Why is there so little social diversity in medicine? | Zara Aziz

Medicine in the UK has traditionally been deemed an elite profession that excludes those from low socioeconomic groups. A mere 7% of students are privately educated, but 26% of medical students went to fee-paying schools.

However, when you look closely at the figures, many students leave school at 16, and 18% of 16- to 18-year-olds are in fact privately educated; the proportion is even higher for those studying science subjects. Suddenly, the figure of 26% of privately educated medical students seems to reflect numbers studying sciences at school. It is not surprising that the majority of doctors come from more affluent backgrounds.

I do not come from a privileged background. But I had opportunity. I did not attend a state school but was awarded a bursary to study at a private school. My husband, a hospital consultant, was state educated. His father was a bus driver and arrived in the UK as an immigrant in the 1960s. In many places in the world, perhaps neither of us would have been given such opportunities.

It is opportunity that social mobility organisations and medical schools themselves are asked to create, in order to remove this disparity in entrants. Universally, access to medical school is limited due to a lack of places; this generates stiff competition and entry criteria tighten every year. Historically, selection for medical school has consisted of exam performance and interview scores (most medical schools will interview their applicants). In recent years, we have seen the introduction of a national UKCAT aptitude test, which all candidates complete. Universities are also moving away from a single interview, which can be an arduous experience for candidates.

The new multiple mini interviews (MMIs) consist of several short stations, which test candidates on standard questions (Why do you want to study medicine?), ability to complete a practical task, communicate effectively or explore an ethical dilemma. These seem to be a fairer way of judging students, who may otherwise perform badly through nerves or even assessor bias.

It has been surmised that MMIs favour state students, but in my experience as an assessor this is not always the case. MMIs favour those who are confident, communicate well and display empathy: all the qualities we would expect from a good doctor. Often students from failing schools do not perform well, if they have had neither coaching nor exposure to similar situations. And modifying the selection process further is unlikely to have major impact as few students from less affluent backgrounds apply in the first place.

Many of the widening access to medical education programmes promote initiatives, such as arranging mentoring or work experience with doctors, and by introducing summer medical schools for sixth formers. This is certainly showing some encouraging results but it does not get to the root of the problem, and you only have to look at school dropout rates to see why: one in five students will leave school after GCSEs; of those who continue in education, few will study core academic or science subjects.

State-educated medical students are usually from good comprehensive or grammar schools, which operate within narrow geographical boundaries. These are often in affluent areas, with little chance of access to those from broken families or challenging neighbourhoods. Many of the independent schools’ bursaries, such as the one I was educated on, have since been abolished.

University tuition fees have also changed the demographics of students. Medicine is usually a five or six-year course, or even longer if students undertake foundation or catch-up medical courses. Students from low-income families are discouraged at the prospect of spiralling debt, which can run into hundreds of thousands of pounds. The government’s controversial plans to change the junior doctor contract and to consider tying newly-qualified doctors to the NHS for four years is unlikely to increase diversity in applicants.

A mix of poor schooling, lack of aspirations and financial deprivation limits access to the medical profession. It is simplistic and even detrimental to try to tackle it through university or social mobility organisations alone. Our aim should always be to have competent and empathetic doctors from different social and cultural backgrounds who reflect our society.

One way of improving diversity is by having doctors from EU and non-EU countries as well, but we still need to increase access to the professions within the UK to young people from all social backgrounds.

The solution to this societal and educational problem is complex. It requires a wider commitment from us and the government towards our children, their education and wellbeing.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

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Why is there so little social diversity in medicine? | Zara Aziz

How Well Do You Know Your Medicine Cabinet?

We live in a self-prescribing society where many of us like to self-diagnose our symptoms and treat them with over-the-counter (OTC) medications. According to the Consumer Healthcare Products Association (CHPA), without OTC drugs, approximately 60 million Americans would not seek treatment for their illness.

The CHPA also estimates that U.S. households spend about $ 338 a year on OTC products.  Although OTC medicine is convenient and easy to use, many people may not know about the potentially dangerous side effects that can result in using such medicines.

How well do you know the OTC products in your medicine cabinet?

1. Pain Relievers

If you check out any “must have in your medicine cabinet” list, pain relievers usually make the top of the list. An OTC pain reliever is either ibuprofen (Advil), acetaminophen (Tylenol), or naproxen (Aleve).

Although these types of pain relievers seem less dangerous than pain medication prescribed by a doctor, they can cause an increase in blood pressure, kidney damage, and gastrointestinal issues. Always talk with your doctor before taking a seemingly harmless pain reliever.

2. Cold Medicine

Although there’s no tried and true cure to getting rid of a cold, many people rely on cold medicine that often contains acetaminophen, dextromethorphan, doxylamine, and pseudoephedrine.

One of the biggest dangers of OTC cold medicine is simply failing to read or follow the directions. Cold medicines should never be mixed with other pain relievers, like acetaminophen, because one could end up taking more than the daily dose without knowing.

3. Vitamins and Herbal Supplements

Vitamins and herbal supplements are a great way to fill in any “gaps” that may be missing from your diet. Some supplements are designed to be a “safer” remedy for similar medications. It’s important to note that most vitamins and herbal supplements are not regulated by the FDA.

Many people who take these kinds of OTC products have little knowledge on the ingredients and may mix them with other OTC medications; the results can be dangerous. Take the supplement St. John’s Wort (for anxiety) and cold medicine. Mixing the two have been known to have a fatal outcome.

4. Laxatives

Some individuals take laxatives to help stay regular, and while this seemingly safe OTC drug is used by young and old alike, it can cause dehydration and kidney issues due to improper dosing.

Considerations Before Taking

While there are hundreds of OTC drugs that are safe and effective, it’s always important to know what you are taking before you try to treat any symptoms. Dangerous side effects are more likely to occur when people don’t read the directions and don’t give or take the proper dosage.

Additionally, some adverse effects happen because people don’t know enough about their health, such as allergies, blood pressure, or any underlying issues. Even if you would rather take OTC drugs than prescription medications, it’s a good idea to have a check-up with your doctor and always tell him or her what OTC medicines you take.

How Well Do You Know Your Medicine Cabinet?

Treat a symptom with medicine but never the cause

There is an important question that begs an answer: is modern medicine the best approach to wellness?
Unfortunately, the unexamined assumption has been yes, but the truth is “not really”.

In some instances of emergency and specific conditions like trauma, fast-growing tumors, and acute heart attacks and strokes, medicine is able to intervene in the disease process, mend broken bones, and stabilize people with heart attacks, etc.

However, 20 years ago the government Office of Technology Assessment clearly stated that only 10 – 20 % of medical and surgical procedures have been scientifically proven. That leaves a whopping 80 – 90% that equates to a guessing game.

In our conscious or unconscious need as human beings to be “taken care of”, we have submitted ourselves to modern medicine. In doing so we must also accept the dark side of medicine.

This trade-off may explain why we seem to be so quick to ignore the mounting evidence that medicine is the number one killer in America.

An aging population wants nothing more than to know how to create a longer and healthier life span and turns to medicine for the answers. However, medicine, purported to base itself on science, has not entered the field of anti-aging or wellness, and is completely ill equipped to even give an opinion.

At this point, it might be a good time to quote Voltaire, who lived from 1694-1778. He said: “Doctors are men who prescribe medicines of which they know little, to cure diseases of which they know less, in human beings of whom they know nothing”.

Medicine is becoming quite adept at causing iatrogenic (caused by medical intervention) injury.
Every year, over the past 20 years, two or three studies have surfaced showing a growing number of people injured by Rx drugs, including treatment with toxic drugs used for non-life threatening conditions such as birth control.

As these studies slowly came before us, as a society we still held on to the notion that medicine was working in our best interest. No one took the time or trouble to compile all the statistics. No one identified the various areas of medicine, each of which causes iatrogenesis or imagined symptoms, ailments or disorders induced by a physician’s words or action. That was a nice way of saying ‘their speculative bullshit’. And when the different injuries and deaths were added up, the final number was incredible.

