The findings in your article (Hundreds of thousands of children being exposed to illegal levels of damaging air pollution from diesel vehicles, 4 April) are scandalous. We are storing up huge unknowns in terms of the future of our children’s lung health. We need urgent action. The government must bring in a fair and ambitious Clean Air Act with targets to ensure pollution levels are monitored around every school and nursery located close to busy roads, arming parents and teachers with the information they need to take action to protect children’s health. Traffic emissions are the main culprit, but we know people bought their old diesel cars in good faith. A targeted scrappage incentive scheme would be a positive step, which could persuade drivers to switch quickly to cleaner vehicles. The Guardian and Greenpeace’s investigation shows our children’s lung health demands action now. Dr Penny Woods Chief executive, British Lung Foundation
• Your article highlights diesel fumes in London.In Hampstead, north-west London, pleas to Camden council to take account of the EU air quality directive and limit developments with massive lorry movements have not been heard. The council accepts that if it complied with the directive it will have to stop developments, and it is just not going to do that. Some 12,500 children go to schools in Hampstead every day, many under the age of seven. Development after development is approved by Camden and government planning inspectors right next to schools where children are exposed to lorry diesel fumes. One such development will see 2,000 lorry movements.
Cycle superhighway 11 will shut five out of 10 lanes on the main north-south corridor used by 40,000 vehicles a day. Transport for London confirmed that traffic will fan out into our narrow residential streets causing congestion and pollution, with up to an extra 475 vehicles an hour on one of our roads which has two primary schools with kids aged from two. Parliament passed laws to enable HS2 to pollute our area with 800 lorry movements a day. The continuing assault on air quality by local councils and government authorities shows that they pay only lip service to improving our air quality. Jessica Learmond-Criqui London
• Schools should be especially concerned as air pollution has been shown to cause a range of adverse effects including obesity, asthma, infant mortality, low birthweight babies, and depressed IQ.
All schools keep a record of asthma inhalers brought to school and over two decades ago, the late Dr Dick van Steenis proposed that “every county conduct a survey of primary schools to ascertain the proportion of children taking inhalers to school, and that any area with high proportions be investigated locally. This would be quick, cheap and effective.” (Airborne pollutants and acute health effects, The Lancet, 8 April 1995).
As far as I know, no council bothered to do so. Perhaps this will change now that Sadiq Khan is mayor of London and an asthma sufferer who’s determined to tackle air pollution, but who seems to have overlooked the impact of incinerator emissions. Will Khan publish the percentages of children in Years 3 to 6 in each London school who bring in asthma inhalers? Michael Ryan Shrewsbury, Shropshire
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One in four adults in England get less than 30 minutes of exercise a week, with women more likely to be inactive, a report shows.
NHS Digital’s annual review of obesity in England also found high levels of obesity among adults and children, with only around a quarter of adults eating the recommended five portions of fruit and vegetables a day.
Twenty six per cent of all adults were classified as inactive (undertaking fewer than 30 minutes of physical activity a week), with women more likely to be inactive (27%) than men (24%).
People who are long-term unemployed or who have never worked are most likely not to take exercise (37%), compared with 17% of those in professional and managerial jobs.
Almost a third of people in South Tyneside, Leicester, Barking and Dagenham and Rochdale are deemed to be inactive, while the lowest rates of inactivity were found in Wokingham (13%) and Brighton and Hove (14%), the report said.
In 2015, 58% of women and 68% of men in England were overweight or obese. Obesity has risen from 15% of adults in 1993 to 27% in 2015.
The prevalence of morbid obesity has more than tripled since 1993, affecting 2% of men and 4% of women in 2015.
The report also revealed high numbers of overweight children, with more than one in five in reception class (aged four to five) being overweight or obese in 2015-16, rising to more than one in three for children in year 6.
On Thursday, Public Health England (PHE) published new voluntary targets for the food industry to reduce sugar levels by 20% by 2020 in nine categories of food popular with children.
The NHS Digital report found that only 26% of adults ate the recommended five portions of fruit or vegetables a day in 2015: 47% of men and 42% of women ate fewer than three portions a day. But 52% of 15-year-olds said they hit the recommended five a day.
The data also showed there were 525,000 hospital admissions in England in 2015-16 where obesity was recorded as a factor. Two in three patients, or 67%, were female.
The data revealed, too, that 6,438 weight-loss surgical procedures were carried out.
A spokesman for the Obesity Health Alliance, a coalition of more than 40 health charities, campaign groups and medical colleges, said: “As waistlines increase, so do the chances of developing life-threatening conditions like Type 2 diabetes, heart disease and cancer, putting further strain on our already overstretched health service.
“This data is a stark reminder of exactly why we need measures like the sugar reduction programme and the soft drinks industry levy to help create a healthier environment for all.”
