, and another 35 (13%) were not medically fit to be discharged but could have been safely looked after in a nursing home if places in them had been available.

Separate research by the Oak Group, a firm that reviews inpatient stays, found the same picture in the bigger hospitals it analysed. “These audits confirmed that significant numbers of patients could be cared for elsewhere; for typically 50%-60% of the acute bed days examined,” Edwards said.

He said 19% could have gone home without receiving any support afterwards, 28% needed nursing or social care support in order to get out of hospital, and 12% needed long-term supported live-in nursing or residential care.

“This failure to record the true situation is significantly increasing the pressure hospitals are facing. Speeding up the discharge of patients who would be better cared for elsewhere needs to be the top priority for the NHS and social services departments,” Edwards added.

Chris Hopson, the chief executive of NHS Employers, which represents NHS trusts, said: “Our hospital members tell us that because the official definition of delayed transfers is so specific, the actual number of patients medically fit to discharge, or who could be cared for in other settings, is much greater than the definition implies. So in that sense the problem of blocked hospital capacity is significantly greater than the DToC figures by themselves suggest.”

Separately, Whitehall’s spending watchdog has concluded that a £5.3bn reserve designed to relieve strain on overcrowded hospitals by integrating health and social care is failing to save money or stem the rise in admissions.

The Better Care Fund has not achieved the main targets set for it when it was established two years ago by the health secretary Jeremy Hunt, according to a report by the National Audit Office.

Health officials hoped to use the fund to reduce emergency admissions by 106,000, but the report discloses that admissions instead rose by 87,000. The fund was supposed to be used to make savings of £511m, but instead spent an additional £311m, the report says.

Officials had aimed to reduce the days lost when patients are ready to leave but cannot do so by 293,000, but instead that figure rose by 185,000, costing £146m more than planned, it adds.

Norman Lamb, the Liberal Democrats’ health spokesman, who helped draw up plans for the fund when a coalition minister, said the report showed the NHS was hurtling towards a “catastrophe” without a bigger financial injection.

“This does not undermine the case for joining up health and social care and ending the irrational divide which too often lets patients down. But it is a clear warning that with demand rising so rapidly, more funding is needed,” he said. “It would be unforgivable for the government not to act in light of these warnings.”

Meg Hillier, the chair of the public accounts committee, which scrutinises public spending for parliament, said the “deep flaws” in the fund were first highlighted two years ago but the warnings had not been heeded by ministers.

Under the Better Care Fund, councils receive money, mainly from the NHS budget, in return for introducing schemes to reduce demand for hospital care.

Auditors found that the Department of Health and NHS England were both over-optimistic about what the fund could achieve.

The NAO did notice some benefits from the fund, such as 90% of local areas agreeing or strongly agreeing that delivery of their plan had improved co-operation between different bodies.

A Department of Health spokesperson said: “The Better Care Fund is just one element of this government’s programme to integrate health and social care for the first time – and as the report recognises, it has already incentivised local areas to work together better. We will build on this for the future in making care even more joined up.”

An NHS England spokesperson said the NAO report was a “statement of the obvious” because the NHS never believed or claimed that cutting hospital budgets to fund social care would by itself save money.

“The obvious lesson for next phase of care integration is that joining up local NHS and council services may be worthwhile, but is not by itself a silver bullet solution to wider pressures on health and social care,” she said.

Bed-blocking three times worse than NHS figures show – study

Cancer rates set to increase six times faster in women than men

Cancer rates will increase nearly six times faster in women than in men over the next 20 years, with obesity partly to blame, experts predict.

As several of the obesity-related cancer types only affect women, the growing number of people of both sexes who are severely overweight is likely to have a greater effect on incidence of the disease among women, according to the analysis by Cancer Research UK.

Cases of ovarian, cervical and oral cancers are predicted to rise the most. Rates will rise by around 0.5% for men and 3% for women, meaning an estimated 4.5 million women and 4.8 million men will be diagnosed with cancer by 2035.

That equates to projected UK cancer rates increasing by approximately 0.5% for men and 3% for women.

The figures were released on the same day as the National Institute for Health and Care Excellence (Nice) announced that it was recommending that the breast cancer drug palbociclib should not be routinely funded on the NHS in England.

Charities decried the decision by the drugs watchdog, stressing the importance of developing and supporting more treatments to help women to survive, but they also urged women to change their lifestyles to minimise their risk.

Cancer Research UK’s chief executive Sir Harpal Kumar said: “These new figures reveal the huge challenge we continue to face, both in the UK and worldwide. Research is at the heart of finding ways to reduce cancer’s burden and ensure more people survive, particularly for hard-to-treat cancers where the outlook for patients is still bleak. We need to keep working hard to reduce the devastating impact cancer can have on so many families.

“The latest figures show that more than 8 million people die from cancer each year across the world. More people die from cancer than Aids, malaria and tuberculosis put together. With more investment into research, we hope to make big improvements over the next 20 years in diagnosing the disease earlier and improving and developing treatments so that by 2034, three in four people will survive their disease.”

Smoking is another factor behind the projected growth of cancer cases among women, which will mean the gap between the number of women and men with the disease narrows. Widespread smoking among women happened later than men and lighting up continues to have a big effect on the number of cancer cases diagnosed each year, says Cancer Research UK.

Sarah Toule, head of health information at the World Cancer Research Fund, said lack of exercise and alcohol consumption were also driving the predicted increase in the UK cancer rate for women.

“It is concerning that rates are predicted to rise so sharply in women, especially as so many cancer cases could be prevented,” she said. “For example, about two in five breast cancer cases in the UK could be prevented if women maintained a healthy weight, were more physically active and didn’t drink alcohol – that’s around 20,000 fewer cases a year. Other cancers that could be reduced by women having a healthier lifestyle include womb and ovary.”

Professor Kevin Fenton, the director of health and wellbeing at Public Health England, said: “The top things we can all do to prevent and reduce the risk of cancer are quitting smoking, maintaining a healthy weight, being physically active and attending cancer screening when invited.”