In a recent compilation of deaths due to properly prescribed drugs, drug errors, surgical mistakes, medical procedure mistakes, bedsores, malnutrition in nursing homes, and hospital based infections, it was found that iatrogenic medicine is the leading cause of death in America.

According to research done by the Nutrition Institute of America under the auspices of Dr. Carolyn Dean and Gary Null, it was found that the 2001 heart disease rate was 699,697; the annual cancer death rate was 553,251. But the annual iatrogenic rate was 783,936.

That’s just the deaths. The number of people injured annually by Rx drugs is 2.2 million; the number of unnecessary antibiotics prescribed annually for viral infections is 20 million; the number of unnecessary hospitalizations annually is 8.9 million; and we really have no way of knowing how many premature deaths can be attributed to overuse of X rays.

Be prepared for another shock. Most studies that care to delve into the topic of what mistakes actually get reported are pretty clear that only 5%, or 1 in 20 errors, are recorded in black and white. We also know that about 20% of mistakes can end up in death, so the undisclosed 3/4 million deaths may be just the tip of the iceberg.

To add insult to injury, drugs are synonymous with modern medicine. “Drugs” and “medicine” are interchangeable words in the dictionary and in most people’s minds, and it’s hard to believe that drug-based medicine is only about 100 years old because of its pervasive hold on our society.

With the discovery of the “Germ Theory”, medical scientists convinced the public that infectious organisms were the cause of illness, not their lifestyle and dietary choices.Finding the “cure” for these infections proved much harder than anyone imagined. Right from the beginning, chemical drugs promised much more than they delivered. But far beyond not working, the drugs also caused incalculable side effects.

The drugs themselves, even when properly prescribed, have side effects that can be fatal. Fully half the drugs prescribed are eventually pulled from the marketplace due to undeniable side effects. By then, the drug companies have laughed all the way to the bank pocketing billions of dollars in profits from an unsuspecting society and are busily marketing the next catastrophe.

The leading causes of adverse drug reactions are antibiotics (17%), cardiovascular drugs (17%), chemotherapy drugs (15%), and analgesics and anti-inflammatory agents (15%). It is, however, probably impossible to estimate the morbidity and mortality due to drugs such as synthetic hormone replacement therapy and birth control pills taken by millions of Americans.

And we haven’t even scratched the surface by not addressing the horrors of Ritalin and Prozac and the mass destruction of shootings and killings at public places by people subjected to these drugs by a psychiatric agenda that never does any tests or blood work and yet throws out the ADHD and Autism labels at will just to push drugs and control people that possibly think out of the box.

NBC’s “Dateline” wondered if your doctor is moonlighting as a drug rep. After a year-long investigation, they reported that because doctors can legally prescribe any drug to any patient at any time for any condition, drug companies heavily promote “off-label”, and frequently inappropriate and non-tested uses of these medications in spite of the fact that these drugs are only approved for specific indications for which they have been tested.

How modern medicine has come to be the number one killer in America is as incredible as it is horrifying. Doctors don’t think of themselves as killers, but as long as they promote toxic drugs and don’t learn non-toxic options, they are virtually pulling the trigger on helpless patients and transforming the Hippocratic Oath into the Hypocritic Oath.

So, what can you do to escape this dependence on modern medicine? Well, maybe there really is no escape but there sure can be a decrease in the dependence by putting your health back in your hands.

If you are eating the flesh of rotting cow bodies, or rotting pig bodies, or rotting fowl bodies, or rotting fish bodies, or dairy products, you need to stop. That includes “range fed” as well. Come on, do you really think that some animal not in a CAFO is running up to someone with a gun or a knife and begging, “Kill me, kill me, please, kill me”.

In reality, when any creature is faced with harm or death, anxiety sets in. Adrenalin pervades the body as do fear hormones. And even though this is what people are eating we are confused as to why there is so much hostility, fear and anxiety in the world. There is so much truth in that old saying, “You are what you eat”.

If you are eating refined grains like white flour products and white rice, you need to switch to whole grains like brown rice, red rice, wild rice, millet, Quinoa, buckwheat, etc. And if our “daily bread” was so great, why is there so much gluten intolerance? Gee, do you think the additives and synthetic chemicals could have anything to do with that?

If you are eating the menstrual cycle of chickens (eggs), you need to stop.

If you are eating malasadas, which are popular in Hawaii and donuts, which the police love, which are nothing more that balls of white flour covered in sugar and cooked in grease, you need to stop.

If you are shopping in supermarkets and not reading labels, you need to start.

The rule is two-fold: if you can’t pronounce it, don’t eat it; and, if man made it, don’t eat it.

If you are still ingesting embalming fluid through diet drinks containing Aspartame, you need to stop.

If you are using “Splenda” (sucralose), which is produced from chlorine, or neurologically damaging Aspartame, which was thrust upon us by Donald Rumsfeld just so he could become rich, as sweeteners, you need to stop.

Everything you are preparing to eat can be transformed into nutritious fare by switching the ingredients.
Whole for refined; tofu and analogs for flesh; organic for pesticide and insecticide laden soy, rice, cotton, sugar, and corn; almond, rice or hemp for dairy milk; and egg-less for egg mayonnaise.

If you don’t have a clue, get some vegetarian cookbooks and shop in natural food stores. Be careful though as most of their products contain MSG euphemisms.

Listen to “Health Talk”. It’s a call-in show and I will gladly answer your questions. Feel free to contact me at any time. If you can’t tune in, go to www.healthtalkhawaii.com and listen to uploaded shows, or on Saturday morning at 8AM Hawaii time log in on your computer to www.kwai1080am.com, and listen to my show as it is being streamed.

You are and should be responsible for your health. Not your doctor, not your health care provider, not your neighbor, you!Besides, don’t you think that all that money you spend on prescription drugs could be put to a more enjoyable use if it were at your disposal?

Remember, the marathon of life starts with the first step. Don’t be afraid to take that step.

Aloha!

Sources:
www.articles.mercola.com
www.drhyman.com
www.quora.com

To learn more about Hesh, listen to and read hundreds of health related radio shows and articles, and learn about how to stay healthy and reverse degenerative diseases through the use of organic sulfur crystals and the most incredible bee pollen ever, please visit www.healthtalkhawaii.com, or email me at heshgoldstein@gmail.com or call me at (808) 258-1177. Since going on the radio in 1981 these are the only products I began to sell because they work.
Oh yeah, going to www.asanediet.com will allow you to read various parts of my book – “A Sane Diet For An Insane World”, containing a wonderful comment by Mike Adams.
In Hawaii, the TV stations interview local authors about the books they write and the newspapers all do book reviews. Not one would touch “A Sane Diet For An Insane World”. Why? Because it goes against their advertising dollars.

Treat a symptom with medicine but never the cause

Your Guide to Health Insurance and Alternative Medicine

Finding and obtaining a health insurance policy that fits your needs can feel like a huge chore. With the time it takes to sift through information about plans and compare them, it can feel like it just isn’t worth the effort when you don’t end up using your benefits.

People who recognize that modern medicine isn’t always the right choice of action for their bodies have a tough time when it comes to insurance companies. However, you can find a policy that fits your needs while still adhering to your wellness plan.

So how can we navigate health insurance when it comes to alternative medicine?

Alternative Medicine Costs Less, but You Pay More

More and more, people are turning away from conventional healthcare providers that use pharmaceutical drugs and instead utilizing alternative medicine. Alternative medicine is a broad term that could include chiropractic care, herbal remedies, naturopathy, massage, and even supplements.

Integrative medicine is the term used when a patient chooses to use alternative medicine in combination with traditional medicine, in which case some of the costs may be covered by their insurance company.

For those seeking alternative treatments—which has grown into a mass of people spending billions of dollars every year—there’s often little luck when it comes to getting insurance providers to pay for these therapies. This is surprising considering that alternative medicine often costs significantly less than traditional medicine, yet patients are forced to pay this cost out of pocket.

