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28 Haziran 2014 Cumartesi

Hi-vis vests search industrious and existence-saving. No wonder politicians adore them | Andrew Martin

Chancellor George Osborne And Prime Minster David Cameron Visit Manchester

Now you see them … David Cameron and George Osborne go large-vis in Manchester this week. Photograph: Christopher Furlong/Getty Photos




In July 1964, the Railway Magazine reported that 15 platelayers operating on the Pollokshields to Eglinton Street line in the Scottish Region of British Railways had been issued with “a new variety of illuminous safety jacket which shines in half-light conditions”. In the absence of a photograph, the magazine strained to clarify this bizarre phenomenon to its readers. The jackets, “made from a fluorescent orange plastic material”, were “comparable in appearance to previous-fashioned ships’ lifejackets”. The writer speculated that these “human fire-fly jackets may possibly be adopted throughout British Railways”.


This is regarded as the first reference in British – and perhaps planet – journalism to high-visibility vests. Practically exactly 50 many years on, they have been adopted not only throughout our railways, but also the entirety of British society. A brief automobile drive across north London this week was met with the following substantial-vis action: two BT engineers fiddling with wires at a junction box wore them, as did a man pushing a black steel trolley along the pavement (his bearing a slogan: “Positive we can”). I stopped at a targeted traffic light up coming to a locked bike with a substantial-vis vest wrapped loosely about the crossbar. The owner was strolling away. It would have been fascinating to meet him, considering that he must be a combination of the prudent (betokened by his ownership of the vest) and the reckless (it was simply nickable from exactly where he’d left it). I was then passed by a guy sporting higher-vis who was driving a van marked “the indoor garden specialists”.


The question of what indoor gardening includes was a lot more pressing in my mind than why this kind of a practitioner may put on a substantial-visibility vest. Soon after all, when I parked my car and entered a shop selling work outfits in purchase to request the proprietor who bought higher-vis vests these days, he stated. “Anybody undertaking perform.” When I asked if revenue of them went up 12 months on year, he explained: “Yeah,” in the bored tone of someone questioning when he would ultimately be asked an interesting query. So I attempted the following: “What sort of men and women put on large-vis vests now but wouldn’t have worn them a few years ago?” “Absolutely everyone,” he stated. I pressed him for an example. “Window cleaners,” he said. “Why would a window cleaner want a large-vis vest?” I wondered. “Properly,” said the shopkeeper, “he’s walking down the street with his bucket and his ladder and he bumps into a person.” “But that,” I countered, “would be an argument for the man or woman he bumped into wearing higher-vis, not the window cleaner himself.” The shopkeeper did not consider a lot of that stage, and I wondered regardless of whether he believed that absolutely everyone who presently does not wear a substantial-vis vest as a matter of course ought to do so in buy to be observed by all the individuals who do put on them.


If so, he could not be bothered to express the view, his complacency perhaps attributable to the fact that he is riding that by no means-ending upward product sales curve. Everybody concerned in high-vis says the very same thing about the product sales, which tends to make me wonder why I’m not in the company myself. The rise can be traced back to the Well being and Security at Work Act 1974, which requires employers to guard against likely risks, and there is no cheaper way of guarding against hazards than to problem high-vis vests, which retail for three or 4 quid and are no doubt considerably less expensive wholesale.


The only gripe of the higher-vis traders is that substandard clothing comes on to the market place, without the CE mark denoting compliance with the European Neighborhood directive for Personalized Protective Products. Officially made vests conform to Class two of the European regular. Class one is substantial-vis trousers. These and a vest worn with each other turn into Class three, the highest attainable higher-vis ensemble: a high-vis suit, in truth. Both trousers and suits combine fluorescence with what is described as “retro reflective tape”. That is not “retro” as in vintage – a conscious reversion to some earlier, far more eye-catching type of high-vis – but as in bouncing light back from, say, auto headlights.


A good deal can be – and is – said towards large-vis clothing. It truly is not trendy. The Mitchell and Kenyon archive films showed us that Edwardian guys digging holes in the road wore dark suits with ties or neckerchiefs, which gave them a sort of dusky elegance. If a high-vis vest and shorts was a great appear for a postman, then why is not Postman Pat – who definitely sets the industry regular – so attired?