In draft guidance explaining its reasoning for its advice on palbociclib, which is made by Pfizer, the drug watchdog said that a full course of treatment costs £79,560. Although Nice found that the drug stalled the growth of the cancer for an extra 10 months on average “it was still not enough to make palbociclib cost effective at its current price”.

The watchdog estimates that around 5,500 people in England – out of 45,000 new diagnoses of breast cancer each year – would be eligible for treatment with palbociclib.

Baroness Delyth Morgan, chief executive at Breast Cancer Now, said: “This is the clearest illustration to date that the drug appraisal system is totally unfit for purpose in assessing first-in-class breast cancer medicines.

“Palbociclib could benefit a large proportion of metastatic breast cancer patients and may even be the closest thing these women would have to a cure in their lifetime.”

She urged Pfizer to reconsider its decision not to offer the NHS a discount on the list price and said the pharmaceutical giant must work with Nice to ensure the drug can be made widely available to women as soon as possible.

The Institute of Cancer Research (ICR), with its partner The Royal Marsden NHS Foundation Trust, led a major clinical trial of palbociclib.

Dr Nicholas Turner, team leader in Molecular Oncology at ICR and consultant medical oncologist at The Royal Marsden, said: “Palbociclib is one of the most important advances in treating the most common type of breast cancer in 20 years.

“If the manufacturer, Nice, and NHS England can find a way of making this treatment available for patients, they will substantially improve the lives of patients with breast cancer.”

In December, Nice turned down another breast cancer drug, Kadcyla, made by Roche Pharmaceuticals, on financial grounds, triggering an outcry from patients’ groups who say it prolongs the lives of people who are seriously ill with the disease.

At present there are an estimated 7.4 million men and 6.7 million women being diagnosed with cancer worldwide each year. The disease is the leading cause of death globally, accounting for an estimated 8.2m deaths in 2012 and approximately 15% of all deaths.

Cancer rates set to increase six times faster in women than men

New concerns over BPA as workers exposed to levels 70 times the average

Health concerns over Bisphenol A (BPA), a chemical commonly found in plastic packaging and the lining of food cans, are well documented. Previous studies have linked low levels of BPA to a variety of potential health issues, including obesity, diabetes and fertility problems. A 2008 ruling by the Federal Drug Administration (FDA) found that low exposure to the chemical is safe because it is generally ingested orally and thus eliminated from the body quickly, although research is ongoing to determine the chemical’s impact on human hormones.

However, a new study – the first of its kind in the US – has looked at the exposure levels of people who come into contact with high doses of BPA, and found that employees who directly handle the plasticizing chemical had urine levels of BPA around 70 times greater than that of the average US adult.

The federal study, carried out by the National Institute for Occupational Safety and Health (Niosh), looked at BPA levels in the urine of 78 American manufacturing workers employed at six companies that either manufacture BPA or use it to make other products.

BPA is used in the production of plastic food containers, the lining of food and soda cans, and in thermal receipt paper. Because of the ubiquity of BPA in food containers, and its ability to leach into food or drink, the estrogen-mimicking chemical can be found in the urine of most of the US population. In addition to finding it in urine, studies have found the chemical in breast milk and umbilical cord blood. BPA was originally researched as a potential source of synthetic estrogen before its current use in plastic manufacturing.

“The Niosh study is a wake-up call about the dangers of workplace exposure to BPA,” says Noah Sachs, a professor at the University of Richmond School of Law and director of the Merhige Center for Environmental Studies. “Every company that manufacturers BPA or uses it as a raw material has a responsibility to workers to prevent such excessive BPA exposures. Business-as-usual is putting BPA workers at risk.”

Studies surrounding the long term effects of BPA on health and reproduction have previously centered on consumer exposure. Pressure from consumer advocates led to manufacturers voluntarily removing the chemical from baby bottles and sippy cups in the US. The FDA eventually also banned it from baby formula packaging. Outside the US, a law prohibiting the use of BPA in food packaging of any kind went into effect in France in 2015. The US has attempted to pass similar legislation outlawing the use of BPA in all food containers, most recently with the introduction of the Ban Poisonous Additives Act of 2016.

While the Niosh study highlights the high levels of BPA found in US manufacturing workers, it does not assess any potential health effects from that exposure.
Previous studies in Chinese manufacturing workers, who had similar levels of BPA in their urine to the workers in the Niosh study, found that male employees who handled BPA had lower levels of testosterone, decreased semen quality and higher levels of self-reported sexual dysfunction.

While the Niosh study raises serious concerns, before there are any policy changes, regulatory bodies will require more research with a larger pool of subjects to show the consequences of BPA exposure in manufacturing workers, explained Lori Hoepner, assistant professor at Suny Downstate Medical Center School of Public Health.

Currently, the Occupational Safety and Health Association (Osha) does not set any workplace exposure limit for BPA. Without Osha exposure limits for the chemical, manufacturing workers who are concerned by their exposure to BPA don’t have any real recourse when to avoiding the chemical on the job. “Workers could request reassignment or more protective BPA handling equipment, but they could face retaliation or getting fired,” says Sachs.

To help convince Osha of the potential dangers of BPA exposure for manufacturing workers, a longitudinal study showing the impact of the endocrine disrupting chemical over time would be needed. But longitudinal studies are notoriously expensive and getting manufacturers to agree to the studies would be difficult, explains Hoepner. For example, collecting urine samples multiple times during the workday, as in the Niosh study, is disruptive for companies.

Any kind of policy change from Osha will take years, says Sachs. “We know from past experience that an Osha rulemaking to set a permissible exposure limit can often take five to seven years, with industry challenging it every step of the way.”

Ideally, Osha should initiate that rule making on its own because it is obligated by law to set a standard that assures, to the extent feasible, no “material impairment” of worker health, even if a worker is exposed to that substance for a lifetime.

