MPs have won the right to introduce a bill to parliament which would decriminalise abortion for the first time by repealing a law that dates back to Victorian times.
A ten-minute rule bill introduced by Diana Johnson, the Labour MP for Hull North, sought permission of the House to change two sections of a law passed in 1861, before women had the vote. It succeeded by 170 votes to 142, a margin of 32.
Johnson argued that the law was unfair and inappropriate in an age when women can and will access abortion pills by post because they want to be able to terminate their pregnancy in the privacy of their own home.
As the law stands, doing so is technically punishable by life imprisonment under sections 58 and 59 of the 1861 Offences Against the Person Act – both for the woman and for anyone, including a doctor, who help her.
Abortion is legal in restricted circumstances, which were laid down in the 1967 Abortion Act introduced by the then Liberal MP David Steel to stop women dying in large numbers as a result of backstreet abortions.
The 1967 legislation allows a termination before 12 weeks with the approval of two doctors and in the interests of the woman’s health. In rare circumstances including foetal abnormality, later abortions are permitted.
Johnson said in the debate that abolishing criminality need not change the current restrictions, which can be enshrined in regulations.
The new bill, which will be brought forward by a cross-party group of MPs, will be the first opportunity to rework the law on abortion since the 1967 act was passed.
MPs have won the right to introduce a bill to parliament which would decriminalise abortion for the first time by repealing a law that dates back to Victorian times.
A ten-minute rule bill introduced by Diana Johnson, the Labour MP for Hull North, sought permission of the House to change two sections of a law passed in 1861, before women had the vote. It succeeded by 170 votes to 142, a margin of 32.
Johnson argued that the law was unfair and inappropriate in an age when women can and will access abortion pills by post because they want to be able to terminate their pregnancy in the privacy of their own home.
As the law stands, doing so is technically punishable by life imprisonment under sections 58 and 59 of the 1861 Offences Against the Person Act – both for the woman and for anyone, including a doctor, who help her.
Abortion is legal in restricted circumstances, which were laid down in the 1967 Abortion Act introduced by the then Liberal MP David Steel to stop women dying in large numbers as a result of backstreet abortions.
The 1967 legislation allows a termination before 12 weeks with the approval of two doctors and in the interests of the woman’s health. In rare circumstances including foetal abnormality, later abortions are permitted.
Johnson said in the debate that abolishing criminality need not change the current restrictions, which can be enshrined in regulations.
The new bill, which will be brought forward by a cross-party group of MPs, will be the first opportunity to rework the law on abortion since the 1967 act was passed.
On Friday 10 March, I will perform an operation in public for the first time. In a live demonstration, I will aim to show how robots can assist surgeons to cut more safely, with greater precision, and achieve better results for patients.
I should say at the outset that no patient’s life will be put at risk during this event. I will be operating on a surgical mannequin – a specially adapted version of the shop mannequin designed to respond like a human body – and the event will take place at the Science Museum in London.
I will be using the same surgical robot that I used in 2001 when I performed the first such operation on a patient in the UK. It has three arms controlled from a console a few feet away, where I sit, allowing me to cut and stitch with great precision. Almost 16 years on, this will be a nostalgic moment for me. From cutting-edge technology to museum piece in less than two decades.
I am taking part in this demonstration, together with Professor Roger Kneebone, head of the Centre for Engagement at Imperial College, because I know that technological innovation of the kind represented by the robot has transformed surgery. But it will only continue to do so in the future if we have the vision and the courage to support it.
Critics will say that past technological advances have not delivered on their early promise. Certainly there have been challenges. Last year a research paper published in the Lancet comparing robotic with non-robotic surgery for prostate cancer found both achieved similar outcomes after three months.
The Times reported the story under the headline “Robots no better than human surgeons”. The Daily Mail, however, went with “Robots are better than humans at cancer ops”, on the grounds that the patients who had the robot surgery suffered less pain immediately after the operation. Is the glass half-full? Or half-empty?
I am firmly in the former camp. As I wrote in the Lancet at the time, the fact that the robot-assisted surgery achieved an equivalent outcome should be seen as a positive result. It shows that the innovation has preserved the intended purpose of the surgery. Advances in technology such as this provide the platform on which additional innovations can be developed, to further improve the quality and safety of surgery.
The device, called the iknife, can detect almost instantly whether tissue is cancerous or not
Consider where we have come from: in little more than 100 years since the two-part silver scalpel, with handle and replaceable blade, was invented by Morgan Parker in 1915, it has increasingly been replaced by the electrosurgical knife – a probe carrying an electric current that burns through tissue, sealing the tiny capillaries as it cuts, reducing blood loss, improving the surgeon’s field of view and the speed of the surgery.
Now a third advance is imminent, with the invention of an electronic “nose” attached to the electrosurgical knife. This absorbs the smoke given off as the blade burns through tissue and analyses it in a mass spectrometer. The device, called the intelligent knife or iknife, can detect almost instantly what kind of tissue the surgeon is cutting through – whether, for instance, it is cancerous or not. Instead of sending tissue samples to the laboratory and waiting days or weeks for them to be tested, the surgeon will in future be able to tell whether all the cancer has been removed before the operation is complete.
Membership Event: Robot Surgery Live
Advances such as this are ushering in a new era of precision surgery, in which established clinical and pathological signs are linked with state-of-the-art molecular profiling, enabling us for the first time to tailor specific interventions to the individual biology of the patient.
I was delighted with the interest and enthusiasm shown by the Science Museum in displaying the first surgical robot ever used in Britain as part of their robotics exhibition. It will remain with the museum as a donation from the department of surgery at Imperial College London.
But if we are to continue moving forward, we need disruptive innovators who are ready to challenge dogmatic practice and an environment in which they are free to experiment. What today looks revolutionary is tomorrow’s museum exhibit.
Lawyers have won the right to challenge a decision to prosecute a mother in Northern Ireland who procured abortion pills online for her 15-year-old daughter.
In a groundbreaking case that is set to focus attention on Northern Ireland’s abortion legislation, a judge in Belfast gave permission for a judicial review to be heard over the prosecution of the mother, stating that the case raised “issues of considerable public importance and public debate”.
The family’s lawyers argued that compelling the child to go ahead with the pregnancy would have breached her human rights; and by extension the decision to prosecute her mother for helping her access medication also amounted to a breach of her human rights and those of her mother. Lord Justice Weatherup said the judicial review would look at whether there should be prosecutions in these circumstances.
The case came to the attention of police because a doctor at the clinic where the girl sought advice from her GP and received counselling after taking the pills reported her. The review will look at whether the decision by police to access her medical records without her permission was also a breach of her human rights.
The girl at the centre of the case is not being prosecuted (and has not been named), but her mother faces two charges of unlawfully procuring poison (the abortion drugs mifepristone and misoprostol) with intent to procure a miscarriage, contrary to the 1861 Offences Against the Person Act, and supplying that poison to her daughter. If convicted, she faces a maximum sentence of 10 years.
Self-administered abortions using pills – often procured over the internet – have become the cheapest, most accessible solution for women in Northern Ireland. The 1967 Abortion Act was never extended to Northern Ireland, and abortion remains illegal in all but the most extreme circumstances. Northern Ireland has the harshest criminal penalty for abortion anywhere in Europe; in theory life imprisonment can be handed down to a woman undergoing an unlawful abortion.
The girl found out she was pregnant in the summer of 2013, after a relationship with a boy a year older than her and who she said was physically abusive. In written evidence submitted to the court, her lawyers said he threatened to kick the baby out of her, and to stab it if it was born.
