It’s often noticed that kids don’t even cross adolescence but go into depression. You must be very worried as a mother, perplexed to figure out how can you care for mental health of kids so that they don’t develop any mental health disorder.
Here are 3 tips that you can follow to keep children healthy:
Encourage them to play board games:
As a mother you must be understanding how much pressure kids go through these days: Be it parental pressure or academic pressure or something else. You also find yourself helpless sometimes as you can’t compromise on kids’ education for their shining future, but you can always try to lessen their burden in some other way. Playing board games is a great way to lessen the stress of kids. Bring educational board games at home and start playing with them. They will have fun playing such innovative games. More they will enjoy the happiness of playing together, especially with parents. Your kids will be learning playfully without even their knowledge. If you are confused about which game to buy, let me get you the solution:
A brand new, interactive board game is going to be launched in market soon, which is designed with the purpose of developing STEM skills of children. This family-friendly tabletop game will take your kid on a journey to a tree squirrel’s world. The animal loving nature of an aerospace engineer, named Randy Hecht, inspired him to invent this game. He even wants to donate a certain percentage of proceed to local animal charities. This game will truly inculcate confidence and competitive spirit in your child as well as will improve their cognitive skills. It’s a fun game that will make your kids happy, hence will reduce their pressure and stress. Your kids will learn about squirrel behaviors. Moreover, the game will improve their verbal and communication skills as well as logical and reasoning skills. Children also will get the opportunity to practice math and negotiation skills through this educational game. Do you intend to support the creators of this board game? You can surely do so, theres a kickstarter campaign being created for you to go and pledge for the project and contribute for the noble cause. It’s not a bad idea because they’re giving back to the community in a positive way.
Make them Eat Healthy
You must be wondering what connection does our brain have with healthy eating. Let me give you a clear picture. Human body needs vitamins and nutrients in order to make the brain function. If you don’t feed your kids correctly, their brain will not function properly. It will affect their academic performance as well as mental health. So, don’t forget to give them energy drink, meat, fish, milk, vegetables, nuts, seeds etc.
Encourage them to do physical activity
Physical activity is very important for kids to keep their brain active. You should encourage them to practice yoga or play in parks. When your kids are physically active interacting with others, they will develop social skills and will learn how to deal with emotions. Physical activity will help them with healthy mental growth. As a mother, you must be the role model of your child. What can be better than if you accompany him in playground or yoga? Think about it.
Chloe Paltrow, MD, is a psychiatrist with more than 20 years of experience. She is also a researcher in the field of neurology. Dr. Paltrow sees patients with different neurodevelopmental disorders and intellectual disabilities. She has shared her knowledge in various websites and blogs like Collective Evolution, PsychCentral and Pick The Brain. Currently, she is studying how brain injury and brain disorders can be treated with hyperbaric chamber, of which OxyHealth is a leading provider.
Anonymous I am once again in the mental health treatment sausage machine. Plucking up courage to approach a GP to admit defeat, being shoved on drugs to stop me topping myself, told that there’s a huge, long waiting list for treatment, the false hope of a “gateway worker” assessment followed by another interminable wait of undefined length. Then I know I will have my allocated batch of treatment before being deemed “fixed” and dispatched back to the world again. I am sick and tired of the roundabout. I suggested that instead of this system, once a mental health patient has had their allocation of therapy, they should remain on the books, so when they feel themselves slipping back down, they can call up for a booster session instead of having to go through the whole rigmarole again.
I’ve just quit my job of six years because, following a disclosure to my new boss that I have bipolar tendencies she proceeded to bully me into submission. She had absolutely no understanding of how to get the best out of (a very talented) employee who has mental health issues. I was stopped from working at home, an important aspect to being able to manage my condition. I had unreasonable targets imposed, with no support offered to go about achieving them. My job was chopped and changed, hours cut and autonomy removed. I have been pushed back to the brink of suicide and had to go on antidepressants to simply survive.
Anonymous From September 2015 until December 2016, while I waited for an NHS referral, I was so ill I didn’t know how to cope and resorted to self harming. These aren’t all of my scars, but they’re the ones no one ever sees; so it’s easy to think they’re not there. One year of my life, and I will have to be reminded of it forever.
Cat, 24, South Yorkshire People often mistake bipolar disorder as your mood rapidly changing from up to down. It’s not like that. That would be my other illness, borderline personality disorder (BPD) or as my psychiatrist put it, emotionally unstable personality disorder. It’s complicated telling people you have both bipolar disorder and BPD, as they both involve intense mood swings. Well, that’s when I do tell people – social anxiety sort of puts a brick wall between me and people. BPD makes your mood change within seconds and it is a strong mood swing. Like fire, it can destroy you and those around you. With bipolar, the mood swing sort of creeps up on you. It’s when the mood gets high (mania) or low (depression) that it becomes destructive.
Every day it feels like I must wear a mask, however, hiding never did me any good with these illnesses. It just becomes more of a shock to those around you when the symptoms start to leak through. Even as I write this, it’s hard to concentrate, thoughts and emotions are saying one thing, while that one bit of mind that tells you “everything will be ok”, is telling me to push on.
The rendition of a darker moment. A painting of a depression experience by Cat, South Yorkshire
I’ll admit when I’ve been at my lowest I’ve done things I’ve regretted. The overdose, which sent me into hospital, was one of the things. I know there’s a stigma around psychiatric hospitals, but I did meet people who it’s worked for. When I was admitted into hospital the first time, I had psychosis – a female voice was constantly screaming in pain in my head. I don’t even bother to count how many times a year I have to go through this. Medication helps keep me in some control, especially with the manic side. I prefer the manic side to the depression side. Mania brings with it the thought that you’re this amazing person, who can do anything, someone who deserves to be with people. The bad side of mania is that loss of control. Nights become sleepless and the thoughts running through your head won’t stop. Every time you try to grab one, it just slips through your fingers. Health and safety also goes out the window.
I managed to get through my art degree. I have to remind myself that I’m more than my diagnosis, but with the right help and support it does become a lot easier.
In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14.
Every year, thousands of people line up for the flu shot. Very soon after –they get the flu. I’ve heard it so many times in the last month and I know from personal experience working as a nurse years ago, the flu shot can cause the flu. Why keep getting one?
The question then, is how did humanity survive throughout millennia without the flu shot? To answer, we have to study ancient history, or we’re destined to repeat it.