While there may not be enough evidence yet for Osha to set limits for worker exposure to BPA, amid growing consumer concern over the chemical, scientists and manufacturers have explored alternatives. BPA substitutes like bisphenol F (BPF) and Bisphenol S (BPS) have been used in plastics that are labeled BPA-free to appeal to consumers. “BPA free is a misnomer,” explains Hoepner. “It should really say BPA substitute.” BPF and BPS are very similar in terms of chemical structure to BPA and there are indicators that they may have similar health effects.

Another alternative that has been studied by scientists is using plastic made from plants. “Studies have determined that it is possible to economically and beneficially switch to plant-based plastic,” Hoepner says. “It costs a lot at the start to make the switch but it pays for itself over time.”

Because of the large economic investment needed to make the switch, companies have been reticent to switch their plastic production. But as companies continue to face pressure to switch away from BPA, and consumers become more savvy and discerning about their plastic consumption, manufactures may eventually make the switch as a way to appeal to customers.

For now, there are no new guidelines around BPA exposure for manufacturing workers around the corner, though Sachs is hopeful that the Niosh study will prompt advocates to file petitions with Osha to set permissible exposure limits for BPA.

But, when it comes to any immediate changes, Sachs warns: “I’m not optimistic about any new BPA regulations under the Trump administration, which has already shown that it disregards scientific conclusions.”

New concerns over BPA as workers exposed to levels 70 times the average

Diesel cars are 10 times more toxic than trucks and buses, data shows

Modern diesel cars produce 10 times more toxic air pollution than heavy trucks and buses, new European data has revealed.

The stark difference in emissions of nitrogen oxides (NOx) is due to the much stricter testing applied to large vehicles in the EU, according to the researchers behind a new report. They say the same strict measures must be applied to cars.

NOx pollution is responsible for tens of thousands of early deaths across Europe, with the UK suffering a particularly high toll. Much of the pollution is produced by diesel cars, which on the road emit about six times more than allowed in the official lab-based tests. Following the Volkswagen “dieselgate” scandal, the car tests are due to be toughened, but campaigners say the reforms do not go far enough.

The new report from the International Council on Clean Transportation (ICCT), a research group that played a key role in exposing Volkswagen’s cheating, compared the emissions from trucks and buses in realistic driving conditions with those of cars.

It found that heavy-duty vehicles tested in Germany and Finland emitted about 210mg NOx per kilometre driven, less than half the 500mg/km pumped out by modern diesel cars that meet the highest “Euro 6” standard. However, the buses and trucks have larger engines and burn more diesel per kilometre, meaning that cars produce 10 times more NOx per litre of fuel.

The ICCT analysis showed that manufacturers were able to ensure that heavy duty vehicles kept below pollution limits when on the road, but that emissions from cars soar once in the real world.

Official EU tests for cars are currently limited to laboratory measurements of prototype vehicles. “In contrast, for measurement of NOx emissions from trucks and buses, mobile testing devices became mandatory in 2013. As a consequence, randomly selected vehicles can be tested under real-world driving conditions,” said Peter Mock, managing director of ICCT in Europe.

Changes to the car testing regime in the EU are due to start in September, with mobile devices, called portable emissions measurement systems (PEMS), attached to vehicles as they drive on real roads.

But Mock warned: “Manufacturers will still be allowed to carefully select special prototype cars for emissions testing. Instead, it would be much better to measure the emissions of ordinary mass-production vehicles, obtained from customers who have had been driving them in an ordinary way.”

Such a system is used in the US where the dieselgate scandal first emerged. It will also be put forward for discussion by the European commission on 17 January in Brussels, but the ICCT said it faces resistance from some vehicle manufacturers and EU member states.

In December, the European commission started legal action against the UK and six other EU states for failing to act against car emissions cheating in the wake of the dieselgate scandal. But later the same month, a draft European parliament inquiry found the European commission itself guilty of maladministration for failing to act quickly enough on evidence that defeat devices were being used to game emissions tests.

Evidence that some diesel cars emitted up to four times more NOx pollution than a bus was revealed in 2015. Catherine Bearder, a Liberal Democrat MEP and a lead negotiator on the EU’s air quality law, said “It is disgraceful that car manufacturers have failed to reduce deadly emissions when the technology to do so is affordable and readily available. The dramatic reduction in NOx emissions from heavier vehicles is a result of far stricter EU tests, in place since 2011, that reflect real-world driving conditions. If buses and trucks can comply with these limits, there’s no reason cars can’t as well.”

Diesel cars are 10 times more toxic than trucks and buses, data shows

I have seen Britain shrouded in darkness before. Better times will come | Harry Leslie Smith

Hope is hard to find in the grey teatime light of this December, because despite all of the holiday cheer around us, darkness gathers. It has been the hardest, saddest and cruellest of years – a sour vintage which has brought to everyone’s doorstep heartache, financial worries and political unease.

Austerity seems eternal, and for many it is as if they are living within a new circle added to Dante’s inferno for the 21st century. Callous and barbarous wars in Yemen and Syria test our faith in humanity, while the unstoppable refugee crisis it produced makes us want to weep in despair for the decrepitude of our civilisation.

Hope is as absent from society today as cash is to a pauper’s wallet because a noxious populism fuelled by hate now smoulders. Everywhere we turn it feels like optimism has been eclipsed by a world we don’t want to recognise as our own. Despair is in the breath of our words because we are frightened.

But as my life has been long, I have seen Britain up against the setting sun of history before. I witnessed our country on its knees from the Great Depression; with its back to the wall and under threat of invasion by the Nazis. Over my nine decades of life, I’ve known despair but never hopelessness.

My hope for a better tomorrow for everyone in our country doesn’t come from our military victories against fascism. It doesn’t come from Churchill’s defiance or the words of present-day politicians. No: the source of hope that has carried me through decades of existence comes from the collective will of my generation in 1945 to beat our swords into ploughshares and harvest a just society through the erection of the welfare state.