Knowing the extent of your insurance coverage can keep you prepared in the event that you want to utilize alternative remedies under your current insurance plan, or when considering a new plan. It can feel tedious to research plans—but your efforts can be well worth it.

What to Ask Your Insurance Company

Here are four questions to ask your insurance representative about your policy if you’re into alternative medicine.

1. What Forms of Treatment Are Considered to Be ‘Alternative’?

It seems a bit ludicrous to think that ancient practices like herbal medicine and acupuncture are considered “alternative” nowadays, but this is, in fact, the case. This means that natural preventative measures you take to avoid disease and sickness can cost you more than toxic pharmaceuticals.

It’s your job to find out which forms of treatment are considered to fall under the category of alternative medicine and which do not. Asking this simple question can help clarify which treatments are covered under the policy and which will not be covered or be only partially covered.

2. Does This Policy Cover All of My Healthcare Needs?

If you’re looking at a specific policy, consider what your healthcare needs are and whether or not they’re covered.

Do you visit the chiropractor regularly for adjustments? What about massage? Herbal therapy? You need to find out whether these things will be covered under your plan. If they are, you need to find out if they need to be ordered by a physician or “preapproved” before the company will grant you full or partial coverage.

Knowing the extent of your coverage can help you choose the best plan for your needs. If the treatments you receive are covered, the next step is to find out just how much of them will be covered under that policy.

3. What Are the Limits for Costs of Alternative Medicine?

Even if your treatments are covered, there is likely a limit on the cost they will cover. Talk with your insurance representative about specifics when it comes to the costs for your alternative medicine. There might be only a few allowed visits and limits on what they’ll pay—for instance, 10 chiropractic visits per year and then you’re done. Ask what you’ll have to pay out-of-pocket for needed services.

Ask your provider if getting a prescription for these services will help secure you coverage. In any case, it’s crucial to always keep your receipt for services in the event that it’s needed for reimbursement. If there are limits on cost, this means your benefits from this plan will only go as far as the number they give you. 

4. Do My Practitioners Need to Be in Network?

Some insurance companies require that your healthcare practitioner be in their network in order for them to cover the cost. Talk with your insurance company about their policy regarding this. It’s helpful to check if your doctors or other healthcare providers are going to be able to continue giving you covered services under your future healthcare plan.

It’s also a good idea to ask if there’s any coverage for your services if you go out-of-network.

Other Things You Can Do

Although insurance companies aren’t allowed to discriminate against different procedures or providers, this doesn’t mean that they have to provide coverage.

You shouldn’t forgo health insurance just because you don’t see a traditional doctor or get standard tests done every year. Anyone can experience an accident that could lead to a hefty hospital bill. In cases like these, preventative measures do little to help us avoid the costs.

Navigating the insurance world can be confusing and scary, especially for those of us who value and utilize alternative therapies to better care for our bodies. Choosing an insurance plan that best fits our needs can help minimize out-of-pocket costs and help us feel better about having health insurance.

By asking questions and being knowledgeable about the plans available to you, you can make the best decision for you and your family in regards to health insurance and alternative medicine!

Your Guide to Health Insurance and Alternative Medicine

Unearth The Secrets Of Ayurvedic Medicine

If you don’t trust your modern medical doctor to give you time, attention and medical information that pertains EXACTLY to you, then I suggest you check out Ayurvedic medicine, the oldest health care system known to Man.

Ayurveda is the ancient Sanskrit word meaning the “science of life.”

It has often been said that modern medicine leaves a lot to be desired. These days when you get sick, you go to the doctor, describe your symptoms, and they give you drugs. What? Aren’t doctors supposed to keep you healthy? The modern-day so-called health care systems, wait until you are sick, THEN you get help. That seems a backward way to approach health care.

Why wait until you are sick to go to the health and wellness experts? How stupid and dangerous. I think it sounds like a better idea to be attuned to Nature and your body, and to keep it maintained in a healthy state to avoid becoming unwell in the first place.

History of Ayurveda

Ayurvedic medicine can be traced back to India to about 3000-5000 years ago. This medicine and health care system are mentioned in the Vedas, the ancient religious and philosophical texts that are the oldest literature to be found in the world, which makes Ayurvedic medicine the oldest surviving, medical type healing system.

According to the Ayurvedic texts, Ayurveda was conceived by the enlightened, wise ones as a system of living in harmony and maintaining the body so that mental and spiritual awareness could be possible. Medical history tells us that Ayurvedic ideas were transported from ancient India to China and formed the basis of Chinese medicine. 

Principles of Ayurveda

In comparison to the modern day ‘one size fits all’ health care approach, in Ayurvedic health care, it is a highly individualized method.

Under Ayurvedic principles of health care, everyone’s specific constitution (prakruti energy) determines his or her physical, physiological and mental characteristics and their vulnerability to the ailment. Everyone has a specific and unique prakruti. That makes more sense that the modern method of prescribing pills and surgery as front line treatment.

Ayurvedic health care acknowledges that all areas of life impact health. For instance, if you have chronic stress in your life, then you place yourself at risk of negative long-term physical health outcomes. This system of health care uses a holistic approach to looking after your overall well-being.

In Ayurvedic medicine, there are five basic elements that contain prana: earth, water, fire, air, and ether. These elements interact and are further delineated in the human body into their three main categories; Vata, Pitta, and Kapha. The aim is to balance these three basic body energies (called doshas) When these are balanced, there is a healthy state of mind and body. When these are unbalanced, ailments begin to appear.

Vata Dosha – is the air element. It is characterized by properties of cold, dry, light and movement. All movement in the body is due to energies of vata. Pain is the characteristic feature of an out of balance vata. Some of the diseases due to vata are flatulence, gout, rheumatism. In the out of balance state of vata, you may also experience a dislike of cold and wind, light and interrupted sleep, nervousness, anxiety, panic and difficulty tolerating loud noises,

Pitta Dosha – is the firey element, controlling digestion, metabolism, bile production and overall energy. The primary function of Pitta is transformation. Those with out of balance Pitta, tend to have a fiery nature that manifests in body, mind, and soul. Heat, digestion and all transformations in the body arise from the Pitta Dosha. Out of balance, Pitta is primarily characterized by body heat or burning sensation, redness of the skin and sour-smelling sweat.

Kapha Dosha – is the water and earth Ayuvedic element. An out of balance Kapha Dosha is characterized by heaviness, thick, white tongue coat, slow and sluggish bowel movements, coldness , excess body weight, and slowness. It is nourishing element of the body. All the soft organs are made by Kapha. You will also find that it’s hard to get up in the morning, with that tell tale sluggish feeling. Feeling slow, foggy, lethargic or heavy throughout the day also points towards an out of balance Kapha. 

Conclusion

If you are following the Ayurvedic system, you want to avoid such life elements as stress, strained relationships, and an unhealthy diet. You also want to include such balancing and healthy elements like meditation, massage, herbal remedies, loving relationships and breathing exercises called pranayama. All these things influence the balance that exists between your Doshas. Keeping a balance with all things in life is the lesson that Ayurvedic medicine teaches us.

References

http://www.encyclopedia.com/medicine/divisions-diagnostics-and-procedures/medicine/ayurvedic-medicine

http://www.naturalnews.com/Ayurveda.html

http://www.apa.org/helpcenter/stress-body.aspx

Unearth The Secrets Of Ayurvedic Medicine

I gave up medicine to make a real difference as an entrepreneur

The paediatricians who started a children’s medical education organisation

Paediatricians Dr Kate Hersov and Dr Kim Chilman-Blair started Medikidz, a children’s medical education organisation, after becoming frustrated at the lack of resources to help explain health conditions to children.

“As a doctor, I could see this lack of knowledge was leading to fear, isolation, added anxiety and sometimes anger in children that already had the weight of the world on their shoulders,” Hersov says. “We did a lot of research and [decided to use] comic books and superheroes. It’s an amazing medium that spans age range and culture [and is] fantastic for low literacy.”