In fact, epidemiologists and viral geneticists studied the worst flu pandemic in the history of the world–the 1918 flu, which infected one-third of the entire world population at the time—over 500 million people. The first wave of this epidemic was typical of the flu—respiratory symptoms, fever, and malaise. As the virus spread beyond the respiratory track, it turned deadly. Instead of being confined to the lungs, the second wave of attack caused massive hemorrhaging from every opening in the body. People bled out from everywhere, not because of the virus—but due to the virus-stimulated cytokine storm, that burst vessels open from inflammation.
A “Cytokine Storm” occurs when the immune system continues to be activated and remains activated against the immune stimulant long after it is necessary. This causes collateral, damaging inflammation.
From scientific research of the viral genome, it appears two events aligned at just the exact time to create the 1918 pandemic:
A new influenza strain had “jumped species” aka an “antigenic shift” occurred from avian (birds) just before 1913. Then by 1915 the virus split into two new forms infecting pigs and humans. Analysis of data showed that the severity of this flu was due to the powerful cytokine cascade initiated by the immune system response to infection. Cytokines are immune regulatory proteins that the body sends out to attempt to kill off an invading pathogen. But the response was a thousand times more extreme than the normal. Usually, those with weakened immune systems succumb because they can’t mount an immune response quickly (the elderly and the young)— but this was the opposite—these were mostly young people with healthy, strong immune systems, thrown together in the middle of war, crowded in trenches with no time to rest. This is what spread and what killed so many so quickly.
The war itself, which began in 1914. This new strain of influenza spread like wildfire through the ranks on both sides of the conflict. Crowded together in trenches, hospital tents, and extremely unhealthy and contagious conditions, the virus found a perfect breeding ground. Sometime between 1915 and late 1917, the virus mutated again. The first to die, after the infected soldiers, were the first to respond—nurses and doctors; followed by morticians. These people were dealing with massive numbers of casualties, bleeding out from everywhere, completely overwhelming the systems in place—so many in fact, and so much blood—that machines were brought in to scoop up and bury bodies en masse. Day after day for two years, the machines, and the mass burials continued as hospitals, school gymnasiums, and any large building were emptied of bodies. As the war ended, millions of infected soldiers crowded onto ships heading home (no air travel yet). As these ships sailed from port to port, so did the influenza virus—and then further from trains, buses, and cars.
And then, between November and December 1920, simultaneously, around the world, the worst pandemic ended. What did we learn? Would a flu shot have prevented this? These are exactly the kind of questions that keep viral researchers and epidemiologists awake at night.
Fast forward. Could it happen again? Well, we have crowded animal feedlots with little inspection and several different animal species living side by side in virus breeding ground conditions—allowing viruses to jump species and mutate more readily. We have lots of population dense areas like inner city housing, day care centers, schools, hospitals, nursing homes, and even corporate offices. And we have air travel—enabling one human to come in contact with infected animal blood in a remote village and to carry that virus (HIV in the 80’s) across the globe, spreading exponentially, in a matter of hours.
Flu vaccines take time to make—at least 4-6 months from production to distribution. By the time the vaccine is available, the infrastructure of the health care system to quarantine and treat those infected, and effectively administer it would already be decimated. Remember– first to succumb are the first to respond—nurses, doctors, health care workers; followed by morticians. If a vaccine could be distributed quickly—it would only work on the specific virus that emerged in that year, that instance, and was administered within 48 hours from the onset of illness. Any viral mutation would render the entire batch useless. Such exact conditions are essentially impossible to predict. In other words—without an actual human with the flu—it is impossible to make the right vaccine for that particular strain and by the time one case is discovered, it is too late. Drugs like Tamiflu are only active when metabolized in the body, and don’t break down before being excreted in the active form to flow unaffected through wastewater treatment plants. As this active form ends up in streams and waterways—it comes in contact with waterfowl. Thus, the avian strains develop resistance; and as the avian, swine, and human strains get together for dinner and share survival strategies—super resistance is passed on to strains infecting humans.
Tamiflu has some serious, questionable side effects too. Is it worth it?
If an epidemic began in an area where you live, would you know how to protect yourself? Your children?
The best defense is a pro-active offense. Find your truth. Stephen Harrod Buhner wrote an amazing and informative book to help you called Herbal Antivirals, listed below.
Thomasina Copenhaver is a naturopathic doctor and registered nurse with over 30 years experience in the healthcare profession. Her passion is writing, researching, and empowering all humans with knowledge of healing at the cellular level; to enable them to make educated and informed choices regarding their health. For more information visit her website www.notesfromanaturopath.com or to buy her book, “Notes from a Naturopath” visit Amazon or Barnes and Noble.
Every year, thousands of people line up for the flu shot. Very soon after –they get the flu. I’ve heard it so many times in the last month and I know from personal experience working as a nurse years ago, the flu shot can cause the flu. Why keep getting one?
The question then, is how did humanity survive throughout millennia without the flu shot? To answer, we have to study ancient history, or we’re destined to repeat it.
In fact, epidemiologists and viral geneticists studied the worst flu pandemic in the history of the world–the 1918 flu, which infected one-third of the entire world population at the time—over 500 million people. The first wave of this epidemic was typical of the flu—respiratory symptoms, fever, and malaise. As the virus spread beyond the respiratory track, it turned deadly. Instead of being confined to the lungs, the second wave of attack caused massive hemorrhaging from every opening in the body. People bled out from everywhere, not because of the virus—but due to the virus-stimulated cytokine storm, that burst vessels open from inflammation.
A “Cytokine Storm” occurs when the immune system continues to be activated and remains activated against the immune stimulant long after it is necessary. This causes collateral, damaging inflammation.
From scientific research of the viral genome, it appears two events aligned at just the exact time to create the 1918 pandemic:
A new influenza strain had “jumped species” aka an “antigenic shift” occurred from avian (birds) just before 1913. Then by 1915 the virus split into two new forms infecting pigs and humans. Analysis of data showed that the severity of this flu was due to the powerful cytokine cascade initiated by the immune system response to infection. Cytokines are immune regulatory proteins that the body sends out to attempt to kill off an invading pathogen. But the response was a thousand times more extreme than the normal. Usually, those with weakened immune systems succumb because they can’t mount an immune response quickly (the elderly and the young)— but this was the opposite—these were mostly young people with healthy, strong immune systems, thrown together in the middle of war, crowded in trenches with no time to rest. This is what spread and what killed so many so quickly.