My hope has always come from the humanity, kindness and intelligence that inhabits the majority of people who reside on our shores. It may seem dormant now, but it will rise again because those sparks of decency that built the NHS, gave affordable housing to each and every one of us, and provided free education to all, are in each Briton alive today – because you are the children and the grandchildren of my generation. If we did it before, then we can do it again.

The 1945 general election was called after our long and brutal war with Germany. It would decide whether our country would cling to its feudal past or accept a bold egalitarian future. I was 22, a member of the allied occupation force and stationed in Hamburg. And it was there that I cast my ballot for the first time – and it’s been a love affair with democracy ever since.

On the day I voted in that occupied city, which looked more worse for wear than Aleppo does now, sorrow could be found on every street corner because of a dead tyrant’s madness. While I queued to vote, I remember how conscious I was of both what I had endured as a boy and teenager during the Great Depression and what I’d witnessed during the war. I felt by making my mark and voting for a welfare state, I was declaring to my country, my peers and those that did not live to see that election day, that my destiny mattered regardless of my humble station in life. The hope that has kept me going all these years came from that election, when ordinary people said their lives mattered just as much as any elite class.

I have seen Britain shrouded in darkness before. Better times will come | Harry Leslie Smith

Colombia Zika outbreak: microcephaly cases four times higher this year

Cases of microcephaly in Colombia were four times higher this year than last, an increase that coincides with a widespread outbreak of the Zika virus in the country, according to a report released on Friday.

At its peak in July, microcephaly cases in Colombia were nine times higher than in the same month in 2015, according to the US Centers for Disease Control and Prevention’s weekly report on death and disease.

Overall, there were about 9.6 cases of microcephaly per 10,000 live births in Colombia, where the virus infected as many as 20,000 pregnant women since the start of the outbreak there in October 2015.

The numbers reflect a sharp increase in rates of the rare birth defect, but the number of cases was still far lower than those in Brazil, where Zika first arrived in May 2015. As of 3 December, Brazil has confirmed 2,228 cases of microcephaly linked with Zika, and there are 3,173 cases still under investigation.

Those numbers are far higher than the 432 cases of babies born in Colombia with microcephaly in 2016, and another 44 that occurred among fetuses that did not survive the pregnancy, according to the report by researchers at the CDC and the Colombian health department.

The study’s authors said the difference could have resulted from a number of factors, including the fact that women in Colombia had early warning about the risk of microcephaly.

In February, the Colombian ministry of health advised women to consider delaying pregnancy for six months, which may have played a role. During the study period, the number of live births fell by about 18,000 from 2015 to 2016.

Several experts also have suggested that women in Colombia took advantage of more permissive abortion laws, an option that was not available to women in Brazil, where abortion is banned in most instances.

Colombia Zika outbreak: microcephaly cases four times higher this year

The squeezed NHS is responding to difficult times by innovating

Times are hard for the health service: performance is on the decline, the money doesn’t add up, morale is low, there are finite resources and increasing demand. Is it a perfect storm? Or a very long winter of discontent?

NHS Providers has published its new report, The State of the Provider Sector, which gives a clear appraisal — and the picture is, in places, quite gloomy. But we also show how hospitals, mental health, community and ambulance services are responding with ingenuity in such challenging times.

The findings in the report are drawn from a wealth of published data alongside the largest ever survey of NHS trust chairs and chief executives, carried out just a few weeks ago. We had responses from well over half of NHS trusts across England. They raised important concerns, including worries over the workforce and sustaining quality of care at current levels.

Quite rightly these are the conclusions that will capture the headlines. The NHS is seven years into the longest and deepest financial squeeze in its near-70-year history. But amid fears over staffing and funding, it is important not to overlook the work trusts are doing to deal with these challenges, sometimes with great success. In pulling together this report, we have been struck by examples of innovation and improvement. This has spurred us to search for the kernel of gold in this situation.

The key to finding that kernel is to think about patients and service users: they should be at the heart of NHS reform. So whether it’s delayed transfers of care, A&E admissions, or mental health crisis care, it is the combination of improving an individual’s experience and making the system work better that can prove a successful approach.

Overcoming delayed transfers of care is a strong reason to focus on what is keeping mainly frail, elderly people in hospital when they are medically fit enough to leave. At Oxford University hospitals, providers have struggled with one of the worst rates of delays for the past five years but under new leadership and new approaches, Oxford has halved its delays. In effect it grew its own social care provision.

It did this firstly through better collaboration with social care providers and secondly by creating its own social care workforce and capacity. This means people can be discharged straight into the community. This not only provides a better and safer experience for patients but also frees up hospital beds, which improves the flow of patients and generates capacity for planned elective work.

Sometimes navigating the myriad health and care organisations must, to a patient or service user, feel like finding your way through a maze. The whole process can be daunting, frustrating and woefully inefficient.

Southwark and Lambeth Integrated Care Programme (Slic) decided its situation just wasn’t slick enough. It embarked on a “radical” join up of services across the local NHS and local authority social care systems. So GPs, community healthcare, social care and local hospitals came together and put the patient first. Over the past four years the Slic approach has not only stabilised the number of hospital bed days used — quite a feat in the face of exponentially rising demand — it also led to a 61% reduction in the number of nursing home placements.

In terms of mental healthcare, Surrey and Borders partnership has worked with local charities and commissioners across the south to launch Safe Havens — a drop-in service that provides out-of-hours help for anyone experiencing a mental health crisis. It has close links to Frimley Park hospital and provides a safe alternative to using A&E. Six months after opening, the service has helped to reduce psychiatric admissions by 33%. Not only is that a better experience for a service user, it also helps to prevent the ongoing call on expensive resources.

We know that hospitals and other services are running at capacity levels well beyond those of other western economies. We know that the NHS is now missing most of its key performance targets. And we know that it interacts with more than five million patients and service users every week.