The first issue, which covered asthma, was published seven years ago. Today, the business has offices in London, New York and Sydney and has distributed more than 4.5m comics in 30 languages to hospitals and clinics across 50 countries. They’ve covered hundreds of conditions that affect children and their loved ones. The most popular so far have been those that cover ADHD, autism and breast cancer.

Each title is written by a doctor on the Medikidz team and sponsored by a private healthcare company, such as Johnson & Johnson, Siemens or Pfizer, which enables the company to distribute the comics for free. Patient groups, leading physicians, nurses and patient families are all consulted on the content before it goes to print, an exercise that usually takes four months.

“It’s very much a collaborative process,” Hersov says. “We believe that to create the best content, you need the perspective of a lot of different voices.”

Although Hersov no longer works as a doctor, she still believes she’s making a real difference to healthcare as an entrepreneur. “The response has been fantastic. Really the best part of Medikidz for me is the feedback from the children and young people who are touched by what we do.”

The midwife who set up an app to help expectant mothers with health advice

Hannah Harvey, founder of the UK’s first health advice app run by midwives, has always been interested in using digital tools to make healthcare more accessible. She still works night shifts as an NHS midwife, but launched Ask the Midwife in July 2016.

“There was a US study that suggested 84% of pregnant women use the internet for health advice,” she says. “So I [wanted to] create something where they could ask questions, instead of using Google or parenting forums.”

The app already has 2,500 users, who can connect with 40 midwives across the UK for a small charge (starting at £1.99). Harvey has plans to expand the business’s offering to video and face-to-face consultations, and hopes to work in partnership with the NHS in the future. “We are there to offer an advice service for non-urgent concerns [so] midwives working in clinical practice [can] focus on continuity of face-to-face care,” she says.

It’s a model the midwives are behind. When Harvey advertised for consultants online, she received more than 500 applications in three days. The midwives all have at least three years’ experience and get paid commission per question they answer. Many manage the work around their NHS shifts.

“I wanted a service for women and their families but it’s been beneficial for the midwives as well,” Harvey says. “Sometimes they need extra work [particularly after they’ve had children], and that’s hard to find outside of clinical practice. We’re really filling a gap there, which is fantastic.”

The biggest challenge, she adds, has been making sure the service is compliant with midwifery regulations and data protection legislation. After months of discussion with lawyers, the Nursing and Midwifery Council and the Care Quality Commission, the advice service is regulated by the Federation of Antenatal Educators.

“‘I believe there is a big market for digital healthcare services,” Harvey adds. “We don’t want to replace triage and community services but rather run alongside them to alleviate the pressure on our NHS.”

The GP who set up a business available across six countries in 19 languages

Dr Mohammad al-Ubaydli saw the difference technology could make to medicine during his ward rotation while at university. After spending a year as a GP, al-Ubaydli went into research and wrote a number of books on IT and healthcare, the last of which proposed giving patients access to their medical records.

“That got me obsessed with the problem,” he says. “I spent a year trying to convince IT directors [to develop something]. But they weren’t doing it at the scale and the pace that I wanted. So I did it myself.”

Patients Know Best, is a platform that contains a patient’s medical records from various healthcare professionals including GPs, hospital staff, social workers and mental health providers. Patients can track symptoms, connect wearable activity devices and message their consultants securely. The business launched in 2008, and is now available across six countries, in 19 languages. Approximately half a million patients use the service.

The success of the business, which secured £5.7m of investment (paywall) in 2015, lay in convincing institutions of the benefits and working collaboratively with them to overcome their initial reservations. The platform has been shown to save time on both sides of the consulting desk – doctors have found that “just in case” appointments are reduced because patients can ask questions online. It empowers the patients – they invite doctors, nurses, carers and relatives to view their records, rather than the other way around. And it enables remote monitoring – an epilepsy team in Peterborough, for example, could view uploaded videos of seizures at home to produce better diagnoses.

Some may argue the business world is incompatible with medicine, but al-Ubaydli believes that everyone working in the healthcare sector has an obligation to make it better.

“A lot of people go through [medical training] thinking there’s only one way to do things and there’s only one way to make a contribution … [But] if you see a problem, you’ve got to fix it. Healthcare will not be fixed without people doing that every day, with every problem that they see.”

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

I gave up medicine to make a real difference as an entrepreneur

My Christmas shift showed me the human connection behind medicine

My first medical on-call shift was on the evening of Christmas Day. Wary of what to expect, I joined my family for an early dinner with a cloud of trepidation hanging over it. The post-food cosy daze that everyone has after their traditional meal turned into the pre-work tetchy panic that every doctor has before a night shift.

I arrived at the hospital at 9pm to find remnants of Christmas cheer lingering on every ward. Boxes of half-eaten chocolates, needles starting to drop from Christmas trees, tinsel becoming unstuck and dangling from the walls, and families trickling away from the hospital after spending the day with their loved ones – it’s like you’ve arrived late at a party after everyone has left.

For the first few hours I was strangely enjoying my first medical on-call shift. It was a refreshing break from the daily grind of writing in patients’ notes what my consultant says on ward rounds and typing discharge summaries. I was reviewing and managing unwell patients, which is what I had been trained to do.

Fuelled by adrenaline, excitement, and those half-finished boxes of chocolates on the ward, I was in full flow. Please review this patient who is not producing enough urine: “urine problems – I remember the causes and treatment in a kidney lecture”. Please review this patient who’s got a temperature: “review patient, check the nursing observations, take some bloods, do I need to start some treatment straight away?”. Please review the ECG of this patient who’s developed chest pain: “reading ECGs – let’s decipher these squiggly lines step by step”.

I had just managed to clear the backlog of jobs when my bleeper barked into life: “Cardiac arrest, ward x. Cardiac arrest, ward x”. I immediately got off at the next floor and ran to the arrest call. By the time I got there, CPR had already started and my medical registrar arrived 20 seconds after I did. It was my first arrest call.

I took over doing compressions. Crack, one rib broken. Crack, another rib broken. At least I was doing good compressions. The consultant asked: “Can you get a blood gas from the patient?” Stab, the needle goes into the groin, nothing. Someone else has got it already. He continued: “Can you get the results please?” pH 6.9, lactate 11 – not good. I ran back to find the patient’s heart had successfully restarted.

At this point, a medical TV drama would cut to another scene. In reality, the patient’s heart was restarted but they were intubated and unconscious. The family later arrived and decided it would be in the patient’s best interests not to continue further care. I later certified death, feeling particularly poignant as it was Christmas, a time of celebration for a birth and new life. As I wrote the last entry in the medical notes, I saw the patient’s distraught family walk away from the ward, feeling their sadness as I signed my name and wrote the letters RIP.

With those swirling thoughts, I was no longer a doctor, but a ​person​ mourning the loss of another

Unyielding and relentless, I was bleeped again. My steps towards the next job got slower and slower as my brain swirled with thoughts of that arrest, that patient, and that family. The arrest call itself is a paradox – laid bare it is the most human act done in the most inhumane way. The act of trying to save someone’s life, of you pumping your fellow human’s heart, touches on the very essence of humanity’s common bond. The process, however, is as savage and barbaric as it is life-saving.

As part of the arrest call team, I was focused on my job of restarting the patient’s heart. That focus strips away the humanity of the patient, reducing life to lines on a screen and numbers on a chart. With each passing cycle, the focus intensifies until it changes into a mix of desperation and willpower – willing the tube to go in the lungs, the blood to flash back into the syringe, the pulse to return. And when it’s suddenly over, the humanity returns.

With those swirling thoughts, I was no longer a doctor, but a person mourning the loss of another. I stopped, turned around, sat in a quiet room and had a chat with one of the nurses who was also at the arrest call. We talked about anecdotes from the patient’s stay in hospital and our own lives. It felt refreshing to talk about the life that was lived in the face of the sadness of a life that was just lost.

Mentally and physically exhausted, I was glad to hand over the on-call bleeper at the end of my shift to the next bearer of that cross. As I walked out of the hospital, I reflected on every job I’d had during the night, still wondering how the family of the patient who died was coping and what the diagnosis would be of one patient I asked my registrar to review.