The war itself, which began in 1914. This new strain of influenza spread like wildfire through the ranks on both sides of the conflict. Crowded together in trenches, hospital tents, and extremely unhealthy and contagious conditions, the virus found a perfect breeding ground. Sometime between 1915 and late 1917, the virus mutated again. The first to die, after the infected soldiers, were the first to respond—nurses and doctors; followed by morticians. These people were dealing with massive numbers of casualties, bleeding out from everywhere, completely overwhelming the systems in place—so many in fact, and so much blood—that machines were brought in to scoop up and bury bodies en masse. Day after day for two years, the machines, and the mass burials continued as hospitals, school gymnasiums, and any large building were emptied of bodies. As the war ended, millions of infected soldiers crowded onto ships heading home (no air travel yet). As these ships sailed from port to port, so did the influenza virus—and then further from trains, buses, and cars.
And then, between November and December 1920, simultaneously, around the world, the worst pandemic ended. What did we learn? Would a flu shot have prevented this? These are exactly the kind of questions that keep viral researchers and epidemiologists awake at night.
Fast forward. Could it happen again? Well, we have crowded animal feedlots with little inspection and several different animal species living side by side in virus breeding ground conditions—allowing viruses to jump species and mutate more readily. We have lots of population dense areas like inner city housing, day care centers, schools, hospitals, nursing homes, and even corporate offices. And we have air travel—enabling one human to come in contact with infected animal blood in a remote village and to carry that virus (HIV in the 80’s) across the globe, spreading exponentially, in a matter of hours.
Flu vaccines take time to make—at least 4-6 months from production to distribution. By the time the vaccine is available, the infrastructure of the health care system to quarantine and treat those infected, and effectively administer it would already be decimated. Remember– first to succumb are the first to respond—nurses, doctors, health care workers; followed by morticians. If a vaccine could be distributed quickly—it would only work on the specific virus that emerged in that year, that instance, and was administered within 48 hours from the onset of illness. Any viral mutation would render the entire batch useless. Such exact conditions are essentially impossible to predict. In other words—without an actual human with the flu—it is impossible to make the right vaccine for that particular strain and by the time one case is discovered, it is too late. Drugs like Tamiflu are only active when metabolized in the body, and don’t break down before being excreted in the active form to flow unaffected through wastewater treatment plants. As this active form ends up in streams and waterways—it comes in contact with waterfowl. Thus, the avian strains develop resistance; and as the avian, swine, and human strains get together for dinner and share survival strategies—super resistance is passed on to strains infecting humans.
Tamiflu has some serious, questionable side effects too. Is it worth it?
If an epidemic began in an area where you live, would you know how to protect yourself? Your children?
The best defense is a pro-active offense. Find your truth. Stephen Harrod Buhner wrote an amazing and informative book to help you called Herbal Antivirals, listed below.
Thomasina Copenhaver is a naturopathic doctor and registered nurse with over 30 years experience in the healthcare profession. Her passion is writing, researching, and empowering all humans with knowledge of healing at the cellular level; to enable them to make educated and informed choices regarding their health. For more information visit her website www.notesfromanaturopath.com or to buy her book, “Notes from a Naturopath” visit Amazon or Barnes and Noble.
This past year has sent shockwaves through an already challenging working environment in the NHS. From the withdrawal of nursing bursaries and junior doctors’ strikes to the uncertain impact of Brexit on 58,000 EU nationals currently working in the health service, workforce pressures continued to build for an already overstretched service.
So what do the findings of the latest NHS staff survey, released on Tuesday, tell us about how staff are coping? Covering 316 participating NHS organisations, the survey is the biggest in the world, capturing the experiences of more than 423,000 healthcare professionals across the country.
The good news is that despite the tremendous pressures the NHS faces, nearly three quarters of staff remain enthusiastic about their job, while 70% said they would be happy with the standard of care provided by their organisation if a friend or relative needed treatment. The proportion of staff who reported feeling unwell due to work-related stress is at its lowest since 2012, down to 37%.
Responses addressing another key aspect of staff motivation – feeling empowered to contribute suggestions for improving work practices – also signalled positives. More than 70% of staff said that there are frequent opportunities to show initiative in their role, and 75% reported making suggestions to improve the work of their team or department. The survey did indicate room for improvement, however. Only a small majority of staff (56%) stated that these suggestions were actually acted upon – staff feedback does not appear to always translate into tangible change.
As is to be expected in such a pressured working environment, the survey does highlight some challenges for the NHS. More than half of staff (56%) report having attended work in the last three months despite feeling unwell, due to pressure from either their manager, colleagues or themselves. This is, however, a significant improvement since 2012, when 64% attended work despite illness. Most of this pressure comes from staff themselves (92%), rather than from managers (26%) or other colleagues (20%).
Generally, staff report feeling that managers are invested in their health and wellbeing. Most say that their immediate manager takes an interest in their health and wellbeing (67%) and that their organisation more broadly takes positive action on the health and wellbeing of staff (90%). These figures are on a par with those from last year’s survey and describe a workforce committed to working together and supporting one another to deliver high quality care – one that struggles more with heavy workloads and external pressures.
A key aspect of wellbeing is maintaining a healthy work-life balance and this is another area that contains some worrying figures. Staff report being satisfied with the opportunities to work flexibly – but 59% are, on average, working additional unpaid hours each week. Overall, the proportion of staff working additional hours is 72%, indicating that not enough has been done to alleviate workloads in light of similar results in recent years. The steady increase in both paid and unpaid overtime since 2012 is concerning as research repeatedly suggests that relying on tired and over-worked staff can lead to poorer standards of care.
The results of the 2016 staff survey suggest NHS staff are showing remarkable resilience despite the huge pressures that have been placed on the system. However, with external pressures such as Brexit likely to exacerbate existing problems in future years, a concerted effort is required from the government and NHS England to ensure that the positives to be found in staff motivation and engagement this year are not lost. NHS staff are subject to immense pressures that are unlikely to ease without significant support.
Rory Corbett is a senior research associate at Picker, a charity that co-ordinates the NHS staff survey on behalf of NHS England
Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.
Every year, thousands of people line up for the flu shot. Very soon after –they get the flu. I’ve heard it so many times in the last month and I know from personal experience working as a nurse years ago, the flu shot can cause the flu. Why keep getting one?
The question then, is how did humanity survive throughout millennia without the flu shot? To answer, we have to study ancient history, or we’re destined to repeat it.