According to statements submitted on behalf of the mother, the girl discussed her situation with her, and considered whether she should keep the baby, give it up for adoption or travel to England for an abortion. Her mother had heard that abortion pills were another option, and read about them on the British Pregnancy Advisory Service website, which indicated they were safe and widely used. She did not know it was illegal to use them in Northern Ireland. She obtained them by post through a website that helps supply the pills to women, particularly in countries where abortion is restricted.
After taking the pills, the girl was upset and was being harassed by her ex-boyfriend, according to the statements. Her mother was concerned about her emotional wellbeing and took her to the GP, where they spoke about taking the pills. A medical examination showed no ill-effects, and a referral was made for counselling.
Two months later a doctor at the medical centre (it is not clear from the court papers if it was the same doctor or another) told police that the girl had taken the pills. Neither the girl nor her mother were consulted about her private medical records being handed to the police, according to the court papers.
In a statement made to her lawyers, and submitted in the case for judicial review, the mother said: “I have been extremely distressed at the prospect of facing what I understand to be serious criminal charges because I accessed pills for my 15-year-old daughter in circumstances where she believed that she was pregnant and did not feel able to continue with her pregnancy.
“None of the people I spoke with about accessing pills told me that it was illegal and I did not believe that I was doing anything wrong. That is why I was totally open with the GP and all other professionals I dealt with. My primary concern throughout this has been to protect my child’s best interests. I don’t believe that [she] would have been able to cope with giving birth and rearing a child.” She added: “Had I been aware that there was any legal issue about the purchasing of the tablets I would probably have been more cautious.”
A statement from her daughter said: “I was only 15 years old and I was frightened by the prospect of being a mother. I was still a child myself and I was not sure that I would be able to cope. I was still at school and was in my first year of the GCSE cycle. I had always planned to do A-levels and I wanted to go to university. I knew that all of this would have been extremely difficult as a single mother.”
She said she was frightened the boy might continue to abuse her, or the child. “The idea of [my ex-boyfriend] being the father of my child and having him in my life in the long term made me physically ill.”
Lawyers for the mother and daughter will focus on the girl’s age and argue that “the blanket ban on abortion is particularly invidious when it comes to children who are unlikely to be able to access appropriate medical services without adult assistance.” The mother’s legal team is hoping to crowdfund the fees for the judicial review because she is not eligible for legal aid.
Earlier this month, in another prosecution involving the use of abortion pills in Northern Ireland, a woman accused of taking the tablets and her partner (who was accused of supplying a poison after getting the pills for her online) accepted cautions and charges against them were withdrawn.
Last year, a woman was prosecuted after her flatmates reported her to police for taking the same pills to terminate her pregnancy at home.
The abortion tablets are recommended as safe by the World Health Organisation for use in early pregnancy; in 2005 an estimated 26 million women worldwide used this drug combination to terminate pregnancies.
The mother’s lawyer, Karen Quinlivan QC, also highlighted the potentially chilling effect of the revelation that medical staff had reported the girl to the police. In Northern Ireland, medics theoretically face prosecution if they do not disclose an abortion to the police. She said the mother and daughter were “being punished because they didn’t tell a pack of lies to the doctors”.
“To pursue the prosecution in these circumstances will inevitably deter other women and girls, who for one reason or another take abortion pills obtained online, from obtaining medical assistance in the aftermath of having taken such pills, because of an entirely rational fear that this will be reported to the authorities,” she argued in the skeleton argument submitted to the judge. “This creates a real risk that women or girls who ought, to ensure access to the best medical care, make full disclosure of the fact that abortion pills have been taken, may not do so, with the potential adverse consequences to their health.”
Grainne Teggart, Northern Ireland campaign manager for Amnesty International, said: “We welcome the decision of the court to grant leave to challenge the decision to prosecute a mother for procuring abortion pills for her daughter – she is not a criminal, her daughter is not a criminal. Abortion is a healthcare and human rights issue and the law must stop treating Northern Ireland women who need abortions as criminals.
“It is wrong that the mother has been treated like a common criminal for attempting to help her daughter by sourcing medication, which is prescribed free on the NHS in every other part of the UK.”
A date for the judicial review hearing was set for May.
A combative Jeremy Corbyn has said he welcomes the tough byelections triggered by the resignations of two Labour MPs as an opportunity to challenge the government, as his ally John McDonnell said the party had had a good week.
Tristram Hunt, a fierce critic of Corbyn’s leadership, announced on Friday that he was stepping down as the MP for Stoke-on-Trent Central, a constituency where Ukip came second in 2015 and that voted heavily for Brexit.
His resignation to run the Victoria and Albert Museum in London followed that of Jamie Reed in December, whose Copeland constituency in Cumbria is home to the Sellafield nuclear plant.
In a robust appearance on the BBC’s The Andrew Marr Show on Sunday, Corbyn said he welcomed the forthcoming contests. “It’s an opportunity to challenge the government on the NHS. It’s an opportunity to challenge the government on the chaos of Brexit. It’s an opportunity to challenge the government on the housing shortage,” he said.
He said the resignations had not affected his determination to keep leading Labour. “I look in the mirror every day, and I think, let’s get out there and try to create a society where there are opportunities for all,” he said.
Labour is still languishing far behind the Conservatives in the opinion polls, but Corbyn said he believed the party’s ratings would start to bounce back as the public realised the full state of the crisis in the NHS.
He said Labour’s priority would be to cancel planned cuts to corporation tax and put the cash into social care.
The two mid-term resignations have raised concerns at Westminster that more Labour MPs disillusioned with Corbyn’s leadership could follow suit. “There won’t be loads, but there will be some, I’m sure,” a senior party insider said.
The Wigan MP Lisa Nandy, who is sometimes talked about as a future Labour leadership contender, told BBC Radio 5 Live on Sunday she planned to spend more time in her constituency in the coming months, as a response to the feeling among some voters that their voices were not being heard.
Asked if she thought other colleagues would follow Reed and Hunt, Nandy said: “People are thinking very seriously about what they can actually contribute personally to the political process.”
She added that Labour was in the difficult position of trying to speak for both sides of the Brexit divide. “A lot of my colleagues are spending a lot more time outside the Westminster bubble and in their constituencies,” Nandy said.
Corbyn’s appearance on the Sunday television interview circuit was part of a new year relaunch, in which his advisers have sought to harness his unpolished style and willingness to reject the political mainstream. He has floated the idea of capping excessive corporate pay and nationalising failing care homes – ideas that Corbyn’s team believe will be popular with the public.
McDonnell, in an interview with Sky News’s Sophy Ridge, said he believed the relaunch was going well. “I think this week’s been pretty good,” he said. “On the issues that we wanted to get across on the day, the issue around pay was raised and he answered honestly, in the authentic way he always does.
“We drew people into a debate that they’d never had before, or not for a long time anyway, and we drew them in on our own terms.”
But an attempt to shift the party’s line on immigration, which many backbench MPs believe is key to winning back votes in working-class constituencies, floundered as Corbyn appeared to back away from the idea of limits on free movement.
The shadow foreign secretary, Emily Thornberry, when asked to clarify Labour’s position by ITV’s Robert Peston, said: “We’re not going to die in a ditch about it, it’s up for negotiation, but Labour’s principle has always been that the economy is the most important thing.”
Diane Abbott, one of Corbyn’s closest allies, has struck a different tone since the Brexit vote, warning that by caving in to demands for a tougher stance on immigration, the party risked becoming “Ukip-lite”.
Corbyn sought to sidestep the issue on Sunday, emphasising the impact of exploitative employers on low-paid workers, rather than the scale of immigration, saying: “Let’s not blame migrants for the problems we have.