Nights are said to be one of the best learning experiences. At the end of my set of nights, I was comforted not only by the wealth of skills and knowledge I could take into the new year, but by the care I had given to my patients to make their Christmases that little bit better.

Everyone takes something different away from their medical on-call experience. I will always remember that behind every patient and medical diagnosis there lies a human connection that binds us all together.

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My Christmas shift showed me the human connection behind medicine

Crowdfunding medicine via Facebook is a lifesaver for sick children in Sudan

A tea stall under a tree on one of Khartoum’s busiest roads doesn’t look like much to pin your hopes on when seeking to cure a sick child. But dozens of anxious parents and unrelated strangers rush to places like this across Sudan every day – the former to press prescriptions and the latter cash into the hands of volunteers managing a crowdfunding operation that saves children’s lives.

The operation, set up in 2012, received donations of some $ 220,000 (£176,000) for medicines in 2014, and also collected $ 533,000 to open children’s intensive care units in two hospitals in the capital.

“If these guys weren’t here I’d start to sell things from my home, like my bed, chairs and cooking utensils,” says Arafa Moussa, who has come from the Jaffar Ibn Ouf children’s hospital across the road to get help to pay for her son’s medicines. Since her husband had a heart attack and lost his job last November, they have not managed to pay the monthly 2,000 Sudanese pounds (£248) to manage their eight-year-old’s rare condition of aplastic anaemia.

“If he didn’t get the medicine, he would bleed from his nose, eyes, ears and whole body,” says Moussa, wiping her tears as she talks about trying to sell the family home to pay for the bone marrow transplant he can only get abroad.

It was seeing children with cancer in pain that led around 15 young Sudanese volunteers to establish the crowdfunding initiative, called Sharia’ al-Hawadith. It was named after a street lined with medical facilities, and which roughly translates as Accident Lane. It is now home to a small army of young volunteers who sit under a tree sipping endless cups of tea between racing off to get prescriptions for parents who turn up or call from hospital.

Decades of conflict and the resulting sanctions against the regime of President Omar al-Bashir have crippled investment and development. International NGOs have struggled to operate in a climate of government suspicion and restrictions, which includes limiting the medical work of Médecins Sans Frontières‎ and the Red Cross.

“Our government doesn’t want [NGOs] here … there were so many, but they were driven out,” says Hathim Ahmed, one of many pharmacists working with Sharia’ al-Hawadith to provide medicines that most insurance won’t cover. None of the volunteers are paid.

The initiative does some preliminary means-testing by speaking to parents, and asks them to contribute between 10% and 50% for expensive medicines or to buy the cheap ones themselves. For those who can’t contribute, Sharia’ al-Hawadith bears the total cost.

“About 25% of the people I see can’t afford to pay for treatment or medicines,” says junior doctor Leben Khair, who has volunteered for Sharia’ al-Hawadith since discovering that most insurance policies only pay for up to 10% of medicines and that “even private insurance doesn’t cover the expensive ones”.

In Sudan, while NGOs have floundered, such online crowdsourcing models have prospered, allowing people to donate for medicines, books, blankets or food without going through an organisation that could be considered a political threat.

“We publish the daily needs in the Facebook page … and we write the medicines or the cheques we need to do today,” says Ibrahim Alsir Alsafi, a journalist, who – like most other volunteers – spends a day or an evening a week sitting at the tea stall the street.

Ayman Saeed, one of Sharia’ al-Hawadith founders, says not being an NGO has its advantages. “It gave us more room to move freely and expand as much as we can, and our [decentralised] management system … was a good strategy.” He says it gives people the chance to approach the concept in their own way.

More than 100,000 people follow the Facebook page where the prescription requests and the whereabouts of sick children are posted. With volunteers working in all of Sudan’s 18 states, and most children’s hospitals, people can give money personally or send it through people they know living locally. “Sudanese people – most of them from outside Sudan – help us by transferring lots of money. We don’t have a bank account but they transfer it to their relatives here and they come to give it to us by hand,” says Alsafi.

The initiative requires a level of trust between pharmacists and volunteers, who all keep accounts of what has been bought or given on credit per shift. Some people who donate, especially for chronic cases or for first-time donors and who want to see where their money’s going, meet the patients, and sometimes, like the volunteers, get to know their families quite well.

Some pharmacists in Khartoum say that per shift they can give away anything from 200 to 2,000 Sudanese pounds’ worth of medicine, but that they trust the initiative and know they will be paid.

“Sometimes people go to the pharmacy and they just pay our debts for the whole month,” he says.

The largest donation received was from a wealthy Khartoum woman who didn’t have cash so turned up with her gold jewellery. When the dealer found out the money was going to charity, he paid double for it.

People living abroad also respond to the regular calls for drugs that are not available in Sudan, or are extremely expensive imports, by sending them over. “Antibiotics, especially injectables, are very expensive, and cancer drugs per injectable dose can cost 900,000 Sudanese pounds. A course of 28 tablets can cost 1.5m,” says Ahmed.

Since running his own pharmacy in the hospital district, Ahmed, like many other pharmacists, has worked with different charitable funds and given away drugs to needy customers for years. He now extends credit to Sharia’ al-Hawadith to reach increasing numbers of poor people who have been hit by inflation and a falling currency, which puts medicines imported from Europe or the US even further out of reach.

“People are really getting poorer and poorer every day; things are getting worse, so we are trying to help,” he says.

Crowdfunding medicine via Facebook is a lifesaver for sick children in Sudan

Expedition medicine: save lives ... and go places

It’s 5am, just before sunrise in the Himalayas. We wake to heavy snowfall, which has slowed our progress to the summit of Kala Patar. It soon becomes clear we will have to wait for the weather to improve. I am the medic with a group of students and staff from special educational needs schools from across the UK. We hunker down for the day and occupy ourselves playing games while we await a weather window.

The role of a medic on expedition has many faces, from doctor to chef, photographer, teacher, pot-washer, latrine-digger and counsellor. You have to earn your salt as a fully-fledged team member, which means being able to fulfil all of these roles and comfortably complete the expedition itself.

For me, expedition medicine offers an exciting combination of the two things I love: medical practice and the outdoors. I have worked all over the world in some incredible places, from Iceland to Belize, the Philippines to Tanzania, Nepal and the Arctic. But it can be challenging combining this with working in the NHS. So how do you go about working abroad as an expedition medic?

Your morning commute as a medic on expedition in Nepal. Photograph: Extreme Medicine

What opportunities are available in expedition medicine? How do you find out about them?

There are a multitude of optionsfor medics to accompany expeditions or projects overseas. Companies running charity trips often seek medics, and there are also expeditions organised by universities, aid or relief work, commercial expeditions and TV work, although this is harder to come by.

Opportunities are advertised in a variety of ways. I was working in a small emergency department in the north of Scotland when I was contacted about a job in Nepal at short notice, but it is also worth following World Extreme Medicine’s Facebook page for the latest opportunities.

What qualifications do you need? Are there any personal qualities that help?

Doctors usually need to be at least two years qualified; other medical professionals should follow guidance from their governing body. You need to attend an expedition medicine course, to learn how to apply your medical skills in remote environments. World Extreme Medicine run courses several times a year all around the UK and abroad.

Experience in emergency medicine and general practice stand you in good stead to deal with the wide range of medical problems on expedition, and the former is usually a prerequisite. You should have a good working knowledge of managing fractures, wound management and dressings, so spending time learning from nursing staff in your department cannot be underestimated.

Crucially, you need to make sure you possess all of the technical skills required of the expedition itself, from winter mountain skills to simple camp-craft, to ensure you are comfortable operating in extreme environments. It helps to be naturally sociable and able to fit easily into a team, and it goes without saying that you need to be physically fit.

‘Make sure you possess all of the technical skills, from winter mountain skills to simple camp-craft.’ Photograph: Claire Grogan

When is a good time to take time out of a career? How do you ensure you will get a job on your return?