In fact, epidemiologists and viral geneticists studied the worst flu pandemic in the history of the world–the 1918 flu, which infected one-third of the entire world population at the time—over 500 million people. The first wave of this epidemic was typical of the flu—respiratory symptoms, fever, and malaise. As the virus spread beyond the respiratory track, it turned deadly. Instead of being confined to the lungs, the second wave of attack caused massive hemorrhaging from every opening in the body. People bled out from everywhere, not because of the virus—but due to the virus-stimulated cytokine storm, that burst vessels open from inflammation.
A “Cytokine Storm” occurs when the immune system continues to be activated and remains activated against the immune stimulant long after it is necessary. This causes collateral, damaging inflammation.
From scientific research of the viral genome, it appears two events aligned at just the exact time to create the 1918 pandemic:
A new influenza strain had “jumped species” aka an “antigenic shift” occurred from avian (birds) just before 1913. Then by 1915 the virus split into two new forms infecting pigs and humans. Analysis of data showed that the severity of this flu was due to the powerful cytokine cascade initiated by the immune system response to infection. Cytokines are immune regulatory proteins that the body sends out to attempt to kill off an invading pathogen. But the response was a thousand times more extreme than the normal. Usually, those with weakened immune systems succumb because they can’t mount an immune response quickly (the elderly and the young)— but this was the opposite—these were mostly young people with healthy, strong immune systems, thrown together in the middle of war, crowded in trenches with no time to rest. This is what spread and what killed so many so quickly.
The war itself, which began in 1914. This new strain of influenza spread like wildfire through the ranks on both sides of the conflict. Crowded together in trenches, hospital tents, and extremely unhealthy and contagious conditions, the virus found a perfect breeding ground. Sometime between 1915 and late 1917, the virus mutated again. The first to die, after the infected soldiers, were the first to respond—nurses and doctors; followed by morticians. These people were dealing with massive numbers of casualties, bleeding out from everywhere, completely overwhelming the systems in place—so many in fact, and so much blood—that machines were brought in to scoop up and bury bodies en masse. Day after day for two years, the machines, and the mass burials continued as hospitals, school gymnasiums, and any large building were emptied of bodies. As the war ended, millions of infected soldiers crowded onto ships heading home (no air travel yet). As these ships sailed from port to port, so did the influenza virus—and then further from trains, buses, and cars.
And then, between November and December 1920, simultaneously, around the world, the worst pandemic ended. What did we learn? Would a flu shot have prevented this? These are exactly the kind of questions that keep viral researchers and epidemiologists awake at night.
Fast forward. Could it happen again? Well, we have crowded animal feedlots with little inspection and several different animal species living side by side in virus breeding ground conditions—allowing viruses to jump species and mutate more readily. We have lots of population dense areas like inner city housing, day care centers, schools, hospitals, nursing homes, and even corporate offices. And we have air travel—enabling one human to come in contact with infected animal blood in a remote village and to carry that virus (HIV in the 80’s) across the globe, spreading exponentially, in a matter of hours.
Flu vaccines take time to make—at least 4-6 months from production to distribution. By the time the vaccine is available, the infrastructure of the health care system to quarantine and treat those infected, and effectively administer it would already be decimated. Remember– first to succumb are the first to respond—nurses, doctors, health care workers; followed by morticians. If a vaccine could be distributed quickly—it would only work on the specific virus that emerged in that year, that instance, and was administered within 48 hours from the onset of illness. Any viral mutation would render the entire batch useless. Such exact conditions are essentially impossible to predict. In other words—without an actual human with the flu—it is impossible to make the right vaccine for that particular strain and by the time one case is discovered, it is too late. Drugs like Tamiflu are only active when metabolized in the body, and don’t break down before being excreted in the active form to flow unaffected through wastewater treatment plants. As this active form ends up in streams and waterways—it comes in contact with waterfowl. Thus, the avian strains develop resistance; and as the avian, swine, and human strains get together for dinner and share survival strategies—super resistance is passed on to strains infecting humans.
Tamiflu has some serious, questionable side effects too. Is it worth it?
If an epidemic began in an area where you live, would you know how to protect yourself? Your children?
The best defense is a pro-active offense. Find your truth. Stephen Harrod Buhner wrote an amazing and informative book to help you called Herbal Antivirals, listed below.
An unimpressed nurse summons the oncology fellow to the chemotherapy chair. “I am not prepared to treat him with chemo. He can barely stay awake.”
“But his oncologist wants to push on,” the fellow responds.
“The patient doesn’t seem to understand how sick he is or how chemotherapy is doing harm. You’ll need to sort this out, I am afraid.”
The fellow sighs, caught on the horns of a dilemma.
Elsewhere, an elderly woman has taken warfarin, a blood thinner, for some time, and now presents with a massive cerebral bleed. She was going to the kitchen one moment and unconscious the next; she is expected to die shortly. As I console her stricken son, it emerges that she had sustained 50 falls that year leading up to the fatal one. There had been many doctor visits but no one had asked specifically about falls.
At the desk, as I solemnly write a note, I overhear the same exchange that’s going on in my head.
“Fifty falls!” one dismayed resident says. “Why would you put her on warfarin?”
“Because someone wanted to reduce stroke risk and someone else watched her heart disease but no one thought of the whole patient.”
“What were they thinking?”
If you listen to doctors and nurses, this is one of the most common questions you will find them grappling with and grumbling about. It reflects part genuine puzzlement and part exasperation that what one doctor has recommended seems ill-advised or even inappropriate to another.
The Grattan Institute estimates the cost of wasted healthcare dollars to be in the order of a billion dollars and the figure stings clinicians but as a disillusioned young doctor sighed, in the age of super-specialisation, it seems expedient to let every doctor manage “their own organ”. Except the practice harms patients who are after all, more than a collection of organs.
If highly trained doctors don’t understand their colleagues’ intentions it stands to reason that most patients feel even more hapless, caught in an endless tangle of tests and explanations but the knowledge and power asymmetry is such that it’s impossible to question the doctor, who must surely know better (if not best).
Physicians overestimated the effect of some interventions on life expectancy by as much as 30%
Unnecessary and expensive medicine is at an all-time high and the usual reasons given are patient expectations, financial incentives, therapeutic uncertainty, medico-legal fears and the sustenance of hope. Now a new study in JAMA Internal Medicine authored by two Australians points out that when it comes to unsound medicine, there is another element at play. It turns out that when prescribing a drug or ordering a procedure doctors are actually quite bad at estimating the benefit and harm associated with it.