But that shouldn’t blind us to what’s happening. With these and other projects, services and programmes that consider the quality of individual experiences and the needs of the wider system together, NHS trusts are innovating, improving care and driving efficiencies. These are the kernels of gold.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

The squeezed NHS is responding to difficult times by innovating

Ginger is 10,000 Times Stronger Than Chemo, Study Shows

Ginger is 10,000 Times Stronger Than Chemo, Study Shows

I cough at all the wrong times. Thank God I"m not Hillary Clinton | David Ferguson

If you are a character in a Victorian novel – which, much to my occasional dismay I am not – you know you’re going to die if, at an otherwise slow plot point, you begin to cough. Within two chapters, your cough will be spraying drops of dark red blood on to your linen kerchief and before long, you’ll be carried off by consumption.

These days we don’t live with the constant threat of tuberculosis and yet, from the way a certain segment of the right wing fever swamp is treating Democratic presidential nominee Hillary Clinton, you’d think she was Fantine from Hugo’s Les Miserables.

Matt Drudge, Sean Hannity, Rush Limbaugh, some ghoul named Steve Malzberg – who probably can’t help it that he’s a dead ringer for 90s make-believe car salesman Joe Isuzu – and even Republican nominee Donald Trump have seized upon Clinton’s seasonal allergies and resulting cough as a sign that she is trembling at death’s door, barely able to function.

“People don’t cough like that,” Malzberg insisted on his Newsmax.com podcast last week. People don’t have coughing fits ‘all the time,’ in public that go on and on and on and on and on and on. Not unless there’s something going on that’s not right.”

Please allow me to disabuse you of that notion, sir. Plenty of people “cough like that,” myself included. According to the Centers for Disease Control and Prevention, an estimated 19.1 adults over 18 were diagnosed with seasonal allergic rhinitis – also known as “hay fever” – in 2014 and 6.1 million children.

I’ve got big sinuses. It’s part of what makes my singing voice able to cut through layers of drums and guitars – a network of large, resonant holes in my skull. My late mother sang opera and had a glorious lyric soprano voice that could fill a whole theater and shake the chandeliers.

Twice a year, for 2 to 4 weeks in the spring and fall, those holes in my head fill up with gunk and it makes my face and forehead feel like a huge throbbing, aching, seriously clogged bottle of rubber cement.

If I don’t get enough sleep, drink quarts of water, eat right and keep my stress levels down, that respiratory distress will move straight down into my chest and I will develop a booming, persistent cough.

For some reason, the fall of 2009 was particularly nasty. I’d quit smoking the year before and thought that would make my seasonal battles with pollen and mold less miserable, but that first year, it seemed to have the opposite effect.

That was when I was a late night classical music DJ. My show went out live to the whole state of Georgia four nights per week. I remember it was Thursday, Sep. 10 because I was queuing up John Adams’ solemn, exquisite symphonic remembrance of the 9/11 victims, On the Transmigration of Souls.

“Our next selection,” I began, “is John Ad–” and I was seized with a violent coughing fit. Most radio consoles have what’s known as a “cough button” for just such an emergency. It mutes your microphone until the cough or sneeze or period of hoarseness passes.

But this coughing fit didn’t pass, it just kept going on and on. I killed my mic and started the music because I wasn’t sure what else to do. I was mortally embarrassed and for an awful moment felt sure I was disgracing the memory of all those people who were killed in the terror attacks of September 11, 2001.

The control room phone rang. I gulped down two swallows of tepid coffee and answered, still weak-voiced and froggy.

“You okay in there?” it was my boss calling from home.

“I’m fine,” I sputtered. “Just fighting for breath.”

He asked if I needed someone to come take over. I said no, I’m fine, it’s already passing. I hung up the phone and it immediately rang again. I picked it up and it was my twin brother calling from his car.

“Boy, that sounded terrible,” he said, laughing. “You’ve really got to quit smoking crack rocks at work.”

“It went out live to the whole state,” I said. “Our listeners probably think I’m dying.”

I wasn’t, though, any more than Hillary Clinton is. The fact is, even an able-bodied, healthy, athletic person like myself can get a cough that sounds like the end of the world. A week later I was back to running four miles a day and breathing like normal.

Sometimes, oh ye right-wing vultures, a cough is just a cough and the woman candidate whose health you’ve never cared one iota about before now is probably just fine, suffering from – as her personal physician disclosed in detail – a round of seasonal allergies.

So, if you’re expecting Hillary Clinton to keel over dead like Mimi, the consumptive heroine of Puccini’s La Boheme, or Hugo’s Fantine, I wouldn’t get my hopes up. I think she’s got a couple of arias to sing first.

I cough at all the wrong times. Thank God I"m not Hillary Clinton | David Ferguson

How real-time data is reducing A&E waiting times

In many trusts, the only way to find out something like how long people are waiting in accident and emergency is to phone the department and ask. “There are not many people at any one time who know what’s going on,” says Marc Farr, director of information at East Kent hospitals university NHS foundation trust. “A hospital has lots of people phoning people all day for information,” he says.

The trust has ended the need for such phone calls. It displays live average emergency waiting times, as well as the number of people waiting, at each of its four hospitals, on its website. As well as informing the public, the business intelligence system helps the trust know when to redirect emergency patients to manage demand.

Farr tells of one situation where they arranged for ambulances to be diverted from one hospital. For six hours, some ambulances that would normally have used Margate’s Queen Mother hospital went to Kent and Canterbury hospital. “You need that type of data and those types of predictions to make those kinds of decisions,” he says.

Related: The NHS needs a strong dose of tech investment

Chris Dodgson, head of information for the Royal Bournemouth and Christchurch hospitals NHS foundation trust, says that real-time information also helps meet the target for 95% of patients to be seen by emergency departments within four hours. This is often affected by other wards being full, preventing patients being moved on from an emergency bed. “You want to know roughly where your blockages are, and this is where real-time information really helps to unpick those questions.”

East Kent shares data with external organisations, including a nursing agency which it pays to support those leaving hospital to return home. “Having a data flow between us prompts us to discharge patients more quickly …”, Farr says. “Having a mobile, real-time view of how many patients they can take at any one time is really helpful.”