There are natural career breaks in the traditional training paths in medicine and it is now common for doctors to undertake an “FY3” year to pursue a particular interest. Some people warned me that taking time out could pose problems for job applications on my return, but my experience was that these were unfounded. At interviews I was often asked more about what I had learned from my experiences as an expedition medic than other details on my CV.

Now I work full-time in the NHS, and it is possible to get away on trips within annual leave restrictions with some creative rota management and a few swaps here and there.

What kind of situations might you face?

Most problems on expedition are minor but occasionally full casualty evacuations need to be carried out, so it is worthwhile ensuring you have a robust system in place for this eventuality. My biggest tip is try to anticipate the unexpected.

In spring 2015, I was volunteering at a high-altitude rescue post in the Gokyo Valley in the Himalayas, running awareness talks on altitude sickness and providing medical assistance to trekkers and porters. A colleague and I had just finished the Saturday morning clinic when a 7.8 magnitude earthquake struck. We knew immediately what was happening and ran outside to safety. Bad visibility masked our view but we heard avalanches roaring in the valley around us.

Over the coming days we established communication with home and our colleagues further up the valley, and helped our local community get back on to its feet. Our rescue post became a place for people to gather and support each other.

‘Try to anticipate the unexpected’ – such as polar bears. Photograph: Claire Grogan

Earthquakes had been one of the risks we discussed before leaving the UK, and we had agreed to always have a grab bag with water, passports and food ready to go in an emergency. It seemed like overkill at the time, but that small amount of forethought really helped. Now I have a grab bag on every expedition, and always keep a head torch by my bed in case of emergency.

How can I gain additional qualifications or experience for this kind of work?

I teach at World Extreme Medicine and we run courses in expedition and wilderness medicine in the UK, as well as environment-specific courses all over the world, such as polar medicine in Arctic Norway, jungle medicine in Costa Rica, and mountain medicine in Nepal. It is a fantastic way to learn when you are immersed in the environment.

In conjunction with University of Exeter Medical School, WEM also run a Masters in Extreme Medicine which may be of interest to those looking to pursue a formal qualification or research in this area.

The World Extreme Medicine Conference, in Edinburgh from 18–21 November 2016, is set to be a brilliant gathering. I love going because it is a chance to meet, share experiences and learn from world-renowned experts in the medical fields of pre-hospital care, expedition, endurance, disaster and humanitarian medicine, and sport, space and extreme medicine.

Claire Grogan is an emergency medical doctor, honorary clinical lecturer at the University of Exeter Medical School and fellow of the Royal Geographical Society.

• Register here for the World Extreme Medicine Conference and enter the code EXTREMEMEDGUARDIAN10 for a 10% discount on tickets.
  

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Expedition medicine: save lives ... and go places

GSK tops list of drug firms improving global access to medicine

GlaxoSmithKline has come top of a league table that monitors the availability of medicine in developing countries, with fellow UK drugmaker AstraZeneca making it into the top 10.

The non-profit Access to Medicine foundation, which compiles the biennial index of drug companies, warned that while the availability of medicines is improving, the industry needs to do more on affordable pricing and the fight against corruption. Jayasree Iyer, executive director of the foundation, said: “Now is the time to step up those efforts.”

Overall, drugmakers have 850 products on the market for the 51 worst diseases in low and middle-income countries. They are developing another 420. But only 5% of products are covered by pricing strategies that were deemed affordable for different population groups within countries.

Iyer said there was no area where drugmakers had gone backwards, but noted that affordable pricing and misconduct were “static”. Breaches of laws or codes relating to corruption, unethical marketing and anti-competitive behaviour continue to arise.

GSK came first in the rankings for the fifth time, followed by Johnson & Johnson of the US, Swiss company Novartis and German group Merck. AstraZeneca jumped from 15th to seventh position after introducing a new affordability-based pricing strategy and expanding its Healthy Heart Africa programme, which aims to treat 10 million people for hypertension, or high blood pressure, over the next decade. The company was in sixth place in 2008 but then fell behind in several areas.

Access to Medicine Index. Photograph: Access to Medicine Foundation

GSK accounted for the most research and development projects in areas of great need but with low commercial incentive, followed by AbbVie and Johnson & Johnson. The British drugmaker also topped the index for considering affordability when setting prices. Its top ranking came despite a damaging bribery scandal in China in 2014, for which it was fined £300m. The scandal prompted the company to overhaul its sales practices.

Iyer expressed some concern about GSK chief executive Sir Andrew Witty’s departure next March and what it could mean for the company’s efforts. He will be succeeded by Emma Walmsley, who currently runs GSK’s consumer healthcare business.

The index assesses the world’s 20 largest pharmaceutical companies on a range of measures, including their willingness to discount prices in poor countries, research on neglected tropical diseases, lobbying, patent policies, breaches of codes of conduct, corruption or bribery, transparency and conduct in clinical trials.

The Access to Medicine foundation is funded by the UK and Dutch governments and the Bill and Melinda Gates Foundation. It says its framework is used by companies to draw up access to medicine strategies.

GSK tops list of drug firms improving global access to medicine

Reasons Why You Should Use Naturopathic Medicine

Naturopathic medicine is a valuable system that is essential in various aspects of patient care. This type of medicine is the most recommended option to prevention, because it involves a lifestyle change, a wellness-oriented diet and supplements that support your body. Naturopathic medicine is also recommended when dealing with chronic diseases, such as eczema or arthritis, because these illnesses tend to improve when lifestyle, diet and nutrient deficiencies are taken into consideration. In addition, naturopathic medicine is an ideal option for non-emergency acute diseases, such as flus and colds, because the medicine is said to support or boost our body’s immune system.

What Exactly Is Naturopathic Medicine?

Naturopathic medicine can simply be defined as a scientific-based tradition that promotes healthiness by recognizing the key aspects of each patient and then using harmless natural therapies to restore their structural, psychological, and physiological balance.

According to the AANP (American Association of Naturopathic Physicians), naturopathic medicine is defined as “An exceptional system of primary health care, science, an art, philosophy, and practice of diagnosis, prevention and treatment of diseases. AANP further explains that naturopathic medicine is well-known by the conditions upon which its practice is based. Its application is always changing because of the day to day advancement in technology.

Top 4 Benefits of Using Naturopathic Medicine

1. Prevention of Type 2 Diabetes

Studies show that naturopathic medicine improved blood sugar control, self-efficacy, and patient self-management behaviors among patients with type 2 diabetes. When compared to conventional medicine or pharmaceutical therapy, this type of medicine is more effective and cost friendly. The medicine is highly recommended to patients who are type 2 diabetic and have a low immune system.

For each quality-adjusted life years saved, naturopathic medicine costs about $ 8,800 while pharmaceutical therapy costs around $ 29,000. What’s more, the naturopathic medicine is proven to be pocket friendly in all adults, while the conventional medicine is somewhat expensive especially after the age of 65.

It is also important to note that naturopathic specialists are pros in guideline-directed, evidence-based lifestyle modifications for diabetes. Several studies have been done to investigate the effects of this type of medicine on diabetes and to date, a total of four studies have shown some great improvements in blood glucose control among patients working with naturopathic medicines. What’s more, the benefits of using this treatment method include lower blood pressure, less depression and weight loss.

2. Reduces the Risk of Cardiovascular Diseases

Cardiovascular disease is one of the top causes of deaths in America today and it is associated with high direct cost of medication and other indirect costs, such as loss of productivity.

According to a recent study, it only takes one year of care under the supervision of a qualified naturopathic doctor to treat cardiovascular diseases. It is documented that naturopathic doctor were able to reduce the risk of cardiovascular disease to patients by 3.07 percent compared to patients under pharmaceutical treatment. One study found out that after a period of one year under naturopathic treatment, patients were 16.9 percent less likely to develop metabolic syndrome than pharmaceutical care patients.

Changing your diet is easy and more cost effective than using conventional medicine. What’s more, there are various types of dishes that one can take. It is therefore more affordable to reduce your risk of cardiovascular disease by changing your diet and adopting naturopathic medicine.