“What I have been talking about all along is the question of ending the grotesque exploitation and the undercutting that goes on. Are we going to cut ourselves off from Europe completely? I don’t think so.”
He also hit out at the representation of Labour and his leadership in the media. Corbyn said it had been unfair and he would like to see a “right of reply”.
No date has been set for the two byelections, but both are expected to be held within weeks, and could give the clearest indication yet of how the referendum has shaken up British politics.
A combative Jeremy Corbyn has said he welcomes the tough byelections triggered by the resignations of two Labour MPs as an opportunity to challenge the government, as his ally John McDonnell said the party had had a good week.
Tristram Hunt, a fierce critic of Corbyn’s leadership, announced on Friday that he was stepping down as the MP for Stoke-on-Trent Central, a constituency where Ukip came second in 2015 and that voted heavily for Brexit.
His resignation to run the Victoria and Albert Museum in London followed that of Jamie Reed in December, whose Copeland constituency in Cumbria is home to the Sellafield nuclear plant.
In a robust appearance on the BBC’s The Andrew Marr Show on Sunday, Corbyn said he welcomed the forthcoming contests. “It’s an opportunity to challenge the government on the NHS. It’s an opportunity to challenge the government on the chaos of Brexit. It’s an opportunity to challenge the government on the housing shortage,” he said.
He said the resignations had not affected his determination to keep leading Labour. “I look in the mirror every day, and I think, let’s get out there and try to create a society where there are opportunities for all,” he said.
Labour is still languishing far behind the Conservatives in the opinion polls, but Corbyn said he believed the party’s ratings would start to bounce back as the public realised the full state of the crisis in the NHS.
He said Labour’s priority would be to cancel planned cuts to corporation tax and put the cash into social care.
The two mid-term resignations have raised concerns at Westminster that more Labour MPs disillusioned with Corbyn’s leadership could follow suit. “There won’t be loads, but there will be some, I’m sure,” a senior party insider said.
The Wigan MP Lisa Nandy, who is sometimes talked about as a future Labour leadership contender, told BBC Radio 5 Live on Sunday she planned to spend more time in her constituency in the coming months, as a response to the feeling among some voters that their voices were not being heard.
Asked if she thought other colleagues would follow Reed and Hunt, Nandy said: “People are thinking very seriously about what they can actually contribute personally to the political process.”
She added that Labour was in the difficult position of trying to speak for both sides of the Brexit divide. “A lot of my colleagues are spending a lot more time outside the Westminster bubble and in their constituencies,” Nandy said.
Corbyn’s appearance on the Sunday television interview circuit was part of a new year relaunch, in which his advisers have sought to harness his unpolished style and willingness to reject the political mainstream. He has floated the idea of capping excessive corporate pay and nationalising failing care homes – ideas that Corbyn’s team believe will be popular with the public.
McDonnell, in an interview with Sky News’s Sophy Ridge, said he believed the relaunch was going well. “I think this week’s been pretty good,” he said. “On the issues that we wanted to get across on the day, the issue around pay was raised and he answered honestly, in the authentic way he always does.
“We drew people into a debate that they’d never had before, or not for a long time anyway, and we drew them in on our own terms.”
But an attempt to shift the party’s line on immigration, which many backbench MPs believe is key to winning back votes in working-class constituencies, floundered as Corbyn appeared to back away from the idea of limits on free movement.
The shadow foreign secretary, Emily Thornberry, when asked to clarify Labour’s position by ITV’s Robert Peston, said: “We’re not going to die in a ditch about it, it’s up for negotiation, but Labour’s principle has always been that the economy is the most important thing.”
Diane Abbott, one of Corbyn’s closest allies, has struck a different tone since the Brexit vote, warning that by caving in to demands for a tougher stance on immigration, the party risked becoming “Ukip-lite”.
Corbyn sought to sidestep the issue on Sunday, emphasising the impact of exploitative employers on low-paid workers, rather than the scale of immigration, saying: “Let’s not blame migrants for the problems we have.
“What I have been talking about all along is the question of ending the grotesque exploitation and the undercutting that goes on. Are we going to cut ourselves off from Europe completely? I don’t think so.”
He also hit out at the representation of Labour and his leadership in the media. Corbyn said it had been unfair and he would like to see a “right of reply”.
No date has been set for the two byelections, but both are expected to be held within weeks, and could give the clearest indication yet of how the referendum has shaken up British politics.
Junior doctors have lost a judicial review challenging the legality of a controversial new contract, which is now set to be introduced by Jeremy Hunt next week.
In a judgment published on Wednesday, Mr Justice Green rejected arguments presented at the high court by five junior doctors that the health secretary had exceeded his powers.
A Department of Health spokeswoman said: “We welcome this clear decision by the judge that the secretary of state acted entirely lawfully. We must now move on from this dispute to the crucial job of making sure patients get the same high standards of urgent and emergency care every day of the week, which involves more than the junior doctors’ contract.
“We urge the BMA to remove all threat of further industrial action so we can work constructively with junior doctors to address their wider concerns and better recognise their vital importance to the NHS.”
The junior doctors nevertheless claimed the judgment as a victory. They said it showed the contract was not being imposed, which they argued meant junior doctors were not legally compelled to sign the new agreement and could continue to negotiate the terms and conditions.
The Department of Health said it would be seeking repayment of taxpayers’ money spent defending the case up to the previously agreed cap of £70,000 and would use the funds to make a charitable grant to NHS charities.
The doctors had argued that the health secretary had no power, whether solely or with others, to take a decision as to the terms on which junior doctors were employed, only to make recommendations, that Hunt had acted in breach of the requirements of transparency, certainty and clarity and that he had acted irrationally.
But Green rejected all three grounds. He further said he did “not accept the claimants’ argument that the evidence base upon which the minister acted was inadequate”, and he rejected the suggestion that Hunt had misled parliament.
In a two-day hearing last week at the Royal Courts of Justice in London, Jenni Richards QC, for Justice for Health, asked the court to quash Hunt’s decision to bring in the new contract, which she maintained he had no power to do, especially since the Health and Social Care Act 2012 reduced the scope of the health secretary’s powers.
The health secretary, Jeremy Hunt, is now set to impose the new contract next week. Photograph: Toby Melville/Reuters
But Gavin Sheldon QC, appearing for Hunt, rejected the doctors’ arguments and said that their case was without substance. The health secretary had not decided to “compel” NHS trusts to use the new contract, he had merely approved it, Sheldon said.
“The secretary of state has not gone outside the scope of his powers,” he told the court. “The secretary of state has been clear about what his powers are.”
The five doctors’ high court legal challenge was crowdfunded by £300,000 from about 10,000 donors, most of them fellow junior doctors. They hoped that the court’s ruling would embarrass Hunt, and make it difficult for him to execute his threat to impose the contract, by finding that he had acted outside his powers or the law.
Many junior doctors, frustrated that eight days of strike action between January and May had failed to force Hunt to lift his threat of imposition, hoped that the lawsuit might delay or even scupper altogether Hunt’s plans.
The British Medical Association is facing a backlash from its members after first announcing, and then last Saturday calling off, plans for a series of four all-out strikes by junior doctors as a way of increasing the pressure on Hunt.
As things stand, NHS trusts across England will start phasing in the contract from next week in a process that will take about 18 months to put all 54,000 doctors below the level of consultant on to the altered terms and conditions.
This week Sir David Nicholson, who was the chief executive of the NHS in England until 2014, criticised ministers’ handling of the year-long junior doctors’ dispute.