Dr Justin Varney, Public Health England’s national lead for adult health and wellbeing, said: “We need many more adults and children to be more physically active. Little and often makes a big difference – just 10 minutes extra walking each day can improve a person’s health and their overall quality of life.”
Chris Allen, senior cardiac nurse at the British Heart Foundation, said: “Being inactive can dramatically increase your risk of having a deadly heart attack or stroke.
“But the good news is that it’s never too late to start being more active, which can help you control your weight, reduce blood pressure and cholesterol and improve your mental health.
“The recommended 150 minutes of physical activity a week may seem like a lot, but you can break it down into 10-minute sessions and gradually build up.”
Almost three-quarters of women in England start breastfeeding after giving birth but less than half are still doing so two months later, according to NHS and Public Health England data.
PHE recommends exclusive breastfeeding for the first six months, as does the World Health Organisation, because it boosts a baby’s ability to fight illness and infection. But a comparison of initial breastfeeding rates and those after six to eight weeks in the final quarter of 2015 found that they were 40% lower for the latter (44% compared with 73%).
A survey of 500 mothers commissioned by PHE found that fears about breastfeeding among women included that it could be painful (74%), prevent them taking medication (71%) and be embarrassing in front of strangers (63%).
The PHE’s chief nurse, Viv Bennett, said:“We can all help women feel comfortable breastfeeding their baby wherever they are. Creating a wider culture of encouragement and support will help make a mother’s experience all the more positive.”
PHE has launched an interactive breastfeeding friend chatbot, accessed through Facebook messenger, to provide personal support for breastfeeding 24 hours a day. Bennett said it would help women through the “crucial” initial period, after which things generally became easier.
A study published in the Lancet last year found the UK had the lowest rate of breastfeeding in the world, with only one in 200 women breastfeeding their children after they reach their first birthday.
The WHO recommends that breastfeeding form part of a baby’s diet up to two years of age. As well as reducing the likelihood of babies getting diarrhoea and respiratory infections, breastfeeding also lowers a mother’s risk of ovarian and breast cancer and burns about 500 calories a day.
The PHE survey found that many women were not only embarrassed about breastfeeding in front of strangers, but also their partner’s family (59%) and around siblings and wider family members (49%).
The results, published on Thursday, suggested high-profile figures who promote breastfeeding can have a positive influence on other mothers. Just under half of respondents said the example of household names such as The Only Way is Essex star Sam Faiers, broadcaster Fearne Cotton and actor Blake Lively, who have recently championed breastfeeding on social media, had inspired them to do so themselves. About two-thirds (64%) said they felt more confident to breastfeed in public because of celebrity mums.
Other concerns raised by more than half of women were not being able to tell if their baby was getting enough or too much milk and that it could potentially place restrictions on the mother.
Jacque Gerrard, the director for England at the Royal College of Midwives, said: “Any initiative that goes towards helping mothers start and sustain breastfeeding for longer is positive as we know the health benefits from being breastfed last a lifetime.”
Please don’t give people an excuse for not making every effort to change behaviours that contribute to air pollution (Omega-3 supplements could guard against air pollution, 4 March). Millions of car drivers can cut air pollution right now by reducing their car use. Driving a car is antisocial in the extreme: it negatively impacts on thousands of lives and there are few places (if any) to escape the toxic waste that car drivers (their cars couldn’t do it without them) spew out from the moment they turn the key in the ignition to the moment they turn it off. One of the most troubling aspects of the human intellect is our ability to rationalise and reason away the most irrational and unreasonable and destructive behaviours. Car drivers are brilliant at it. Jo Whateley Sheffield
• It appears that may be true for mice and may yet prove to be so for humans. However, bearing in mind that around a quarter of all car journeys are for less than one mile and that car engines are significantly more polluting when the engine is cold, wouldn’t it be more immediately effective and expedient if far more people simply left their cars behind and walked? Bill White Leeds
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Scientists are calling for a major effort to make cannabis use less harmful as a rising number of countries look to replace long-standing and outright bans on the drug with more relaxed legislation.
A number of countries and US states have softened laws around cannabis use against a backdrop of rising drug potency and an apparent increase in the number of people in treatment for cannabis-related problems.
Researchers at King’s College London and UCL said it was now crucial for health officials to consider measures to reduce the harm from cannabis use. Many of the health risks that users face could be reduced by discouraging people from smoking it with tobacco, and using vapourisers instead.
In regions that have legalised cannabis, health interventions could target the drug through caps that enforce a limit on the strength of cannabis, and higher taxation on the most potent varieties. Tinkering with the chemical composition of cannabis could also make the drug safer without altering the pleasurable effects users want, they add.
Writing in the journal Lancet Psychiatry, Amir Englund and other researchers say that with laws around cannabis rapidly changing, the need to protect users from the most harmful effects has never been greater, while more research is urgently needed to inform fresh drug policies.