3. Relief from lower Back Pain 

Naturopathic medicine is said to be effective in improving lower back pain and other musculoskeletal illness, getting folks back to work at an affordable price. In the year 2010 ineffective lower back pain cost American employers about $ 297.4 to $ 335.5 billion in lost productivity. Patients who receive naturopathic treatment are said to be stronger and rarely complain about lower back pain.

When compared to pharmaceutical treatment, naturopathic medicine is more effective and capable of reducing the risk of musculoskeletal illness to a higher level. Many people fail to report to work because of lower back pain and musculoskeletal illness. Naturopathic medicine can help to reduce the number of workplace absenteeism by preventing this illness.

4. Asthma

Every year there is a significant increase in the number of patients diagnosed with asthma. For many years now, asthma patients have relied on conventional medicine but the number of asthma hospitalizations is always on the rise. Studies show that asthma patients under naturopathic medicine have higher chances of surviving when compared to those under conventional medicine. Naturopathic medicine is ideal for both the prevention and treatment of chronic lung diseases, including the use of fish oil supplements, nebulized glutathione, and magnesium for acute symptoms.

What makes this type of medicine effective is that naturopathic doctors are experts in creating a partnership relationship between them and their patients. In simple terms, naturopathic doctors spend a significant amount of their time with their patients. They are also good listeners. They listen to their patients and try to get a full understanding of all aspects of their patient’s health issues. They then explain both the disease process as well as the treatment approach that they are going to employ to treat the disease. This enables the patients to understand why each treatment recommendation is vital. Naturopathic doctors try their best to treat the root of the underlying disease, choose the right medication that are risk free and works well with the body of the patient in question.

The Bottom Line

Naturopathic treatment is a whole medical system that is well defined by its philosophy which includes disease prevention, health promotion, and health care education to empower the patients. Patients adopting this method of treatment report much higher health improvement and patient satisfaction, as compared to pharmaceutical medicine. In addition, this type of treatment is cost effective and comes with a lot of benefits. It is also wise to note that naturopathic doctors have an extensive knowledge in physical medicine, home therapy, lifestyle counseling, hydrotherapy, clinical nutrition, and botanical medicines. Naturopathic doctors specialize in treating the underlying causes of disease rather than just the symptoms of the illness. If you are suffering from any of the four conditions mentioned above, it is highly recommended that you visit a naturopathic doctor.

We hope this article proves helpful in your steps towards naturopathic medicine. If you like this article then don’t forget to share it with your friends. For more information on naturopathic services check Active Back To Health. Naturopathic medicine is indeed a blessing from above for renewing our health.

References

http://www.bastyr.edu

http://www.nyanp.org

Reasons Why You Should Use Naturopathic Medicine

UN agrees to fight "the biggest threat to modern medicine": antibiotic resistance

All 193 United Nations member states are set to sign a declaration agreeing to combat “the biggest threat to modern medicine” in Wednesday’s high-level meeting on antibiotic resistance.

The agreement was reached just before the general assembly convened to discuss the threat of antibiotic resistance, which is only the fourth health issue to trigger a general assembly meeting.

“It’s ironic that such a small thing is causing such an enormous public threat,” said Jeffrey LeJeune, a professor and head of the food animal research program at Ohio State University. “But it is a global health threat that needs a global response.”

The declaration routes the global response to superbugs along a similar path as the one used to combat climate change. In two years, groups including UN agencies will provide an update on the superbug fight to the UN secretary general.

It is estimated that more than 700,000 people die each year due to drug-resistant infections, though it could be much higher because there is no global system to monitor these deaths. And there has been trouble tracking those deaths in places where they are monitored, like in the US, where tens of thousands of deaths have not been attributed to superbugs, according to a Reuters investigation.

Scientists warned about the threat of antibiotic resistance decades ago, when pharmaceutical companies began the industrial production of medicine. The inventor of penicillin, Alexander Fleming, cautioned of the impending crisis while accepting his Nobel prize in 1945: “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant”.

But in the last few years, studies have dramatically increased awareness about antibiotic resistance. There has also been considerable advocacy by health officials, like Sally Davies, chief medical officer of the UK.

“Drug-resistant infections are firmly on the global agenda but now the real work begins,” Davies said in a statement. “We need governments, the pharmaceutical industry, health professionals and the agricultural sector to follow through on their commitments to save modern medicine.”

Signatories to the UN declaration committed to encouraging innovation in antibiotic development, increasing public awareness of the threat and developing surveillance and regulatory systems on the use and sales of antimicrobial medicine for humans and animals.

Only three other health issues have been the subject of general assembly high-level meetings: HIV/Aids, non-communicable diseases and Ebola.

Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, said he was encouraged that unlike with HIV/Aids and Ebola, the UN is addressing this health crisis before it has spun out of control.

“It’s very serious indeed – it’s killing people around the world at the rate of hundreds of thousands of year and we all expect it to get worse if something isn’t done now,” Woolhouse said. “But the UN is coming in at just the right time, in a sense.”

UN agrees to fight "the biggest threat to modern medicine": antibiotic resistance

Chinese actor Xu Ting dies after choosing traditional medicine over chemotherapy

Confronting photos of the bruised and swollen body of the Chinese actor Xu Ting widely circulated after her death have been used to highlight the dangers of using traditional Chinese therapies over conventional medicine for treating cancer.

In July Xu, 25, announced on the Chinese social media website Weibo she had lymphoma, a cancer of the lymphatic system that best responds to chemotherapy as a first-line treatment.

However, Xu said the high cost of chemotherapy in China and her fears about side effects and pain meant she had decided to treat her cancer with a mix of Chinese therapies instead.

“No matter how long I live, I want to enjoy every day happily,” she wrote, adding that she did not want to “let chemotherapy torment me to the point where there’s no beauty and talent left”. The actress appeared on television in the series Dad Home and acted in the comedy Lost In Macau.

Later in July, Xu posted photos to Weibo of the aftermath of some of the alternative treatments she had undergone, including acupuncture and cupping, which involves placing a flammable substance into a cup, typically a cotton bud, and setting it on fire. As the fire goes out, the cup is placed upside down on the skin, usually the back, creating a vacuum and leaving welts on the body.

Some users begged her to seek chemotherapy. One user wrote on her Weibo page: “You need to rely on modern medicine to save yourself.”

The American Cancer Society guide to complementary and alternative therapies warns of the risk of burns from cupping and states that “available scientific evidence does not support claims that cupping has any health benefits”.

Xu also turned to gua sha, a treatment that involves scraping the skin with a tool, and which is practised by the actor Gwyneth Paltrow and the swimmer Michael Phelps. It left Xu with red marks and bruising down her neck.

“Frankly, traditional Chinese medicine is also painful,” Xu wrote as a caption underneath one of the images of the treatment she posted to her blog.

According to a study published in the journal Complementary Therapies in Medicine, gua sha users in Hong Kong tended to use it mostly to treat respiratory and pain problems.

In August, Xu’s sister encouraged her to undergo chemotherapy as she became more unwell. Xu died on 7 September, shortly after starting chemotherapy.

Her death has sparked a debate in the Chinese media about the use and effectiveness of Chinese therapies. On the Chinese news website people.cn, the head of the traditional Chinese medicine department at the Chinese Academy of Medical Sciences in Beijing, Dr Feng Li, wrote that Chinese therapies should not be blamed for Xu’s death.

He wrote that “while western approaches like radiology, chemotherapy, and surgery are effective in shrinking the tumour”, Chinese therapies were “effective in reducing symptoms such as nausea, vomiting and pain that comes with western treatment”.

“Moreover, after the tumour is under control, traditional Chinese medicine helps to repair the immune system, accelerate the body’s recovery and minimise the chance of the tumour returning.”

A 2014 review of complementary and alternative medicine for cancer pain found alternative treatments, including Chinese treatments, had “low or moderate” evidence for alleviating cancer pain.