The substantial-vis vest is usually worn in location of the quasi-military uniforms of the past. I mean that it really is worn not so a lot to make the wearer conspicuous as to betoken authority. When I asked a single safety clothing insider to identify the class of man or woman who may give large-vis a poor identify, he muttered darkly, “stewards”. Rod Liddle has described large-vis as “the symbol of spurious authority”, and I feel the libertarian objection is that large-vis suggests both officialdom and victimhood. The wearer is bossing you about although also embodying the worry that you may possibly, through your sheer stupidity, run him down.


A couple of Darwinian steps from the bumptious steward is the sleek cabinet minister. The orange higher-vis vest worn by George Osborne at Manchester Victoria railway station this week (and not for the very first time) suggested that he personally would be building this high-speed railway for the north he was going on about. But the key was the blue Network Rail hardhat he also wore. Blue hat means visitor. White hat indicates “cleared for track accessibility”.


The high-vis wearer can also seem wimpish. My nearby publish office sells large-vis vests advertised by a image of a fluorescent household standing in a garden. Any individual scared to go into their personal garden without having wearing high-vis deserves to be struck down by one particular of those hazards high-vis can’t avert: a nice swift bolt of lightning, say.


But the case is diverse with the British employee. Most who disdain high-vis have by no means even worn the visitor hat at a development internet site, and I can’t recall carrying out so myself. But I discover it moving to see that motorway warning indicator “Workmen on the road”, specially when it’s late at night, and I am glad I’m not on the road myself. The sight of the Class 3 high-vis fits assuages my guilt, and I say to the libertarians: these guys are not protected as a collective mass, but as a series of individuals. To give them these fits is the least we as a society can do. It truly is as if they’re wearing spacesuits, which is fitting provided the remoteness of manual perform from most of our lives.


British health and safety in the workplace is the envy of the globe. The Well being and Security Executive press is nicely-armed with graphs displaying how far we have come. In his history of Britain’s railways, Fire and Steam, Christian Wolmar writes that, “in the five many years up to the finish of 1878, the railways killed an average of 682 of their staff each and every year”. In The Nation Railway, David St John Thomas wrote: “On scarcely a mile of track in Britain has a ganger not been run down by an sudden train.” Railway infrastructure jobs are nonetheless comparatively hazardous, but the deaths are in the lower single figures every year. It really is extremely hard to say how a lot this improvement owes to increased visibility. But when, travelling west from Paddington, I see the armies of orange-clad guys constructing Crossrail, I believe of the debt we owe to whoever made human fireflies of individuals 15 platelayers half a century ago.


Andrew Martin’s novel, Night Train to Jamalpur, is published in paperback by Faber &amp Faber on three July. Acquire it for £6.39 at guardianbookshop.co.united kingdom.




Hi-vis vests search industrious and existence-saving. No wonder politicians adore them | Andrew Martin

15 Mayıs 2014 Perşembe

Statins: Do we adore them with all our heart?

Prof Peter Weissberg, medical director of the British Heart Foundation, said: “Statins are an important weapon in the fight against heart disease and it is essential that trusted medical journals like the BMJ do not mislead the public. Patients should feel reassured by this move and should not stop taking their statin.”


Yesterday, Dr Godlee said the figure of 18-20 per cent included in the BMJ paper was based on data from an “uncontrolled observational study” and was incorrect. Speaking to BBC Radio 4’s Today programme, she said: “The BMJ and the authors have withdrawn the statements made in [the articles] that side-effects of statins were higher than we now think the evidence supports.”


Some experts don’t think the BMJ is going far enough. In March, Prof Sir Rory Collins, Professor of Medicine and Epidemiology and Co-Director of the University of Oxford’s Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), who has led global trials into statins, warned that these figures were dangerously misleading. “It is a serious disservice to British and international medicine,” he said. He claimed that the alarm caused would probably kill more people than had been harmed as a result of the MMR vaccine scare created by a now widely discredited paper in the Lancet written by Andrew Wakefield.


Although Dr Godlee has said that the remainder of the content of the articles is valid, she has also set up an independent expert panel to decide whether the BMJ needs to retract them completely, which is what Prof Collins now wants. “This is a serious misrepresentation of the scientific evidence and has a substantial public health impact,” he said.


A storm in a scientific tea-cup? If we weren’t talking about statins, you might well think so. But this is a row we can’t ignore. Not least because the use of statins is recommended to carry on rising. Draft guidance from the National Institute for Health and Care Excellence (Nice) in February suggested that the threshold for starting preventive treatment for heart disease, stroke or peripheral arterial disease should be halved from a 20 per cent risk of developing cardiovascular disease over 10 years to a 10 per cent risk. This would effectively double the number of people to whom statins are prescribed, bringing the total prescription cost alone (not including blood tests and biannual GP appointments) to just under £600 million.