East Kent sells the information-sharing systems it has developed through Beautiful Information, a company jointly owned by the trust, Farr – its founder – and other individuals. Its customers in the NHS and private healthcare sectors access up-to-date data on areas such as bed usage, finance and the workforce through online systems including a smartphone app.

Providing data through smartphones means managers can react quickly, but small screens require clear and simple presentation. The information dashboards use the common traffic light code, with green indicating few problems, amber some and red a serious situation.

However, it also offers black for the worst cases and blue for measures that continually meet targets, meaning “you don’t need to keep checking up on these people,” according to Farr. Users of the system can set their own thresholds for each colour code, which he says is important in getting them to trust its warnings.

Royal Bournemouth and Christchurch, which is working on developing its own data visualisations, uses business intelligence to monitor its progress on treating strokes. The Royal College of Physicians works out a grade for hospitals based on more than 50 clinical measures every four months. The trust puts the same data into the same formula to calculate the grade as often as clinicians want to check it, allowing them to redesign the service and see improvements far faster. “The impact of that over the last few months is that if you plot our scores we’ve gone from being at the lower end up to the very top end,” says Dodgson.

The trust has just installed a Microsoft SQL 2016 data warehouse to improve its work in this area. In his previous job at Salisbury NHS foundation trust, Dodgson established a business intelligence system that greatly speeded flows of information. Demand on beds varied significantly throughout the year, so Dodgson and colleagues used three years of data to predict availability for each week. As a result, more staff were placed on-call for the weekend after New Year’s Eve: “It was a really busy weekend,” he says, adding that by publishing what actually happened as well as predictions, staff gained confidence in the accuracy of the forecasts.

Related: Why the closure of care.data is bad news for the NHS and society

Dodgson says business intelligence can be hit by poor-quality information if staff do not have the time to collect it. This can be tackled by using data that is already being gathered for other purposes, such as patient observations.

He has also occasionally met opposition, including a consultant who didn’t like the idea that decreasing lengths of stay could lead to bed closures. He says it is vital to take all views into account: “The numbers say one thing, operationally it says something different. Where do we meet in the middle? Business intelligence from my point of view is about the beginning of a conversation, it’s not about cast-iron certainties, especially when you’re talking about service transformation and change.”

Health and Care Innovation Expo in Manchester on 7 and 8 September will explore the Five Year Forward View in action. High profile health leaders will speak across two stages, while feature zones will explore digital health, personalised medicine and new models of care. NHS colleagues can attend free-of-charge. Click here to register.

Do you work in the NHS? Please take our survey and tell us whether bullying is a problem and how it affects your work.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

How real-time data is reducing A&E waiting times

$1.8 Billion For The L.A. Clippers? That"s 3.27 Occasions A lot more Than Any Other NBA Team, And 120 Times The Team"s Working Revenue

Two swift ideas on the rumor that ex-Microsoft CEO Steve Ballmer is ready to pay up to $ one.8 Billion to get the Clippers.

1st, the NBA is a shared monopoly, which permits group crew owners to charge unusually large charges for the sale of their franchises as prolonged as no other crew owner is looking to promote at the exact same time.

Second, no other NBA proprietor is actively seeking to sell his staff correct now, which gives Donald Sterling a true monopoly in excess of the marketplace for buying an NBA franchise.

Based mostly on these variables, the stars purportedly have aligned for Donald Sterling to have obtained an offer you for the Clippers that is too great for even Montgomery Burns to have refused.

Presuming today’s rumors are correct, let’s put these numbers in viewpoint.

Sterling’s sale to Steve Ballmer would pay out him 3.27 times more for his franchise than the earlier NBA substantial of $ 550 million — paid for the Milwaukee Bucks back in April.  This is not a slight premium over previous NBA staff income.  It turns all previous valuations on their head.

In addition, the rumored $ 1.8 Billion sale price tag for the Clippers represents a worth of 14.06 times the team’s annual revenues and 120 times the team’s working revenue primarily based on values presented in a most recent FORBES report about NBA teams (the report that listed the Clippers’ revenues at $ 128. million and their operating earnings at $ 15. million).

This kind of ratios are astounding not only for a lot of conventional companies, but also for most sports franchise income.

Steve Ballmer. (Photo credit score: Wikipedia)

While territory rights to the Los Angeles market would on one hand appear to make the Clippers uniquely useful, the fact that the Clippers shares these NBA territory rights with the Lakers as effectively as competes to limited extent towards the NHL’s L.A. Kings would have seemed to have offset some of the market place benefits.

In addition, one would have expected the “goodwill” related with the buy of the Clippers to have been tiny if any.  Shedding methods and purportedly racist speech do not normally increase of business’s brand equity.

Prior to Sterling’s racist rant, 1 could have reasonably expected the Clippers franchise to have fetched Donald Sterling amongst $ 500 and $ 800 Million in an average sellers industry.

$ one.eight Billion?  Perhaps, V. Stiviano actually is the best salesperson of all time.

________________________________

Marc Edelman is an Associate Professor of Law at the City University of New York’s Baruch University, Zicklin School of Enterprise, where he has published a lot more than 25 law overview articles on sports activities law issues.  His latest articles or blog posts include “A Short Treatise on Amateurism and Antitrust Law” and “Are Commissioner Suspensions Actually Any Various from Illegal Group Boycotts.”

Steve Ballmer is rumored to have manufactured $ 1.8 Billion bid to get the L.A. Clippers (Photo credit: Wikipedia)

$1.8 Billion For The L.A. Clippers? That"s 3.27 Occasions A lot more Than Any Other NBA Team, And 120 Times The Team"s Working Revenue

Dr Richard Hughes: "I saw them by means of the ideal and worst times"

He started out his medical occupation in London, qualifying at Guy’s Hospital in 1977, and came to Portsmouth to operate in common medication 3 years later on, aged 25. Having made the decision hospital daily life wasn’t for him – “I wasn’t sufficiently confident of my personal viewpoint to be a consultant” – he trained at Hanway in 1981, utilized for a complete-time vacancy there the following 12 months, and has been working at the surgical treatment ever given that.