“Clearly the government overall got it wrong,” Nicholson said. He said given that today’s generation of junior doctors wanted to work more flexibly and have more control over their lives, “it seemed to me that the way the conversation was going … I was really worried that it was less to do with the issues around that particular problem and more to do with a general idea that somehow we needed to put the junior doctors in their place.”
“With a positive attitude and determination,” he adds.
“Then you’d be the first,” I silently retort.
A successful retired engineer, he is one of those who don’t fall ill until catastrophe strikes.
He had gone to the doctor feeling vaguely unwell and inherited a cancer diagnosis, and with it, an endless series of investigations. For a while, his surgeon sat on the fence – although the primary abdominal cancer was technically operable he had a hunch that the tiny, indeterminate nodules on the lung represented metastases.
“Why won’t my surgeon operate?”
“Because he doesn’t think he can cure you.”
“Do you think he is being too cautious?”
“No, I think he is looking after your best interests.”
His dogged determination refuses to consider the nuances I keep putting forward.
“I’ll do everything in my capacity to help you,” I say.
“I know you will. We’ll beat this together.”
“We may not be able to,” I respond, running away from the battle metaphor.
Unlike other patients, he doesn’t question my judgment or warn me off discussing bad news. He isn’t aggressive or demanding, in fact the opposite. Being a logical man, he doesn’t believe in miracles. But he just has an unshakeable belief that I am his companion in the fight of his lifetime and with me on his side, he can win.
I look across the desk at my well-dressed, thoroughly organised, thoughtfully spoken, impeccably mannered patient and ask myself how I am going to convince him that he has months to live.
I look at his wife searchingly. How does she regard his maniacal self-belief?
He starts chemotherapy and the remarkable response surprises everyone. Moreover, he suffers none of the anticipated toxicities, prompting him to grin, “Are you sure it’s not placebo you’re giving me?” Patients ask this from time to time, belying a real fear that their doctor has given up, so I answer seriously, “I promise you, I am treating you with the most intensive cocktail available.”
“Then why am I not sick?”
“Isn’t that great?”
“We will overcome this!”
I look at his wife searchingly. How does she regard his maniacal self-belief? Will she help me inject reason into the conversation? But she doesn’t utter a word, as if reminding me that the doctor-patient relationship is between me and her husband.
The surgeon calls me to say that he has finally ruled out the prospect of surgery. “He does realise he is having palliative chemo, right?” The surgeon’s mild exasperation mingles with mine, threatening to overflow at the next visit.
As I take a minute to collect my thoughts, I find myself wishing that my patient would say just once, “Yes, I understand I have an incurable disease.” We don’t have to talk about prognosis, compare patients, or dwell on anything other than how great he feels but the acknowledgement would take a burden off my shoulders.
As these thoughts toss through my mind, my vague discomfort suddenly finds form in a single question, as if posed by an outside observer who is fed up of my attitude.
“Why does his relentless optimism bother you so much?”
I answer my invisible interlocutor with gusto.
“It bothers me because it makes me feel like I haven’t sufficiently explained things to him and maybe, he has taken my silence to mean assent. It bothers me that one day, when his disease inevitably progresses, he will blame me for concealing the truth. It bothers me that his death will be fraught because how will we cross over from joking about placebo to accepting mortality?”
The invisible interlocutor retorts, “But how you deal with your fear and conflict isn’t your patient’s responsibility.”
Stung by the realisation, I face my patient again.
“I’m determined to beat this,” he repeats.
“You know what, that would be truly wonderful,” I answer with a smile, suppressing all my dread and discomfort.
Something in me relents and something in him revels. The next few months are blissful, devoid of rancour and competition. He directs the conversation; I lose the urgency to say anything to tip our fragile balance. When I feel a stab of anxiety about the future, I remind myself that my greatest value to him may be in not undermining hope.
To sustain hope while preserving honesty – this is the greatest challenge in oncology.
Oncologists attract much disdain from other doctors and patients for withholding bad news, twisting facts and distracting patients from dying well. Studies show that the majority of patients with advanced cancer don’t know that their life is limited and that treatment is not curative.
Other studies highlight the anxiety and distress faced by patients and their carers when there is confusion surrounding the future and when oncologists don’t play a role in helping shed the uncertainty. But just like cancer represents many different diseases, cancer patients represent many different kinds of people, each with their own needs, longings and expectations. To address them all in one tone would be as pointless as treating all cancers with one drug. Grief has no arc.
Just as I’d feared all along, the cheer dissipates but what takes away my breath is how quickly it happens. One week he is well and the next week he’s glowing yellow with liver failure and in pain. I am dismayed.
“I can do a scan if you want but clearly things look worse.”
I brace myself for the onslaught of protest with a reminder that this is the price of the preceding months of bonhomie. But I am wrong again. He regards the numbers, looks at me, and says as calmly as if discussing the weather, “So this is it, then?”
Tears prick my eyes. Looking at his pale face and sleepless eyes, I yearn to have his old, ebullient self back, the self that wanted to challenge nature itself. I am tempted to lend him some of his hope back but all I can muster is, “I am really sorry.”
He sits there for a while, his face a kaleidoscope of emotions.
“I can’t thank you enough for the way you have held me up,” he finally says. “I’ve always appreciated your honesty.”
He’s got the wrong person in mind, I think dully as I recount my endless quest to save him from his delusions. His humility astounds me, giving rise to a tide of frustration at yet another death at the hands of some invisible, unrelenting process that neither my patient understood nor I could genuinely explain.
The next week, at an unscheduled visit, he looks terrible.
As I write a morphine prescription, he mentions he is pleased to have the beehives sorted.
“What beehives?” I ask, wondering what else I don’t know about him.
“If I can manage the travel, I’ll show you.” He hesitates, then hugs me. I know I won’t see him again.
Defying progressive symptoms, he assiduously ties up loose ends and gives away various belongings. Then, he surprises me one last time by making a final trip to hospital.
I stare at the gleaming jars of honey, pale gold, painstakingly decorated and wrapped, finally understanding just how hard he must have worked to finish the intricate undertaking.
It turns out only one of us was in denial and it wasn’t the patient.
Life on an informal gold mine is hard for any child. In Guinea, it means searching through piles of dark earth for glittering particles from a young age, going hungry if the family has no luck that day, and surviving violent attacks by other miners or the authorities.
For Lounceny, a dark-eyed boy who has spent the first four years of his life watching his mother look for gold in Kintinian in the country’s north-east, life is harder. He caught polio when he was two.
“It started with a wound on his foot,” says Lounceny’s grandmother, Sita Aidara, touching her frightened grandson’s shoulder as he sits on a wooden bench beside her, trying to keep him calm. “He started complaining about his leg – then it spread to the other one.”
Related: Pakistan and Afghanistan join forces to wipe out polio
She took him to a clinic 20 miles away, where it was confirmed that he had become one of the few children in Africa to contract polio. There was little they could do for him, and now Lounceny cannot walk. His family has to carry him to the mines, where he sits on a mat all day as they search.
On Thursday, Africa was set to celebrate two years with no new cases of wild polio, a major step on the way to consigning cases like Lounceny’s to the past. However, the global fight to eradicate the disease suffered a blow when two new cases were found in Nigeria.
Globally, hundreds of thousands of children used to become paralysed as a result of polio every year, before vaccines were developed in the 1950s and 1960s. While it was almost eliminated in rich countries, the problem endured in poorer states. The Global Polio Eradication Initiative, set up in 1988 by Rotary International, the World Health Organisation (WHO), Unicef and the Centers for Disease Control and Prevention (CDC), has now almost managed to eradicate the disease.