In a systematic review of 48 studies performed in 17 countries and involving more than 13,000 clinicians, they found that doctors rarely had accurate expectations of benefits or harms. The inaccuracies were in both directions but more often, harm was underestimated and benefit overestimated.
No group of doctors fared well. As a result, children with acute ear infections may be overprescribed antibiotics and women with troublesome postmenopausal symptoms may be deprived of hormone replacement therapy. Obstetricians and neurologists underestimated the risk of birth defects from antiepileptic drugs and GPs overestimated the benefit of prostate cancer screening and underestimated the benefit of warfarin for atrial fibrillation, a common heart condition. Transplant surgeons were biased towards an inaccurately low estimate of graft failure and all types of doctors were unaware of the risk of radiation exposure from imaging.
Physicians overestimated the effect of some interventions on life expectancy by as much as 30% and for elective but by no means inconsequential surgery on the thyroid, lung, prostate and uterus, there were clinicians who believed that complications “never occurred or had a rate of zero”. Dermatologists couldn’t agree on psoriasis treatment and psychiatrists differed on the risk of harm from long-term antipsychotics. There was a reluctance to convey a numerical estimate of benefit and worryingly, clinicians “overwhelmingly recommend the interventions they provide”.
This study is a wake-up call for doctors because it speaks to our collective failure to appreciate that in prescribing more for our patients we don’t always help, and indeed, commonly inflict harm. The goal of good medicine is not only to avoid harm but also to provide actual benefit, a distinction that’s commonly blurred, including in oncology. Chemotherapy at the end of life improves neither quantity nor quality of life. It leads to more invasive procedures and greater likelihood of dying in an intensive care unit but patients continue to receive it.
In the reign of evidence-based medicine it is discomfiting news that doctors may not understand the data in the form of hundreds of thousands of studies poured upon us.
First, as any patient knows, the art of medicine matters as much as its science. Evidence applied without tact, consideration, empathy and an understanding of the patient’s perspective can be as harmful as evidence not applied at all. Doctors are increasingly exhorted to provide collaborative care and practice shared decision-making. The catch is that both art and science suffer when we don’t know the facts or struggle to convey them.
Part of the problem is the sheer volume of publications. Entwined in increasing bureaucratic demands many doctors lack the time and also the confidence to interpret academic research so we turn to (commonly paid) expert opinion, “peer influencers” and biased pharmaceutical advertising.
Medical schools run the obligatory statistics course but don’t ingrain in doctors that their interpretation of a journal article or more commonly, an “advertorial”, and their participation in marketing disguised as “literature” peddled by pharmaceutical representatives has a direct impact on patient experience, the cost of care and wasted healthcare dollars. Hospitals who should care even more about such education virtually ignore it and when it’s volume, not quality of care that’s rewarded, it all but extinguishes the desire to do better.
Meanwhile, what should patients do? The JAMA study suggests that doctors frequently don’t know and certainly, don’t know best. This is vexing but not all doom and gloom because doctors now have at their disposal an unprecedented number of sound guidelines, robust protocols and genuinely plain-language information for patients, not to mention easy web-based access to experts. When it comes to doctors seeking advice the world really is a global village. In a world of rapidly evolving information, patients should be prepared for a doctor to say, “I don’t know” provided this is followed by, “but I’ll find out.”
Here are three questions that every patient should ask of every new proposed drug or intervention:
What are my options?
What are the specific benefits and harms to me?
What happens if I do nothing?
If patients asked these questions more often and doctors took it upon themselves to answer faithfully, medicine might yet experience a new dawn.
Every woman comes to a stage in her life when she would like time to stop so that no more spots or wrinkles appear on her face. Everyone knows it’s impossible to stop the time. But, what’s possible is to avoid making mistakes that make your skin more wrinkled than it should be. It is also possible to make your skin glowing and radiant again, just like when you were a teenager.
1. Overwashing
There is one rule for how many times you should wash your face. And that’s once when you get up in the morning and once before you go to bed in the evening. If you wash your face three or more times a day, your skin’s natural moisture will strip off and this will be a very good base for more wrinkles.
2. Believing that every anti-aging product will give you anti-aging effects
It is important to know what your are nourishing your skin with. Read the ingredients of the creams you are using. Test them first. If you don’t feel comfortable enough with the cream you are using, don’t apply it anymore. No matter how expansive it is, give to someone else. It will cause more damage than good to your skin. If you want to have more naturally glowing skin, then pay more attention to the food you eat and to the beverages you drink.
3. Making too many facial expressions
Don’t make too many repetitions of the same facial movements over and over again. They can cause permanent wrinkles. If you are concerned about your face circulation, facial yoga is right for you. Try to relax your face as much as you can, and don’t stretch your muscles too much. Gentle massage is perfect to keep your muscles active and circulation going.
4. Wrong pillow
Sleep on your tummy or on your sides might feel more comfortable than sleeping on your back. However, bear in mind that if you make this a habit, lines on your face will start to appear from the pillow. Try to find as much comfortable material for your pillow as possible. Bamboo and silk are an excellent natural combination that wouldn’t do much of a damage on your skin.
5. Thinking that your sunscreen will redeem you from sun damage
Sunscreen does not give you 100% protection to your skin. You can still damage your skin from the strong UV rays even if you apply sunscreen regularly. Put on your sunglasses and a hat if it is really necessary to go out when UV radiation is the strongest. This is a small habit that can protect your skin and prevent it from early aging.
6. Using too much makeup to cover up deep-seated wrinkles.
Don’t put too much makeup or cosmetic layers on your face. Too much of it is worse than not at all. Your skin can’t absorb too much makeup and the layers will seep through the cracks. Too much cosmetics will just highlight those wrinkles more.
7. Remove your makeup with soup
Soup may make you feel like the best product to remove your makeup thoroughly. However, if you use unsuitable soup for your skin type, it can make your skin dry and more prone to early wrinkles. Therefore, if you don’t want to spend a lot on expensive lotions, you can use olive oil to remove your makeup thoroughly. It easy, natural and cheap and you’ll do a big favor to your face.
8. Leaving your aging issues for your creams to solve on their own.
You don’t want to leave all to your creams to solve your aging issues on their own. You must help them to help your skin. Lifestyle choices are crucial to keep your skin radiant and glowing. So, smoking is a big no, eating processed unhealthy foods is also a big no. Going to the gym, eating fresh fruits and veggies, and drinking plenty of water are big yeses to your skin. You’ll notice that your face will look fresh, your cheeks will be red and glowing and your eyes shining!