The healthcare occupation, indeed the entire NHS, was very various then, he recalls. “We have been less nicely-organised. We didn’t know how several individuals we had we certainly did not know their names and we did not have a correct grasp of their overall health needs. We were one particular of the 1st practices in Britain to get up computerisation in the mid-Eighties, however, and that manufactured a planet of difference.”

Time passed and his knowledge broadened. He noticed babies born, develop up, then turn out to be dad and mom themselves. He watched households nurse loved ones at the brink of death, and mourned the reduction with them. He held hands, wiped tears and delivered lifestyle-modifying information. 1 elderly gentleman, who came on Saturday in his wheelchair, has had “more illnesses than a medicine textbook” – and survived. “It’s because he’s loved by so several individuals, rallying around,” he says. “That, for me, is the essence of family medicine.”

Dr Hughes’s favourite memories are happy ones. “I’ve observed houses total of caring family members, all sharing joy or sharing grief – and that is humbling,” he says. “It’s been educational watching people cope with really tough doses of what lifestyle has to throw at them, and pop back up like corks. At times, between consultations, I’d see somebody with a really sad story, followed by a very wonderful story. You’d nevertheless be in tears from the final 1 when the following one would stroll in, and you’d have to smile and be there in the identical way.”

And it was this, his selfless commitment of time and an ever-listening ear, which created Dr Hughes so popular with individuals. He went out of his way to do house visits by no means turned any individual down, even on his days off. He was a GP of the kind that Jeremy Hunt, the Wellness Secretary, called for far more of final 12 months in his overhaul of healthcare for the more than-75s. Maureen Baker, chair of the Royal University of GPs, warned in March that this kind of individualised, patient-centred care is vital to the survival of loved ones medical professional services, but is threatened with extinction from increasing demand.

It is a threat Dr Hughes is aware of properly. “We always felt stretched in my practice,” he admits. “I utilised to get to the surgical treatment at six.45am and would depart among 8pm and 10pm. 5 days a week. And it was in no way adequate time – you constantly went property realizing that you left some factors undone.”

What does he think of Labour leader Ed Miliband’s calls for sufferers to be guaranteed a GP appointment inside of 48 hours? “The actuality,” he says, “is that individuals would like accessibility to somebody they know and trust, but they could have to wait to see them. We’ve never ever been able to square that circle. If you went to an A&ampE division, you’d want to see the physician who could make you far better – not necessarily the one particular you know. I realize why it is a criticism of the recent program, but I don’t believe it is fairly justified.”

And Labour has much to do to restore its reputation for NHS “reforms”: Dr Hughes says medical professionals are nonetheless recovering from its 2004 contract method, which enabled GPs to opt out of night and weekend function by sacrificing element of their salary. “That was a extremely soft contract – a lot of folks on the outside noticed it like that,” he adds. “I’ve done my share of nights, weekends and bank holidays, and it just comes with the task. You either get on with it, or do some thing else.”

Other adjustments since he began – the introduction of the National Institute for Well being and Care Excellence (Great) in 1999 and the rise of female GPs – have been positive, he says. “It’s no shock that females are dominating general practice. There are specific areas the place there is no query that female doctors are much better. But we’re going to have to accommodate their needs or the system will fall apart. There are some extremely talented female medical professionals who also need to have to be great mothers.”

It is clear the occupation was far more a vocation than a profession for Dr Hughes. But last yr he was diagnosed with Parkinson’s Condition – and decided it was time to retire ahead of the illness took hold. “I would have gone on longer if I could,” he sighs. “At the moment, it’s not affecting me specifically badly, and I’m not sorry for myself in any form or form, but I really do not believe it’s compatible with prolonged-phrase health-related practice. I wouldn’t want to make a blunder simply because I wasn’t working properly.”

He hopes retirement will enable him to devote a lot more time with his loved ones – his wife, Theresa, a teaching assistant near their property in Fareham, and his 3 young children, Chris, 34, a maths teacher David, 33, an officer in the Merchant Navy and Katie, 22, a lawyer in Bristol. Weekends will be spent on his favourite pastime, conservation and wildlife appreciation but most of all he’s searching forward to “taking stock of almost everything and obtaining a bit of a rest”.

For now, Dr Hughes’s outdated work at Hanway Healthcare Practice remains vacant. “It’s a genuine shame that they haven’t been capable to locate a replacement but – there just are not sufficient people interested in carrying out previous-fashioned general practice any much more,” he says. Would he recommend it? “Absolutely. I’ve acquired no regrets. It was my existence and I loved it. The method, like all British institutions, is a bit crickety and rickety, but it looks to be limping along. Just like I did for all those years.”

Dr Richard Hughes: "I saw them by means of the ideal and worst times"

Premature menopause is linked with bad contemplating and response times

They had been also one third far more probably to have proven a decline in their reaction instances and general considering ability, 7 many years later on.

The findings have been published in BJOG: An International Journal of Obstetrics and Gynaecology.

The tests included recognising a line drawing they had been proven previously, the amount of phrases they could believe of in a given class this kind of as colors or animals in thirty seconds, connecting numbered circles and the mini-psychological state examination which covers general pondering potential.

The researchers said the final results ought to mean that surgical procedure to get rid of the ovaries in girls below the age of 40, which induces menopause, ought to take into account the result on thinking and memory.

They discovered that remedy with hormone replacement therapy at the time of menopause did not counteract the changes in thinking and memory.

There was some proof that HRT could be advantageous for visual memory, but it could increase the danger of bad verbal fluency, it was found.

Lead writer, Dr Joanne Ryan, postdoctoral study fellow in Neuropsychiatry at Hospital La Colombiere, in Montpellier, France, mentioned: “Both premature surgical menopause and premature ovarian failure, had been connected with extended-term negative effects on cognitive function, which are not fully offset by menopausal hormone therapy.”