When Nigeria marked two years without any new cases last month, Afghanistan and Pakistan were thought to be the last countries in the world left where polio is endemic. However, Nigeria’s celebrations were premature. The WHO said the strain of polio discovered there is most closely linked to one last seen in Borno in 2011. The two children have become paralysed.
Nigeria’s minister of health, Isaac Adewole, put the latest occurrence down to the “insurgents’ eclipse”, referring to the fact that the terrorist group Boko Haram controlled large swathes of territory in Borno state, where the polio cases were found. Health workers could not get there and vaccinate children for months.
Women pan for gold in the mining area of Siguiri, Guinea. It was in such circumstances that Lounceny contracted polio. Photograph: Kate Holt/Unicef
“Mr President himself, when we had a meeting last week, observed that as we liberate more areas, we should expect challenges,” Adewole told Nigerian media. “But we did not expect that there would be polio. We were expecting nutrition and other problems.
“It wasn’t that we were not doing the job. A chunk of the state was out of reach, and we couldn’t reach children there.”
Nigeria had appeared to be losing the battle against the disease, with some states banning all vaccines in 2003 amid suspicions about their safety. There were also several attacks on people administering vaccines. However, an immunisation campaign led by the CDC vastly improved the situation.
Africa needs three years with no new cases to be declared officially polio-free. The Nigeria outbreak resets the clock.
Guinea, one of the poorest countries in Africa, ranked 182nd out of the 188 countries in the UN’s 2015 human development index, had its last big outbreak of wild polio in 2009, when there were 41 cases.
But a new outbreak of vaccine-derived polio hit in September 2015, after the crippling Ebola outbreak that diverted all Guinea’s healthcare efforts. Seven children under five contracted the virus in the eastern region of Kankan.
“At that moment the Ebola outbreak hit, so we couldn’t do anything,” said Souley Lalibou, leader of the WHO’s polio response in Guinea. “While Ebola was happening, everything else stopped.”
Children sit outside a clinic in a community near Doko, Siguiri, in northern Guinea. They have just been vaccinated for polio as part of a Unicef campaign backed by the Spanish government. Photograph: Kate Holt/Unicef
As soon as they could, the WHO, Unicef and the government launched a campaign to stamp it out. In two weeks, Lalibou will find out whether their efforts paid off and Guinea’s polio outbreak is officially over.
“There are probably more cases out there that we don’t know about, but I don’t think there are any wild cases,” Lalibou said.
Vaccine-derived polio is easier to control than wild polio, but the effect on a child’s life is the same.
Lounceny only had one dose of the polio vaccine. Aidara wished she had known the risk to her grandson, as she would have tried to get him the 20 miles to the clinic for his second dose.
“His mother was in the mines, trying to earn money so we could eat. We didn’t know he could get polio,” she said.
As it is, the whole family struggles to survive at the same time as looking after a child with disabilities.
“The problem we have is that if you don’t carry him, he can’t move,” Aidara said. “You always have to help him. Taking care of him and looking for gold don’t go together. I’m really worried about his future – I don’t know what it will be like.”
It is often easy to dismiss viral charity campaigns as “slacktivism”, which lacks in real-world impact (we never did catch the warlord Joseph Kony, after all) but a breakthrough discovery bankrolled by 2014’s ALS ice bucket challenge may give the lie to that cynicism.
The ice bucket challenge was a phenomenon in the summer of 2014 in which people dunked a bucket of iced water over their heads in order to solicit donations before nominating others to do the same.
Scores of celebrities including Mark Zuckerberg, Anna Wintour, Tom Cruise, Charlie Sheen, Robert Downey Jr and hundreds more made videos, but the campaign was criticised by some.
Slate wrote that “for most of the people posting ice bucket videos of themselves on Facebook, Vine, and Instagram, the charity part remains a postscript”, while Time called it “problematic in almost every way”, going on to say that “most of its participants … didn’t mention the disease at all. The chance to jump on the latest trend was an end in itself. In fact, the challenge’s structure seems almost inherently offensive to those touched by ALS.”
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But the proof of the pudding was in the eating: the campaign raised more than $ 100m in a 30-day period, and was able to fully fund a number of research projects.
One of these was Project MinE, a large data-driven initiative funded by the ALS Association through ice bucket challenge donations, as well as donations from the organization’s Georgia and New York chapters. The project’s researchers announced on Monday that they have identified a new gene associated with the disease, which experts say could lead to new treatment possibilities.
Amyotrophic Lateral Sclerosis, also known ALS or Lou Gehrig’s Disease, is a neurological disorder in which the motor neurons that control muscle function slowly die. The disease can be either sporadic or inherited, and in either case there is currently no cure.
“It’s very exciting because it shows everyone who contributed to the ice bucket challenge that their donation had an impact on the research,” said Brian Frederick, executive vice-president of communications and development at the ALS Association. “The work that Project MinE is doing is really important, and the discovery of this new gene will help us better understand ALS.”
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The newly discovered gene, NEK1, is only associated with 3% of ALS cases, but it is present in both inherited and sporadic forms of the disease, which researchers say gives them a new target for the development of possible treatments.
Project MinE has been working to sequence the genomes of 15,000 people with the disease, and the discovery, which was described in a paper published on Monday in the journal Nature Genetics, involved more than 80 researchers in 11 countries.
The discovery was significant, Frederick said, “because it helps us understand what’s triggering this and can help us better find a treatment,” though he added that “it’s still very early in our understanding of this particular gene, and we still have a ways to go with understanding ALS generally.”
When the British Healthcare Journal recently asked John Ashton to describe himself in three phrases, the president of the Uk Faculty of Public Overall health, chose “visionary, outspoken, impatient”. An hour in his organization confirms all 3 traits, and “loquacious” and “political” have to have been close contenders for inclusion also. If garrulousness was an Olympic sport, he would have a gold medal. His solutions routinely but engagingly veer way off-subject, and grow to be element historical past tutorial, element individual story and portion refreshingly authentic diagnosis of the nation’s most pressing overall health ills – many of which, in his view, are not healthcare in origin.
Asked to determine the country’s most significant public well being difficulties Ashton does not cite obesity, smoking or alcohol. “One is the increasing inequalities in people’s position, income and manage in excess of their lives more than the last twenty or thirty many years. Tons of individuals are becoming left behind. Outside the wealthy parts of the country people are living miserable, quick lives, with a good deal more sick-wellness than men and women in the far more advantaged components of the country.
“Becoming a northerner, I am aware that a lot of individuals in the more advantaged components of the south-east have no awareness at all of what individuals are up against in some other components of the country. I’m speaking about men and women on the west coast of Cumbria or in parts of north Liverpool or east Manchester where nobody’s worked for two or 3 generations, they can’t put meals on the table and the youngsters can not take element in school trips, so individuals young children are expanding up as 2nd-class citizens relative to other young folks”, he stresses. All this matters, he adds, because of the massive distinctions in daily life expectancy among rich and bad up to a decade among Glasgow and Surrey, for example.
Ashton’s instruction in psychiatry before he turned to public overall health emerges when he talks, with the two passion and disappointment, about what he says is the expanding burden of mental sick-well being. He blames that on a disparate list including the “intransigent” epidemic of obesity that can be each a result in of and impact of depression, addictive behaviours, the changing roles in male-female relationships and the escalating sexualisation of young people, particularly girls.
“The condition of grownup males is of increasing concern due to the fact suicide has been going up in working-age men, specially the below-40s. There is something in the dramatically changed place of males in society vis-a-vis females and vis-a-vis the labour marketplace that is affecting men’s self-esteem and self-self-confidence as a consequence of this dislocation, with the reduction in their traditional role as breadwinners”, he says.