Developing new drugs is an incredibly expensive and lengthy process: it costs about £1.2 billion and takes 12 years on average to develop and bring a new drug to market, according to the Association of the British Pharmaceutical Industry, and it will then get just 20 years of patent protection (although this can be extended occasionally for five years in the US and Europe).


This week’s mistake aside, peer-reviewed journals such as the BMJ play an important part in the scrutiny process that decides both whether those drugs are efficacious and whether they have undesirable side-effects. But some of the highly specialised medical journals cost a fortune to subscribe to. According to pharmacologist Prof David Colquhoun, access to 2,000 journals from publisher Elsevier costs University College London, his academic home, £1.38 million a year. This means that research published there can languish a little, especially if no one draws attention to it – which might suit a pharmaceutical company if the results aren’t so hot.


Prof Colquhoun points out that new “open access journals online” are a positive move. “Instead of just two referees looking at each piece, you get many minds and multiple comments underneath with some very incisive views, which can only be a good thing.”


It is worth noting, too, the increasing success of the All Trials campaign. This initiative, led by the journalist and scientist Dr Ben Goldacre, the BMJ, and the independent medical review body the Cochrane Collaboration, among others internationally, aims to get all clinical trials published and reported. It warns that currently around half of all clinical trials have not been published; some trials have not even been registered.


In the end, those millions who are using statins without obvious side-effects, and who see a significant lessening of their cholesterol levels, may say: what’s the problem?


Dr Malcolm McKendrick, a GP in Macclesfield and author of The Great Cholesterol Con, does not agree that statins are indisputably vital to all now. “For the vast majority of people, taking a statin will have zero impact on their life expectancy,” he says. “There have not been any trials carried out in the elderly, and there is no evidence any women will benefit from taking them.”


Dr Adam Fitzpatrick, a cardiologist and an expert in heart rhythm disorders at the Manchester Royal Infirmary, perhaps surprisingly, agrees. “Even if you have suffered heart disease and are male, the most benefit you can expect after taking statins for 20 years is an extra three months’ life, according to the research. That’s three months at the end, mind you, when you will probably be dying of cancer or have dementia. Is that really much of a gain?”


Dr Fitzpatrick also points out that the evidence for statins still doesn’t prove that they are responsible for fewer people dying of heart disease. “Saying statins save thousands of lives a year is just propaganda. The mortality rate for cardiovascular disease has been falling for 50 years anyway – and it reflects other factors, including quality of care and diagnosis, not to mention the number of people stopping smoking.


“We should be focusing on what the patient is complaining of. Our job is to tell them what it is caused by and reassure them, if that is appropriate. I see so many old ladies with atrial fibrillation who have been stuck on 80mg daily of the statin Lipitor and haven’t been able to move since due to muscle weakness. It is madness not to be tailoring care to those individuals.”


Dr McKendrick says that we could soon be hearing a lot more about side-effects. “When the new cholesterol-lowering drugs – monoclonal antibodies called PCSK9s – get through their trials, the pharma companies will need to create a market for them that doesn’t pitch them head-to-head with statins.”


Then, he suggests, we could suddenly find ourselves quizzed more closely by our GPs about muscle aches and brain fog, with the option, for those worried about side-effects, of taking these new drugs instead of statins.


These are drugs that will be in patent for 20 long, fertile years and which are far more expensive than statins ever were. With them will come a whole new set of possible side-effects – and, once again, patients may be left to weigh up the risks themselves.



Statins: Do we adore them with all our heart?

19 Ocak 2014 Pazar

MP Eric Ollerenshaw: "After 35 years of adore, pancreatic cancer took him in just 6 weeks"

A unusual exception was Hoggart, who died from the illness just right after Christmas. He had managed to survive three-and-a-half many years following a diagnosis of terminal pancreatic cancer in 2010, undergoing “cutting-edge” chemotherapy at the Royal Marsden Hospital, according to his daughter Amy. Jobs also survived for several years right after he was diagnosed with a uncommon kind of the condition.


But Eric’s partner, who worked in retail, was a more common example, each of the problems in receiving diagnosed and in the velocity of the cancer’s progression. “It was the summer season of 2009, and Michael, who was 61, kept struggling upset stomachs,” says Eric. “Whatever he took or did, he couldn’t look to get right. From being the kind of guy who never troubled the GP, he was suddenly there a lot, asking for assist. With hindsight, you have to say, is not that the type of alter in behaviour a doctor must discover?”