You were only in your 40s when you came into hospital and I was asked to see you. You reminded me of my mother, only you were 10 years younger.
The cancer had spread throughout your body. Your husband had brought you into hospital because you hadn’t eaten or drunk for almost a week and had collapsed.
I took one look and knew you didn’t have long. Your husband said that a week ago you had been your usual self, walking, laughing, living, loving. He broke down in tears. He didn’t need me to tell him you weren’t going to leave hospital. He told me how grateful he was for the cancer treatment we’d given you, what wonderful care you had received. His wish was that you would stay alive long enough for your parents to see you one last time. They were away and you hadn’t told them you were unwell for fear of hurting them, so they’d only found out today. They were getting the first flight to come and see you one last time. To say goodbye.
Your husband was overcome by emotion, hoping, begging I’d say you’d make it long enough to see them. I should have managed his expectations, explained that we’d do everything we could, that you were very unwell, that your organs were failing, your body was failing. I should have found a way to say all this, sensitively, compassionately and professionally. Instead, my lip trembled. My voice broke. Tears started rolling down my cheeks. I had to leave you to compose myself. I walked to the bathroom and wept.
I came back five minutes later, and your husband apologised for upsetting me. I didn’t have the heart to tell him that his last wish for you would be taken away. Instead, I told him we’d try our best. I said I would get the consultant to see you, partly because I hoped he’d have an answer I didn’t have, partly because I knew I couldn’t tell your husband you had hours to live.
When the consultant told your husband that he had only hours left with you, and that he should call your loved ones to your side, your husband thanked us between sobs.
I came into your room a couple of hours later to see how you were. The lights were dim. You looked at peace. You had left us. Your sister was there, your son was there. Your husband was there. He thanked us for everything we had done in giving you the time you had together. Your parents never made it.
I hope you are resting in peace. I hope your husband is somehow coping with your loss.
Some details have been changed.
If you would like to contribute to our Blood, sweat and tears series about memorable moments in a healthcare career, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.
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Almost every hospital in England has fewer nurses on duty than each believes are needed to guarantee safe patient care, research shows.
Analysis of official data by the Health Service Journal (HSJ) found that 96% of NHS hospital trusts in England had fewer nurses covering day shifts in October than they had planned and 85% did not have the desired number working at night.
The disclosure of such widespread failure to ensure hospitals are properly staffed has prompted fresh concern that a chronic lack of nurses and the NHS’s dire finances are putting patient safety at risk.
Nurse shortages have led to patients having to wait for medication, going unwashed or not having observations done on time, the HSJ said.
Janet Davies, the chief executive of the Royal College of Nursing, said: “This is yet more evidence that there are too few nurses caring for patients, putting people at serious risk. Safe staffing levels aren’t an optional extra. Having the right number of nurses is essential to ensure that patients can recover properly.”
The college estimates there are as many as 24,000 vacancies for nurses across the UK.
Nurses told the HSJ that understaffing meant hospitals were already providing substandard care, leading to patient safety “near misses”.
The figures are the worst hospitals have recorded since they were obliged to start publishing details of staffing levels in 2013, in the wake of a report on the Mid Staffordshire care scandal.
The number of trusts that do not have planned numbers of staff at work has gone up despite the recruitment of record numbers of nurses by acute hospitals. Limits introduced in 2015 on the amount hospitals can pay to hire agency nurses may help explain why staffing levels are dropping in many places.
One nurse said: “Sometimes observations get missed and I can recall many times where the patient is found to be deteriorating when they are eventually done. This gives you immense stress as you are left with the realisation you did not pick up on your patient’s condition early enough to prevent an acute episode.”
Another said: “I have seen patients not have proper care, dressings not changed, [and] not given the choice of shower or a wash as it takes more time that we do not have.”
HSJ reached its conclusions by examining data on nurse staffing levels that trusts release through the NHS Choices website. These include the numbers present in general medical wards, maternity units, surgical wards and intensive care units at 214 acute hospitals.
In hospitals in England, a nurse is meant to look after no more than eight medical patients, and the ratio can be as low as one to one in neonatal and intensive care units.
The figures show that Dewsbury and district hospital in West Yorkshire had 75% of the number of nurses it had planned to have on duty last October, down from the 87% it managed in the first three months of 2015.
Princess Alexandra hospital in Harlow, Essex, which went into special measures that month, covered 77% of shifts, as did Pontefract general infirmary in West Yorkshire.
The HSJ found that some trusts were employing unusually high numbers of healthcare assistants. That may suggest they are replacing nurses with cheaper personnel who have little clinical training.
Prof Peter Griffiths, of Southampton University, a member of NHS Improvement’s safe staffing committee for acute wards, said: “This is clearly not a good place for the NHS to be and it isn’t getting any better.” He said healthcare assistants could help plug gaps but relying on them to deputise for nurses in the long term risked compromising patient safety and involved “the risk of a false reassurance”.
The shadow health secretary, Jonathan Ashworth, said: “Tired, overworked nurses cannot be expected to continue providing the quality of care which patients need. The government needs to do much more to make sure nursing remains an attractive profession and to ensure hospitals can get in place the number of nurses they need to keep patients safe.”
A Department of Health spokesman said: “We expect all parts of the NHS to make sure they have the right staff in the right place at the right time to provide safe care. That’s why there are already almost 26,000 extra clinical staff, including almost 11,400 additional doctors and over 11,200 additional nurses on our wards since May 2010.”
Scale of loneliness among over-60s revealed as Age UK develops scheme to provide support and companionship
Half a million people over the age of 60 usually spend each day alone, with no interaction with others, and nearly half a million more commonly do not see or speak to anyone for five or six days a week, a poll suggests.
Age UK, which commissioned the research, said the results highlighted a growing number of chronically lonely older people, which was placing increasing demand on health services.
Related: Jo Cox’s campaign to tackle loneliness lives on with help of friends
Related: Loneliness is a hazard of old age. A phone call can mean a lot | Michele Hanson
Peppermint is a plant, like all other mints. The plant was originally indigenous to Europe and the Middle East but is now cultivated in many regions all over the world. Researchers recommend that everybody should drink peppermint tea. It has a pleasant, delicate flavor and serves as a refreshing beverage even if there’s no ailment that needs to be fixed and it is also excellent for your body and your mind.