His main worry, although, is young individuals. Rising divorce costs, residing away from your loved ones, a lack of help for parents, widespread youth unemployment, and fact that “bringing up young children is a really lonely business” are all creating young children and younger men and women who, uncertain of their location in the globe, are increasingly troubled, he says.
“We’ve acquired youthful men and women who are self-harming, whose lifestyles will consequence in troubles later on in life – the alcohol, the drugs, the lack of self-esteem – but our kid and adolescent mental well being solutions are a disgrace. They are in crisis. We’re not stopping difficulties in young individuals and we’re not responding to them when they get them. Folks can not get witnessed, even when they are genuinely sick”.
The FPH’s annual conference, which commences nowadays in Manchester, involves a debate on what public wellness experts can do to tackle the objectification of youthful men and females, notably the latter, by means of clothes, music, specially promotional video clips, the pornography industry and the media.
“The fact that a third of ladies have now had sex by the time they are 13 is element of a sexualised culture that can often be adverse in final result, such as pregnancy and disease, but can also be measured in its impact on psychological health”, says Ashton.
He bemoans that National Institute for Overall health and Clinical Excellence tips on sex schooling for youthful men and women have gathered dust on schooling secretary Michael Gove’s desk given that 2010.
“Classroom teachers will tell you that boys are hunting at pornography on their iPhones at the age of eleven,twelve and 13. This is where they are receiving their intercourse data from, because we’re not offering them correct intercourse and relationships education.”
If only credit card companies this kind of as Visa would, on ethical grounds, cease allowing clients to shell out for porn with their cards, the multibillion pound business would no longer be so capable to do its damage, Ashton suggests.
He is effortlessly the most colourful of the senior physicians at the helm of the health care royal colleges and their constituent groups. (The FPH represents 3,300 public wellness specialists across the Uk operating in the NHS, academia, NGOs and English neighborhood government). That’s partly because no other health care large cheese would ever dress in a pink shirt, pink stripy tie and cream jacket, but also because he speaks his thoughts to a degree his peers may take into account reckless.
The Liverpool-born Labour party stalwart is an virtually identikit leftwing public wellness physician, describing his politics as “pragmatically radical”, although he surprisingly names Denis Healey alongside Tony Benn and Ken Livingstone as politicians he admires.
The Sunday Occasions was wrong to report last 12 months that he supports reducing the age of consent from 16 to 15, he insists. What he actually stated, he maintains, is that if Britain does not tackle the roots of “early sexualisation”, then legalising intercourse at 15 might be needed.
Ashton is not shy about detailing unconventional suggestions. “When you search at the way we lead our lives, the anxiety folks are underneath, the strain on time and sickness absence, mental health is plainly a significant situation. We ought to be moving in the direction of a four-day week simply because you have acquired a proportion of men and women who are functioning too challenging and a proportion that haven’t acquired jobs. The lunch-hour has gone individuals just have a sandwich at their desk and carry on functioning”, he explains.
“So we want a four-day week so that folks can take pleasure in their lives, have more time with their families, and maybe minimize high blood stress simply because folks might commence doing exercises on that further day. It would suggest that men and women may well smile a lot more and be happier and increase general overall health.”
Age 67.
Lives Cumbria.
Household Married 4 sons, two stepsons.
Education Quarry Financial institution large college, Liverpool Newcastle-upon-Tyne healthcare college London College of Hygiene and Tropical Medication (LSHTM).
Job 2013-current: president, Faculty of Public Health 2006 -13: director, public health (PH)/county healthcare officer (MO), Cumbria 1993-2006: North West regional director, PH/MO 1993-94: regional director, PH/MO, Mersey Regional Health Authority 1990-93: director, Liverpool Public Overall health Observatory 1983-93: senior lecturer/professor, public overall health, University of Liverpool 1980-82: senior lecturer, LSHTM 1975-79: senior registrar, lecturer, University of Southampton 1971-75: principal/registrar/SHO, Newcastle on Tyne & Northumberland 1970-71: property surgeon, Newcastle hospitals.
Public life Chairs in various health-related colleges and universities. CBE for outstanding services to the NHS.
Interests Smallholding, walking, cycling, Liverpool FC.
This week on Science Weekly presented by Ian Sample, we discuss the Longitude Prize 2014. 3 hundred many years following the 1st prize to learn a way of identifying longitude at sea, a new set of challenges have been shortlisted and thrown open to a public vote to choose the one scientific and technical dilemma that merits the £10m prize fund.
Ian is joined by Guardian on the internet environment editor Adam Vaughan, Observer Tech Month to month commissioning editor Nicola Davis and Dr Emily Grossman, educator, broadcaster and expert in molecular biology.
We also hear from two members of the new Longitude committee, Astronomer Royal Lord Martin Rees and the UK’s Chief Medical Officer Dame Sally Davies, on the scientific issues that could win the prize, and how the public – yes, that means you and me – can establish the nature of that challenge.
The public vote closes at 7.10pm on Wednesday 25 June:
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Or text/sms the following keyword to 60011 To vote for antibiotic resistance text ANTIBIOTICS For sustainable nutrition text Food For dementia care text DEMENTIA For restoring mobility text PARALYSIS For fresh water text WATER For zero-carbon flight text FLIGHT
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Abortion companies in Wisconsin tried Tuesday to persuade a federal judge that a state law requiring them to have hospital admitting privileges was pointless and damaging to girls seeking the process.
Planned Parenthood and Affiliated Medical Solutions contend the law will force AMS’s Milwaukee clinic to near simply because companies there lack such admitting privileges. State attorneys counter that the law supplies continuity of care if issues come up.
Wisconsin is a single of a handful of states in which abortion opponents just lately got laws passed requiring medical professionals to have hospital admitting privileges. Abortion clinics in Alabama have filed a lawsuit similar to the one particular in Wisconsin.
Planned Parenthood and AMS filed their lawsuit in Wisconsin on 5July, the identical day Republican governor Scott Walker signed the Republican-backed legislation.
The organizations initially argued that the law would place an undue burden on females looking for abortions by forcing a Planned Parenthood clinic in Appleton and an AMS clinic in Milwaukee to close. Suppliers at the Planned Parenthood clinic have because obtained admitting privileges, but individuals at the AMS clinic have not.
Closure of the AMS facility would effectively finish abortions following 19 weeks in Wisconsin because no other facility offers them later than that, the clinics have explained.
AMS clinic director Wendie Ashlock testified in a bench trial Tuesday that between 2010 and 2012 about 60 of the clinic’s roughly 7,000 sufferers suffered issues and 3 were transferred to hospitals in 2012 and 2013. Planned Parenthood of Wisconsin healthcare director Kathy King testified that problems are uncommon and emergency room physicians can deal with the sufferers.
State attorneys counter that the law promotes a more thorough evaluation of abortion providers’ competency, assures continuity of care if a lady develops issues requiring a hospital visit and prevents providers from abandoning their patients. They also argue that there’s no longer a cause for the Appleton clinic to close and AMS’ providers haven’t attempted hard enough to get admitting privileges.
Along with Wisconsin and Alabama, Louisiana, Mississippi and Texas require abortion suppliers to have admitting privileges. Wisconsin’s law has not yet been enforced since a federal judge put it on hold although the lawsuit was pending.
The owner of an abortion clinic in Alabama’s capital city testified Monday that for the 36 years she’s been in business, she has always used out-of-town doctors who wouldn’t be able to admit patients to local hospitals as required under a new state law.
June Ayers, the owner of Montgomery’s Reproductive Health Services, was the first witness in the trial of a lawsuit that she and others filed over the law that requires clinics to use doctors who have approval to admit patients to nearby hospitals in case of complications. Her clinic and clinics in Mobile and Birmingham would have to close if the law is enforced, officials have said.