The pancreas is a glandular organ in the upper abdomen – the hormones (such as insulin) and digestive enzymes it creates aid us to process meals and to regulate blood sugar. Signs of pancreatic cancer can be vague and consist of stomach pain, excess weight loss and jaundice. Changes in bowel habits, loss of appetite, fevers and even onset of diabetes can also be indicators.


At that stage, Eric admits, the couple in no way considered cancer but when Michael admitted he felt also unwell to go on their annual holiday to Turkey that July, it was clear that anything severe was happening.


“In August, he was asked to go into our regional hospital, the Homerton in east London, for more tests, and a handful of days later he started turning yellow via jaundice. We have been advised to rush him straight back in, and it was there that a physician informed us the bad news.” In shock at the time, Eric does not recall the information of the exams Michael underwent, but a biopsy is normally needed to verify pancreatic cancer.


This was when the couple entered what Eric calls the “parallel universe” of cancer. “You just go along with your standard lifestyle, and then abruptly, bam, you are in this other globe of cancer – statistics, treatment options, percentages. We had been completely and utterly unprepared.”


Eric asked the consultant, who, like the majority of the medical employees, showed great devotion and care to Michael in the following few weeks, what his partner’s probabilities have been. “I knew there had been huge enhancements in cancer care in common, but she told me that with this sort of cancer, doctors nevertheless have little idea who will survive longest.”


The couple have been left in no doubt a few days later. “I was going in to see Michael each and every day, and was visiting him following a method to drain fluid from the region. He was groggy, just coming round genuinely, and there – with just the curtains pulled round for privacy – a different medical professional came in and mentioned: ‘Oh, it is terminal.’


“Well, there’s just no excuse for currently being advised like that. We had been devastated.”


Back property, Michael soon began to endure a lot more issues, with fluid accumulating around his upper abdomen creating him excellent discomfort. He was unable to get back into hospital right away and doctors advised that he try St George’s hospice in Hackney rather. “Just the word ‘hospice’ can make you believe, ‘Bloody hell…’,” says Eric, in his blunt Lancastrian accent.


On September 15, Eric drove his partner to the hospice, and stayed with him the following day. “That evening, a medical doctor advised me he didn’t consider Michael would last the night.” He was at Michael’s bedside when he passed away the subsequent day.


Eric was knocked sideways by the loss of his partner, and years on nonetheless keenly feels it. He requests that we do not publish a photograph of Michael, since “I feel I should ask his permission 1st – but I cannot now, can I?”


Eric was a member of the London Assembly when Michael died, and felt like retreating from public existence altogether. “I almost packed up – what was the level in going on with ideas to enter Parliament?”


But, he admits, he felt driven by the require “to put some thing back or make it much better for somebody else”. Elected to the Property of Commons the following May possibly, he established to place his “privileged position” to very good use, especially through the APPG.


“There is a great deal we can do,” he says. “We need to make positive not only that the public, but also medical professionals are a lot more conscious of pancreatic cancer. GPs may possibly not see more than 1 situation a year, if that. Analysis into far more successful chemotherapy is also necessary. And we need to appear at strengthening surgical treatment. Removal of the pancreas had a high mortality price, but now that it’s usually performed in specialist centres, good results charges have gone up.”


However, the APPG report says that while twenty per cent of patients may possibly advantage from surgical treatment to remove the cancer, only ten per cent are operated on, even though some sufferers have reportedly travelled to Germany for the operation.


Eric felt encouraged just lately when David Cameron supported his contact in the Commons for fairer research funding, to make certain that significantly less properly-identified illnesses do not miss out on financial support. Meanwhile, researchers at Cancer Analysis UK’s Cambridge Institute think a new drug, identified as AMD3100, or Plerixafor – which destroys a protective coating about diseased cells, making it possible for targeted therapies to attack the tumour – could be accessible to pancreatic cancer patients inside a decade.


His greatest hope, even though, is that enhanced awareness will lead to that all-crucial swifter diagnosis that gives patients, physicians and families much more time for therapy, and much more time to consider in what is taking place.


“It’s the velocity that catches you,” he says. “We have been in a daze these six weeks. It is been the two of you collectively your complete lives, and then out of the blue, terminal cancer.


“What do you do with your daily life after one thing like this? You have to go on. I’ve had great support – but I’ve been left on my very own.”


pancreaticcancer.org.uk



MP Eric Ollerenshaw: "After 35 years of adore, pancreatic cancer took him in just 6 weeks"