Peppermint is great sources of manganese, copper and vitamin C. In addition, it has antioxidant, antispasmodic, antibacterial, antifungal, antiviral and carminative properties. Here are some of the many benefits you’ll enjoy with a cup of peppermint tea.
Simply Peppermint Tea Recipe
Pour 1 cup of boiling water over 1 tablespoon of dried peppermint leaves, Steep for 10 minutes. If desired, sweeten with honey, brown sugar or maple syrup. Drink small sips after meals, up to 3 cups a day.
7 Health Benefits of Drinking Peppermint Tea
Respiratory Issues
As an antispasmodic, it can also relieve you of that irritating sensation that makes you want to cough, thereby exacerbating your respiratory condition. By relaxing the muscles of the throat and chest, you can eliminate that aspect of cold and flu symptoms.
Sinus Relief
Peppermint contain menthol, it is a natural decongestant, providing relief from sinus pressure, related to colds and allergies, and the hot liquid can also soothe a sore throat that accompanies seasonal cold symptoms too.
Treats Cough
Peppermint tea has been cited as one of the best weapons against all types of coughs. It is stomatic, tonic, refrigerant, anodyne, stimulant, and carries menthol, a great soothing element for clearing phlegms and clogs inside our throats.
Eases Muscle Pain
Peppermint improves circulation and exhibits anti-inflammatory and analgestic effects that help relieve muscle pain. Menthol, one of the main components in peppermint, helps soothe inflamed muscle tissues.
Weight Loss
The aroma of peppermint oil and some of its organic components can actually eliminate the appetite, so smelling this substance can help reduce overeating, and subsequently, obesity!
Relieves Gas
Drinking peppermint herb tea may help relieve your symptoms, notes the American Pregnancy Association. The reason peppermint tea may effectively relieve bloating and gas is that peppermint helps relax your muscles, allowing digestive gases to pass more easily.
Reduces Fever
This might be a bit surprising, but peppermint tea is also beneficial for fever. Menthol (the decongestant), the main component in the tea, cools the system and hence, lowers the temperature of our body, both internally and externally.
More than 100 people have killed themselves in prisons in England and Wales so far this year, , according to penal reform groups, prompting warnings of a mental health epidemic within the incarcerated population.
The Howard League for Penal Reform said it had been notified of the deaths by suicide of 102 people up until 18 November – the equivalent of one every three days and breaking the record for frequency of suicides.
“With five weeks remaining until the end of the year, it is already the highest death toll in a calendar year since recording practices began in 1978,” said Frances Crook, the director of the Howard League. “The previous high was in 2004 when 96 deaths by suicide were recorded.”
Crookwho is meeting the justice secretary, Elizabeth Truss, on Monday, said: “The number of people dying by suicide in prison has reached epidemic proportions. No one should be so desperate while in the care of the state that they take their own life and yet, every three days, a family is told that a loved one has died behind bars.
“By taking bold but sensible action to reduce the number of people in prison, we can save lives and prevent more people being swept away into deeper currents of crime and despair.”
The current rate of self-inflicted deaths in prisons across England and Wales of nearly 10 a month means the final toll for 2016 could be as high as 115, compared with 89 in 2015.
A joint report, Preventing Prison Suicide by the Howard League and the Centre for Mental Health, links the rise in the number of prison suicides to cuts to staffing and budgets and the rise in the number of people in prison that has resulted in overcrowding.]
Prison deaths Prison deaths
“Violence has increased and safety has deteriorated. Prisoners are spending up to 23 hours a day locked in their cells, the imposition of prison punishments has increased and a more punitive daily regime was introduced in prisons at the same time as the number of deaths by suicide began to rise,” it says. “The prison suicide rate, at 120 deaths per 100,000 people, is about 10 times higher than the rate in the general population.”
The report calls for a recently revised incentives and earned privileges regime to be scrapped and for an undertaking that prisoners with mental health problems or at known risk of suicide should never be placed in solitary.
The Howard League’s figures show that the highest number of self-inflicted deaths – six – this year have been at Woodhill prison, Buckinghamshire, which is at the centre of a high court legal battle.
Mr Justice Lavender gave permission on Thursday for a judicial review case to be heard, saying that evidence of repeated failures to implement policies to prevent self-inflicted deaths at Woodhill could not be dismissed as “operational failures”.
It has also emerged that an independent monitoring board at Bedford prison, which has had four deaths so far this year, wrote “an urgent letter of concern” to the prisons minister about the “alarming rise in prisoners attempting to hang themselves” at the jail before its recent riot. They highlighted that staffing shortages were “beyond crisis point”.
An independent monitoring board report published on Monday into Bullingdon prison in Oxfordshire warns that inadequate staffing is also damaging morale and relationships with prisoners.
“The board is concerned about increasing difficulties in recruiting and retaining sufficient officers to maintain levels defined as acceptable by the prison service. It has also observed that indiscipline and violence have increased noticeably since staff cutbacks were implemented in 2013,” says the Bullingdon report.
The chancellor, Philip Hammond, confirmed in the autumn statement last week that an extra £555m over the next three years would be made available to fund prison safety measures, including the recruitment of 2,500 extra prison officers.
A Ministry of Justice spokesperson said that mental health in custody was taken extremely seriously: “Providing the right intervention and treatment is vital to improving the outcomes for people who are suffering and all prisons have established procedures in place to identify, manage and support people with mental health issues.
“But we recognise that more can be done. That is why have invested in specialist mental health training for prison officers, allocated more funding for prison safety and have launched a suicide and self-harm reduction project to address the increase in self-inflicted deaths and self-harm in our prisons.”
The heart is a remarkable muscle. It sits behind the rib cage, pumping 100,000 times a day to carry nutrients to the furthest extremities of the body.
But it is also a vulnerable organ, prey to the excesses of a modern western lifestyle – and as excessive lifestyles have spread around the globe, they have had a predictable effect.
Around the globe, the morbidity burden of cardiovascular disease (CVD) has increased by 40% in the past 25 years. The gains in the west – since the 1960s, deaths from heart attacks and strokes in the UK have nearly halved – have been outweighed by the fact that the global population is increasing in number and ageing. There were 12.3m CVD deaths worldwide in 1990 – this had risen to 17.3 million by 2013. That’s over three times the number caused by Aids, TB and malaria combined.