Pierre Martin Hirsch, BJOG deputy editor-in-chief, stated: “With the ageing population it is critical to have a greater knowing of the long term effects of a premature menopause on later-life cognitive perform and the prospective benefit from utilizing menopausal hormone treatment.

“This research adds to the existing proof base to propose premature menopause can have a significant influence on cognitive function in later on lifestyle which healthcare professionals must be aware of.”

Premature menopause is linked with bad contemplating and response times

Hospital trusts scewing waiting listing times in "blatant fraud"

The MPs stated that the failure to record waiting occasions properly is stopping individuals from currently being ready to make informed options on exactly where they are treated.

They also identified that hospital trusts are failing to impose economic penalties when targets are missed to help “drive up specifications”.

Margaret Hodge, the chairman of the committee, said: “Public self-assurance in the good results hospital trusts have had in meeting the 18 week waiting time target is inevitably undermined by mistakes in trusts’ recording of waiting time details.

“If individuals cannot be assured of exact comparable data on the functionality of hospitals they cannot workout choice. Each GPs and their individuals require reliable and comparable data about the waiting time performance of person trusts so that they can make an informed decision about the place to be taken care of.”

Labour introduced NHS targets in 2008 which state that 90 per cent of hospital patients who need to have in-patient care and 95 per cent of individuals needing outpatient therapy must wait no longer than 18 weeks.

Hospital trusts scewing waiting listing times in "blatant fraud"

Numerous sclerosis and "miracle cures": at times it"s the hope that"ll kill you | Margo Milne

I have progressive a number of sclerosis. I’m very disabled, and I have no idea how disabled I’ll end up. That’s what MS is like. It is unpredictable, and it is various for every person. Request 100 people with MS, and you will get 100 diverse sets of signs and symptoms.

There are therapies: things that slow down progression, or even halt it in some situations. But the Holy Grail is something that will cure multiple sclerosis, fix the injury our incorrectly primed immune programs are causing to the myelin that coats our nerves, and restore us to total working.

Faced with the uncertainty of a issue that can manifest itself in many diverse approaches, progress at variable speeds, and have a number of unpredictable endpoints, it is not surprising that we are so susceptible to grasp at any suggestion of a remedy, nevertheless improbable it could sound, and even so scant the proof.

We nevertheless don’t know for certain what causes MS, even though several factors have been advised, some less probably than other people. For instance aspartame, hefty metals (which includes dental fillings), and allergic reactions have all been debunked as causative agents. Going by present research, a number of variables are really concerned, such as genetics, viruses, environmental aspects, and vitamin D deficiency.

And what of cures? Person stories, such as that of Dermot O’Connor who claims to have cured his MS through diet, exercising, and acupuncture, sadly show nothing at all. Multiple sclerosis has relapses and remissions. You get worse then far better. So it’s usually challenging to tell regardless of whether you’re feeling much better by possibility or because of anything you’ve accomplished, except if it is portion of a properly performed clinical trial.

A single theory that is acquired a whole lot of publicity more than the final couple of years is CCSVI – persistent cerebrospinal venous insufficiency. It is unusual in that it is obtained interest both from the media and the healthcare and scientific establishment. The thought runs that compromised movement of blood in the veins draining the central nervous technique leads to iron deposits around the pulmonary veins, which triggers autoimmunity and degeneration of myelin.

The examine that initial proposed the theory of CCSVI, carried out in 2008 by Paolo Zamboni, was intriguing but had a quantity of methodological concerns. It was inevitably tiny, it was non-randomised and non-blinded, participants remained on their normal remedies throughout the trial so it was extremely hard to determine the result in of any effect, and all participants have been in relapse, so had been very likely to enhance anyway.

The study found venous abnormalities in every 1 of the participants, a outcome that immediately sets suspicious Spidey senses tingling in researchers. And when Dr Zamboni had the blockages cleared making use of angioplasty, his paper quoted outcome results at six months submit-method, with most exhibiting an improvement. At 18 months, on the other hand, his participants were undertaking the very same or even worse than they had prior to the intervention. Additionally, there is a prospective conflict of curiosity in Zamboni owning the patent relating to the diagnostic tools utilised for diagnosing CCSVI, or the support his study centre has acquired from its manufacturer in the kind of tools and technical support.

But the operate certainly merited more study, to see if CCSVI did without a doubt exist, if there was a link between it and MS, and if so, whether angioplasty to clear the blockage could support MS.

News of the study soon reached the MS local community, and many men and women with MS, impressed by the reported benefits, needed angioplasty straight away. As there was insufficient proof for health authorities to fund the therapy, folks have been travelling to personal clinics in Poland, Puerto Rico, or Thailand, usually remortgaging their houses or undertaking months of fundraising to increase the 1000′s of pounds needed.

Final results were reported back on social media, often on YouTube. But, of course, person uncontrolled anecdotes do not equate to evidence. And even Zamboni himself was urging a go-slow approach, telling folks with MS to enrol on clinical trials rather than have the treatment method done privately.

And was the treatment safe? In most instances, it looks to be. But there have been incidents of attainable side effects, including intercranial haemorrhage, thrombosis, compression of cranial nerves, heart arrhythmias, and deaths, for instance of Canadian Mahir Mostic. Trials at Stanford University have been halted following one particular participant died and an additional required emergency surgical treatment to remove a stent that had migrated into their heart.

Meanwhile, analysis was being completed. And it wasn’t very good information for the CCSVI advocates. So far, no important big difference has been identified in the presence of CCSVI in folks with and without having MS. A managed and blinded sham surgery trial of the angioplasty procedure found no benefit from the intervention. Study continues, as without a doubt it must. But I’m not hopeful.

Will there be a remedy for multiple sclerosis? At some point, yes I feel there will. But I believe it will come by means of stem cell analysis. Prevention of MS, and many other diseases, will be attained through vitamin D supplementation in pregnancy.

And only right after detailed clinical trials to present efficacy and safety. Naturally.

Margo Milne is on Twitter, @margojmilne

Numerous sclerosis and "miracle cures": at times it"s the hope that"ll kill you | Margo Milne