But a peer-reviewed paper published in the journal Cancer and Oncology Pain described the barriers some people faced obtaining conventional medical treatment. Led by Dr David Garfield from the ProMed Cancer Centre in Shanghai, the authors wrote that “Mainland Chinese attitudes are different from what we are accustomed to in the west”.

“There is a lack of trust between patients/families and physicians, related in part to there being few urban general practitioners, resulting in no longstanding, physician-patient relationships,” the authors wrote.

“There is a feeling that care is being provided for personal gain, much more so than in the west. When individuals are ill, or think they may be, they go directly to hospitals, including traditional Chinese medicine hospitals, rather than seeing a non–hospital-based practitioner.”

“Anti-cancer drugs, even for patients treated in public hospitals, are costly,” the authors added, writing that proven and effective treatments “although available, are out of reach for all but the wealthy”.

Cost, rather than mistrust, appeared to be a factor for Xu shunning chemotherapy. In one post on her Weibo blog, she wrote about how exhausted she was from trying to provide for her family financially.

“Over the past five years, I worked very hard to support the large family,” she wrote. “I made money to pay for my younger brother’s tuition fees, pay my parents debts and even buy a house. The pressure made me breathless.”

Chinese actor Xu Ting dies after choosing traditional medicine over chemotherapy

Giving birth in Guinea: a life or death lottery bereft of midwives and medicine | Ruth Maclean

A baby was born, took one breath, then left the world again. No amount of the midwife pumping his legs up to his ribcage and back, or poking a finger hard and fast at his chest, would bring him back.

His 17-year-old mother lay in pain on the delivery table as her son was wrapped up in a yellow cloth. There was no time even for her to hold him, as another woman was about to give birth. The midwives quickly changed their bloodied robes and gloves. Because there was no other table, the second woman gave birth lying on the floor.

This time, the baby yelled as soon as she came out. She was healthy. While the midwives moved on to the next urgent case, their small delivery room filling up, she spent her first few minutes screaming on the concrete slab.

Welcome to life in Guinea, baby Katherine.

The situation for newborn babies and their mothers in this west African country is dire. Of every 1,000 babies born in Guinea, 123 die before their fifth birthday. For every 100,000 live births, 724 women die. Guinea has the world’s second-highest rate of female genital mutilation (FGM), after Somalia – 97% of women between 15 and 49 have been cut. Women who have had FGM are twice as likely to haemorrhage during childbirth, and haemorrhage is the leading cause of mothers dying in Africa.

Medicine is in short supply, and health workers’ salaries rely on selling enough of it. This leads to staff shortages; most health centres have one or two health workers when they should have eight.

The Ebola outbreak, which killed more than 2,500 people in Guinea, revealed how little access to medical care rural Guineans had. The health situation has improved slightly post-Ebola, but without donor money, the system would grind to a halt.

“The needs are identified, but the money is just not coming from the government,” says Guy Yogo, Unicef’s deputy representative in Guinea. After Ebola, the government increased its contribution to health from 2.66% to 4.66% of GDP, and has committed to 7% for next year. According to Yogo, however: “The minimum is 11-15% if you really want to have an impact.”

Katherine is one of nearly 5,000 babies officially born each year at Doko health centre in the Kankan region of north-eastern Guinea, but about 2,000 more are born to unregistered mothers who come to the area to search for gold in artisanal mines.

Births take place in one small room, with its single delivery table presided over by two midwives.

“Lots of women come, and there’s nowhere to put them all. They often have their babies on the floor. Better there than next to sick people – at least it’s clean,” says Bernadette Mansaré, a midwife.

Sayon Keita, who is pregnant with her seventh child, is examined by a midwife at a health post near Doko, Siguiri

When there is a moment between deliveries, she lectures the dozen pregnant women waiting outside on the importance of coming in for checkups.

Doko’s midwives have not had any training in 20 years. If they had, they might have known how to give the baby who died mouth to mouth resuscitation or proper compressions. Thousands of babies die from preventable causes each year.

One of the things that the response to Ebola brought was medical supplies, the like of which had not been seen in a generation.

Kondiadou health centre is near Kissidougou, one of the towns to which the UN started regular flights during Ebola. Before, reaching south-east Guinea from the capital involved a bumpy car journey lasting several days. Now, because of the flights, it is easier to get supplies and staff in, although the UN is expected to cancel the flight as soon as the threat of Ebola is completely over.

“It’s the first time we’ve got equipment like this since the centre was built in 1990,” says Therese Soropogui, a community health worker at Kondiadou, as she pulls out standard latex gloves and yellow washing-up ones and explains the difference.

Why do women still die in childbirth?

A small camping stove, some sterilising kit, bandages and a few hundred pairs of gloves have been donated by the Spanish government and Unicef. And a red plastic bucket. It does not take much to save lives in remote Guinea.

“Before, we burned tools in the fire, and that took too long,” Soropogui says. “And if you had two women giving birth at the same time, you had to use our one set of tools for both women, one after the other. That was very difficult. Now we have three or four sets of tools and, at the end, you can sterilise them.”

Not all of the equipment seems to have been used, however, showing up what many see as an endemic problem with the UN’s approach.

“They give out supplies like sweets,” says Yolande Hyjazi, the country director of Jhpiego, an international health organisation. “The UN system is: what the government asks for, they buy, and that’s it. We’ve seen a lot of vacuum extraction equipment, but if you ask the staff about it they say: ‘I don’t know [what it is], the UNFPA [UN population fund] sent it.’ They give equipment without training.”

Even when staff do know how to use it, obstetric equipment does not solve a problem many women have – getting to a clinic.

Harriet Somadouno, a 20-year-old farmer in her third trimester, walked 17km to Kondiadou for a checkup, carrying 10kg of peanuts on her head to sell at the market en route.

“I walked with my friends, but I carried the peanuts myself,” she says. “It took me six hours. I’m going home tonight but I think it’ll be a quicker journey as I sold all the peanuts – perhaps four hours.”

Somadouno, exhausted after her walk, barely seemed to take in the information given by the nurse.

One scheme to help women involves what looks like a giant old-fashioned pram, which is attached as a sidecar to a motorbike. Spain has given 15 of them to health centres in Guinea.

Mamady Berete doubles up as Doko health centre’s broken bones specialist and the moto-ambulance driver. Dressed in high-vis from head to toe, he bumps up and down bush tracks and through enormous puddles, picking up pregnant women, strapping them in his sidecar and taking them to Doko.

The giant pram turns heads, but brings fresh problems, such as how to pay for petrol or maintenance.

“We have someone here who can fix it but, if a tyre breaks, we have to send to Conakry for a new one. It’s a bit difficult,” Berete says.

On his trips to the villages, Berete spreads the word about the health centre and encourages more people to use it.

Mamady Berete heads off to collect a pregnant woman from a remote outpost and bring her to the Doko health centre

Trust in Guinea’s health system was in short supply during Ebola, when clinics closed their doors, doctors and nurses died, and infected people seemed to disappear into hospitals never to return.

“People were afraid of our health centre – they said if you came here you’d catch Ebola. So people avoided coming,” says Berete. Because nobody came, salaries could not be paid, so the clinic had to shut, leading to even less trust in the service.

According to Yogo, the lack of working health systems meant the death toll from “collateral” diseases and health complications outpaced that of Ebola.

“More people died from malaria, diarrhoea and in childbirth than of Ebola,” he says. “The country did not have enough ambulances. They were all used for Ebola patients – nobody else.”

Now, people are trying to take advantage of the supplies and attention that Ebola brought, and keep people coming through the doors so staff can afford to keep those doors open.

Berete and his colleagues are succeeding: several health centres, including Doko, are recording pregnant women coming in greater numbers than before Ebola.

Somadouno, who left school aged nine and had her first child at 16, plans to repeat her gruelling 17km journey to give birth.

“I gave birth to my first child here and, because it went well, I’m coming back for this one,” she says. “My mother-in-law will come with me, but we’ll be on foot then too. My plan is to try to catch it early.”

Giving birth in Guinea: a life or death lottery bereft of midwives and medicine | Ruth Maclean