Mississippi, Wisconsin and Texas have laws similar to Alabama, but Texas is the only state where the law is being enforced.
Ayers said she has never been approached by any Montgomery physician wanting to perform abortions at the clinic. She said doctors can be harassed for performing the procedure that brings emotional debate from opponents and supporters.
She recounted one physician the clinic used from Baltimore, Maryland, who had his picture taken outside the clinic and then had posters about him being an abortion doctor show up in his neighborhood.
Proponents of the law say problems arise because traveling doctors remain in a city only a few hours and aren’t around to handle complications. Attorney General Luther Strange’s staff said in a court filing that the state will present witnesses, including physicians, who will testify that having a doctor on hand to manage complications and admit a patient to the hospital will improve the quality of care.
Ayers testified complications are rare, but her traveling physicians wouldn’t qualify for the privileges because they don’t live in the Montgomery area and would not have the required number of hospital admissions.
Three of Alabama’s five licensed abortion clinics, including Planned Parenthood Southeast clinics in Mobile and Birmingham, use traveling doctors and say they will have to close if the 2013 law is enforced.
The West Alabama Women’s Center in Tuscaloosa and the Alabama Women’s Center in Huntsville use local doctors who have admitting privileges at hospitals in those cities.
The owner of an abortion clinic in Alabama’s capital city testified Monday that for the 36 years she’s been in business, she has always used out-of-town doctors who wouldn’t be able to admit patients to local hospitals as required under a new state law.
June Ayers, the owner of Montgomery’s Reproductive Health Services, was the first witness in the trial of a lawsuit that she and others filed over the law that requires clinics to use doctors who have approval to admit patients to nearby hospitals in case of complications. Her clinic and clinics in Mobile and Birmingham would have to close if the law is enforced, officials have said.
Mississippi, Wisconsin and Texas have laws similar to Alabama, but Texas is the only state where the law is being enforced.
Ayers said she has never been approached by any Montgomery physician wanting to perform abortions at the clinic. She said doctors can be harassed for performing the procedure that brings emotional debate from opponents and supporters.
She recounted one physician the clinic used from Baltimore, Maryland, who had his picture taken outside the clinic and then had posters about him being an abortion doctor show up in his neighborhood.
Proponents of the law say problems arise because traveling doctors remain in a city only a few hours and aren’t around to handle complications. Attorney General Luther Strange’s staff said in a court filing that the state will present witnesses, including physicians, who will testify that having a doctor on hand to manage complications and admit a patient to the hospital will improve the quality of care.
Ayers testified complications are rare, but her traveling physicians wouldn’t qualify for the privileges because they don’t live in the Montgomery area and would not have the required number of hospital admissions.
Three of Alabama’s five licensed abortion clinics, including Planned Parenthood Southeast clinics in Mobile and Birmingham, use traveling doctors and say they will have to close if the 2013 law is enforced.
The West Alabama Women’s Center in Tuscaloosa and the Alabama Women’s Center in Huntsville use local doctors who have admitting privileges at hospitals in those cities.
Melissa Morris: ‘If individuals are prevented from seeing their GP they can finish up with far worse conditions which are a lot more high-priced to deal with this could bankrupt the NHS.’ Photograph: Network Locum
Describe your role in 1 sentence Chief executive of the very best team in London, helping to resolve massive challenges dealing with the NHS.
Why did you want to operate in healthcare? There are great individuals on the frontline functioning really tough but inefficiencies in the program mean that healthcare solutions usually can’t be delivered at the proper time, scale and high quality. I genuinely think this can alter if the staffing model is more reasonably priced, far more flexible and of a greater good quality, which is what our organization is striving to achieve.
How do you want to see the sector adjust in the subsequent five many years? I would like to see all patients becoming able to get a GP appointment when they need one and to do this not only with a practice close to their home but wherever in the United kingdom they take place to be at that stage.
My proudest achievement at work was … when GPs commenced to recommend the Network Locum internet site to their pals.
The most hard point I’ve dealt with at work is … the sum of bureaucracy in the NHS and outdated resourcing designs.
The most significant challenge dealing with the NHS is … fixing accessibility to primary care. If men and women are prevented from seeing their GP they can end up with far worse problems which are far more expensive to deal with this could eventually bankrupt the NHS.
The folks I work with are … experts in their field who are quite passionate about healthcare. They are all really wise, tech savvy and fantastic fun to be about.
I do what I do because … I needed to see if I could make a variation.
Often people feel that I … am overly crucial of myself, being an entrepreneur, it comes with the territory.
Appropriate now I want to … win the Common Practice Awards which we have been shortlisted for.
At work I am always understanding that … people are wonderful. I am consistently astonished by the creativity and capacity of the men and women who operate with me, the suggestions they have and the pace with which they can execute them is astounding.
The 1 thing often on my thoughts at work is … cashflow. All efforts and achievements would be misplaced if we run out of funds we could not afford to let that come about.
If I could go back 10 years and meet my former self I’d tell them … read through much more books, have faith in by yourself and don’t be afraid to do issues your way.
If I could meet my future self I would count on them to be … energetic, but much less naïve and proud of my business achievements.
What is the best portion of your work? Doing work with wonderful people, no matter whether it is my group, GPs or practice managers.
What is the worst component of your job? Fundraising. It truly is a needed evil for any organization as it can be time consuming and demoralising answering the identical inquiries each time with a smile on your encounter.
What can make you smile? Craig, our chief technology officer, is most likely 1 of the funniest folks I have ever met, and Matt, our head of corporate, can do each and every accent from the quite north of Scotland to the bottom of Cornwall.
What keeps you awake at evening? Working a begin-up, I stress about funds and generating our projections each and every evening but I’m passionate about what I do and that makes it worthwhile.
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Adam Pearson is used to people noticing him. A couple of weeks in the past, he was in a DVD shop near his property in Croydon, south London, and a gaggle of teenage women starting up talking loudly about him and taking images of his face on their smartphones. “They have been saying ‘Oh, search at that man’,” says Pearson. “And all I wished to do was purchase The Hobbit on Blu-Ray.”
Pearson suffers from neurofibromatosis, a situation that affects a single in each 2,300 individuals and which brings about non-cancerous tumours to grow on nerve tissue. In his situation, the vast majority of these tumours are on his face even though, he adds drily, “I’ve received one particular on my arse I possibly will not demonstrate you”. During his 29 years, he has been bullied, harassed and referred to as every thing from Elephant Guy to Scarface.
Every single time he goes out, men and women stare. On the way to our interview, Pearson was stopped by a couple of passersby as he acquired on the train. This time, nonetheless, it was not as a consequence of his problem – it was because he has begun to be recognised. Pearson is presently starring alongside Scarlett Johansson in Below the Skin, a critically acclaimed science fiction film directed by Jonathan Glazer about an alien who roams the streets of Glasgow abducting and killing unsuspecting males. In 1 of the most poignant scenes, the alien (Johansson) is proven choosing up a hooded man at night (Pearson). When the unnamed guy reveals his disfigured face, it is a pivotal minute: the alien becomes humanised and conflicted. The two of them have a brief conversation about the nature of ignorance and prejudice. The alien does not remark on the stranger’s encounter, instead complimenting him on his “stunning” hands.
“One of the primary motives for taking the part was simply because it was so moving and truthful,” says Pearson in excess of a lunch of fish and chips in a south London cafe. “For me, the movie is about what the planet looks like with no expertise and without having prejudice. It really is about seeing the planet via alien eyes, I guess.”