The World Health Organisation (WHO) and World Heart Federation have said the risk of premature death from CVD could be cut by 25% by 2025 with a three-pronged attack to reduce high blood pressure, curb smoking, and provide at least half of those who have already had a heart attack or stroke with secondary prevention, such as medication.
But a panel of international experts – which I chair – say in a highly critical report to be presented at the World Innovation Summit for Health (Wish) in Doha this month that the response from policymakers has been weak.
Given the fact that the disease develops slowly and does not create the panic caused by a flu pandemic, there is a lack of urgency and responsibility is fragmented, with governments facing opposition from powerful lobby groups such as the tobacco industry, says the report.
Hypertension affects 1 billion people worldwide. Smoking kills 6 million annually and although its use is falling the number of smokers worldwide has increased from 721 million in 1980 to 967 million in 2012. In secondary prevention, a single measure – controlling low-density lipoproteins in those who have already had a heart attack – reduces the risk of a further one by 40%.
Some countries have launched bolder initiatives, leading the way for the rest.
New Zealand set a goal in 2011 to reduce smoking prevalence to 5% by 2025 and provided NZ$ 5m (£2.9m) a year.
Brazil uses community health workers to visit every household in their catchment area once a month. The scheme covers half the population. This has led to a significant cut in hospital admissions, with a 20% drop in age-standardised deaths from heart disease and stroke over the course of the 20-year programme.
In South Africa a scheme called Practical Approach to Care Kit (Pack) supports nurses to provide care in the community, leading to improvements in prescription, referral and screening, and reductions in the length of hospital stays.
In India, the mTobaccoCessation service – a text based programme sending free, customised messages to help smokers give up, launched in January 2016 – enrolled 800,000 people in the first 60 days, showing the extent of demand. Trials have shown the programme can double or triple smoking cessation rates.
In the UK, a trial is underway in Cheshire and Merseyside, in collaboration with the WHO, to raise awareness of blood pressure and develop a suite of text messages to help people keep it under control. Tests have shown that this can lead to “statistically significant improvement”.
These are conditions that kill more people than any other, yet policymakers rarely make CVD prevention a major focus of their attention, despite the high health and economic burden and the unnecessary loss of life. It does not get as much attention as diseases that are perceived as more life-threatening, or as posing a greater risk, such as cancer or Ebola.
We in the UK cannot afford to be complacent. Although the total number of cardiovascular deaths has come down – from 320,000 in 1961 to 180,000 in 2009 – CVD is still the biggest killer, accounting for 32% of all deaths in 2009 [pdf].
Nearly every single country worldwide shares the same burden and faces the same challenge. That means that there are many innovators around the world testing new ideas and trialling new solutions. But they need political and financial support if they are to find an answer to the most significant public health threat in the world today.
Lord Darzi is a surgeon and executive chair of the World Innovation Summit for Health (Wish), an initiative of the Qatar Foundation.
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Tobacco use, the leading cause of death from non-communicable diseases such as heart and lung disorders and cancer, claims about 6m lives a year. On Monday, countries will gather in Delhi, India, for the seventh conference of the parties to the World Health Organisation framework convention on tobacco control, a treaty that has sparked global action to stem the epidemic.
The treaty is already one of the most widely embraced in UN history. One of my proudest accomplishments at the helm of the World Health Organisation has been rallying global efforts to drive down tobacco use. I’m pleased to say that, following the adoption of the agreement, governments around the world have taken decisive steps not only to reduce tobacco use, but also to stand up to the multinational tobacco companies standing in the way of global progress.
The tide of tobacco use is beginning to turn. After decades of Big Tobacco targeting low- and middle-income countries and years of steadily increasing sales, tobacco sales show signs of dropping.Countries are passing stronger laws to reduce demand for tobacco products not envisioned even a few years ago, and tobacco companies are losing the legal challenges they mount against these measures. From Uruguay to Australia, countries large and small have stood up to the tobacco industry by implementing plain packaging and large pictorial health warning labels. Where tobacco companies have tried to threaten and bully nations, governments have responded with firm measures to protect public health.
However, amid these clear signs of progress, the tobacco industry has made it absolutely clear that it has no intention of abandoning a business model that depends on enticing millions of new users – especially young people – to its deadly products.
The impetus of the global movement to reduce tobacco use should not be lost. More than ever, decisive action is needed. Now is the time for countries to build on the momentum established and protect their citizens. By raising tax on tobacco products, requiring graphic warning labels, conducting hard hitting mass media campaigns and banning tobacco industry advertising and marketing, countries can improve the health of their citizens, reduce healthcare costs and prevent the tobacco industry from addicting another generation of children.
Illicit trade in tobacco threatens the progress governments make in tobacco control by making cheap and unregulated products available. I am pleased to note that governments are increasingly taking action and becoming parties to the new international treaty to eliminate illicit trade in tobacco products.
I urge global leaders convening in India to see this as an opportunity to bend the course of public health history
We need to work together, as allies in global health, to fight to protect people from the dangers of tobacco. I recently appointed Michael Bloomberg as WHO global ambassador for non-communicable diseases because of his track record in tobacco control, which includes more than 10 years of support for low- and middle-income countries. Advocates like him, and many others who champion tobacco control, stand with the WHO to support governments in this fight.
I am also heartened by progress on standardised or “plain” packaging – a measure introduced by the treaty and pioneered in Australia, where smoking rates have now fallen to record lows. The early evidence from Australia shows that plain packaging, as part of a comprehensive approach to tobacco control, is diminishing the appeal of tobacco products, increasing the effectiveness of health warnings and reducing the ability of the pack to mislead. France and the UK have begun implementing plain packaging laws, and New Zealand and Hungary have recently passed legislation. Many other countries are close behind.
We have made great strides, but we have so much more to do. Tobacco use remains one of the most vexing challenges we face in the global health arena.
I urge global leaders convening in India to see this moment as an opportunity to bend the course of public health history and commit to returning home with a renewed dedication to fully implement the WHO framework convention. To make the event effective, it is vital that governments recognise the inherent conflict between public health and the interests of the tobacco industry. Representatives from the latter should be completely excluded from government delegations.
Every death from tobacco is an avoidable tragedy. It is our task to reverse the tide, effecting an irreversible decline in the number of such deaths.
We need history to show us that the turning point in the tobacco epidemic is now. We know what to do and we know how to do it. We now need to ensure that every country moves forward and no one is left behind. Future generations depend on us.