A lot of the dialogue was improvised. Pearson and Johansson had a conversation beforehand about exactly where it may go – the line about the hands, for instance, came from him. “My mom likes my hands,” he says now, a touch embarrassed. He also had to movie a nude scene with Johansson – some thing even the most experienced actor would be nervous about.
“They just said ‘action’ and you do it,” he says. “I did not actually believe about it … I didn’t broadcast the info [that he was in the movie] till fairly near the release. I did not inform some folks at all and just took them to see the film. I suggest, my buddy Heidi hasn’t created eye get in touch with with me for a week.”
Johansson was “brilliant. She’s genuinely wonderful, charming, humorous and intelligent after you get in excess of the feeling of ‘Oh my God, this is Scarlett Johansson!’”
1 of his favourite memories was engaging the actress in a two-way competition to see who could tell the most inappropriate joke. Pearson won, but Johansson place up an excellent battle (and the jokes in question are eye-wateringly unrepeatable).
Much more importantly, Under the Skin gave Pearson an possibility to challenge what he sees as the stigma surrounding representations of disfigurement on display. “There is a great deal of worry close to the unknown. If I can attempt to be as normal as achievable and show there is practically nothing to concern – either on movie or day to day, going round the corner to go purchasing for milk – then the much more men and women see it in wider society, the less stigma there is. If I just sit at home and mope, hugging the puppy and crying, nothing’s going to adjust.”
He points out that facial imperfections are typically utilized as shorthand for evil in movies, regardless of whether it be Blofeld’s eye scar in James Bond or the villain in Disney’s current adaptation of The Lone Ranger, whose face was severely scarred and who was offered what appeared to be a cleft palate in makeup. “It really is always used very lazily,” explains Pearson. “In an ideal globe, actors with circumstances would play the characters with these very same problems, but which is a way off. Instead, movie-makers tend to get a generic, ‘normal’ actor and use prosthetics. If they’d acquired Adam Sandler and blacked him up to perform Nelson Mandela, there would have been an uproar … but with scars and things, it looks like individuals are amazing with that.”
In individual, Pearson is the two eloquent and really humorous. He possesses a quiet self confidence and a degree of self-awareness that is rare amongst young males in their 20s. As a little one, he had to grow up fairly rapidly. He was diagnosed with neurofibromatosis when he was 5, soon after he knocked his head on a windowsill and the resulting bump refused to go away.
His identical twin, Neil, was also diagnosed with the issue, but in him it takes a different type. “He appears typical,” says Pearson, “but he is acquired horrible short-phrase memory.”
Secondary school in Croydon was challenging. He was insulted and bullied on a typical basis and no a single knew what to do about it. He remembers 1 event when a so-called pal stated a instructor wanted to see him in 1 of the classrooms. When he got there, Pearson was assailed by a group of his peers who had been lying in wait. “I went house with spit all above my blazer,” he says. “That was horrific.”
Throughout all this, Pearson was getting operations to “debunk” some of the tumours to date, he has undergone thirty health-related procedures. As a end result, he is understandably sceptical about the growing trend in elective cosmetic surgery. “I am not a fan of cosmetic surgical procedure profiting from people’s insecurities,” he says. “I go through someplace 9 out of ten females do not like how they appear and I consider which is since they are evaluating themselves to the airbrushed pictures they see in Vogue or FHM. People lack a actual literacy in the media. They never know what goes into generating these pictures. Media literacy ought to be part of training. I think we’ve completed attractiveness a wonderful disservice by quantifying it.”
It was during 1 of Pearson’s normal visits to Great Ormond Street hospital for remedy that he saw a poster marketing the organisation Changing Faces, which helps people and households who are residing with conditions, marks or scars that influence their visual appeal. Pearson acquired in touch and asked for help with no telling his mother and father – the very first they knew about it was when the literature arrived in the publish. The charity gave him coping mechanisms, encouraging Pearson to preserve positive and to don’t forget that “they [the bullies] are the ones with the dilemma, not you”.
Factors got better when he went to Brighton University to research organization management. Right after graduating, he had jobs in television manufacturing for the BBC and Channel 4, the place he is still involved in casting for series such as The Undateables and Beauty and the Beast, the two of which challenge society’s notions of disability.
It was while he was at Channel four in 2011 that he received an email from Shifting Faces saying that a film business was hunting for a male character for Below the Skin. Pearson replied and received the work. The film has been an overwhelmingly optimistic encounter, and not just due to the fact he left with Scarlett Johansson’s personalized e-mail handle.
Pearson is keen to do far more acting. He’d like to get a girlfriend (“I’m currently single”) and, although there is a 50% possibility he could pass his condition on to any youngsters, this doesn’t fret him unduly: “My little ones will be genetically wonderful anyway.”
At the second, he is residing with his retired dad and mom, Marilyn and Patrick. Are they proud of his recent achievements?
“It truly is surely a excellent subject of conversation amongst them and their friends,” he says. “A good friend will say: ‘Our daughter just received into Cambridge’ and they will go: ‘Adam’s in a film with Scarlett Johansson.’” He polishes off the final of his battered cod. Then he adds: “Booyah! Competitors over.”
Simon Stevens: ‘Service pressures are intensifying and longstanding problems are not going to disappear overnight.’ Photograph: Linda Nylind for the Guardian
The NHS is dealing with the most significant challenge in its 66-yr history and need to radically adjust how it cares for sufferers in buy to cope with intensifying pressures, the service’s new boss has warned.
A budget squeeze combined with a expanding demand for care driven by the ageing population indicates that “for the NHS the stakes have never been greater”, Simon Stevens will say on Tuesday – his very first day as NHS England’s chief executive.
He will use a speech in Newcastle to mix praise for the NHS he has inherited with a clarion contact to its one.three million employees to embrace main adjustments to their roles above the subsequent few years in order to improve the good quality of care individuals get.
“I know that for the NHS the stakes have in no way been larger. Service pressures are intensifying and longstanding troubles are not going to disappear overnight,” Stevens will say. “Efficiently navigating the next couple of years is going to get a crew effort, involving the most significant team in the greatest effort the NHS has ever seen.”
In his 1st public statement Stevens will identify improved care of older men and women, greater joint functioning amongst the well being and social care providers and new designs of care, which harness advances in medicine as currently being between his essential priorities.
An NHS dealing with new challenges will want to find new solutions to remain sustainable, he says. “An ageing population with much more continual wellness circumstances, but with new options to live as independently as possible, indicates we’re going to have to radically transform how care is delivered outside hospitals,” he will include.
Stevens, 47, will also plead with the several different kinds of personnel who function for the NHS to move beyond divisions and work much more closely. “Our traditional partitioning of overall health providers – GPs, hospital outpatients, A&E departments, community nurses, emergency psychological health care, out-of-hours units, ambulance services and so on – no longer can make a lot sense”, he will say.
Dr Mark Porter, chairman of the British Healthcare Association, mentioned that Stevens – a well being adviser to Tony Blair’s government from 1997 to 2004 – is arriving when “the NHS is facing a excellent storm of growing demand, funding pressures and worryingly minimal employees morale”.
Each he and Andy Burnham, the shadow overall health secretary, cautioned that Stevens would have to confront issues produced by the coalition’s shake-up of the NHS in England last year, particularly involving competitors.
With the service even now digesting the lessons of the Mid Staffs scandal, Stevens will acknowledge that, although “the high quality of NHS care is generally really higher, occasionally it isn’t”. He will also laud the essential function of whistleblowers in exposing poor care and warn that “an NHS with a ‘like it or lump it’ attitude will merely not survive”.