It is hard to be sure what varieties of cannabis people use and in what amounts because the data tends to be based only on drugs that are seized by the police. But the best estimates suggest that on the global market, cannabis use has on average doubled in the past four decades. In many countries, including the UK, high potency cannabis now dominates sales on the black market.
In the past eight years, the number of Europeans entering specialist treatment for cannabis-related problems has increased by more than 50%. It is unclear how many people refer themselves for treatment and how many are sent to clinics by the legal system, but the scientists believe the evidence that cannabis can cause harm to some users is strong enough to justify efforts to make it safer.
Several European countries have relaxed their laws around cannabis use, including the Netherlands, Spain and Portugal, and in the US eight states have formally legalised recreational use of the drug. Canada is due to follow suit this year. Many other regions now allow the drug to be used for medicinal reasons.
While legalising the drug is expected to cut the costs of cannabis-related crime, it is unlikely to reduce the number of users, the researchers write. “A lot of countries are deciding to change their cannabis policies to more permissive ones and we don’t know whether that will lead to significantly more use and problems, but we do know there are vulnerable groups out there,” said Englund.
The main compounds found in cannabis are THC (delta-9-tetrahydrocannabinol) and cannabidiol (CBD). The THC produces the “high” from cannabis, but greater levels of the chemical are also linked to a higher risk of psychosis. There is some evidence that CBD can combat the negative effects of THC, such as poor memory and paranoia, but in high strength cannabis levels of CBD are often minimal.
One option the scientists propose is to boost levels of CBD in high potency cannabis, so that users can get their hit without being at such risk of mental harm.
“We don’t always have the luxury of waiting for a lot of research and we can sometimes use the scant evidence we have to try and make some kind of best case judgment,” said Englund. “We are fairly confident that higher THC levels in cannabis are not a good thing, and it does seem that higher CBD levels in cannabis are protective, at least to some extent.” Later this year, Englund will launch a study funded by the Medical Research Council to test whether different levels of CBD can reduce the harmful effects of THC.
Ian Hamilton, a lecturer in mental health at York University, said the European habit of smoking cannabis with tobacco was the greatest health risk users faced, but this had largely been ignored by public health. He said there was “a real opportunity to minimise such harms by adapting the strategies that have proved to be effective in reducing smoking incidence and prevalence in the general population.”
Another week, another dreadful story about patients suffering at the hands of our increasingly cash-strapped NHS and care system. This time it was Iris Sibley, an 89-year-old woman kept isolated on a hospital ward for six months, despite being well enough to be discharged, because of a failure to find a suitable nursing home place. The result: not just huge financial expense for the NHS, but great human cost in distress and anxiety for Iris and her family.
The NHS’s alarm bells have been trilling furiously for months. Nine out of 10 hospital trusts have experienced overcrowding this winter, and the number of people facing long waits of more than 18 weeks for routine – often pain-relieving – care, has doubled in the last four years. Cynics are deploying the NHS’s current woes to argue the cherished principle at its heart – free care at the point of delivery based not on ability to pay, but on clinical need – makes for inefficient and unsustainable healthcare. Nothing could be further from the truth: one study rated it the top-performing healthcare system out of a group of countries that included Germany, France and Canada, despite costing less per head than all but one in that group.
What we are seeing is the direct result of our health service being starved of the financial resources it needs to maintain existing levels of care to an ageing population. The government has imposed the tightest funding squeeze the NHS has faced in its 70-year history. Little surprise, then, that hospital trusts in England ended the year with a record deficit triple the size of the previous year’s. The NHS’s problems have been compounded by cuts to social care: council spending on social care has fallen by 11% on average since 2010. Less state spending on social care means older people languishing on hospital wards when they are fit to be discharged, at great damage to their physical and mental health, and to NHS finances. More cash is not the only ingredient needed for the delivery of world-class care.
The NHS needs reform and modernisation to respond to changing needs, with more care delivered in the community for people living with long-term conditions, and more specialist acute care delivered in bigger centres. But deliberately depriving the NHS of the resources it needs makes this even more difficult. Local NHS leaders in England have been charged with transforming the delivery of care in their areas over the next five years to make it fit for the future. There are examples of real innovation, such as Manchester’s ambitious efforts to bring together health and social care in one budget. Yet, forced to find immediate savings, the process has inevitably become more about cutting back than about modernisation.
The government’s response has been shameful. Health secretary Jeremy Hunt continues to insist the English NHS has been given the resources it asked for, despite the health select committee pointing out the dodgy financial engineering involved in this claim. Even worse, he has sought to deflect from the funding crisis by launching an offensive against overseas patients, despite the fact that pre-charging them for elective care would raise only a tiny sliver of the NHS’s annual budget. This dog-whistle politics is all the more revolting given the NHS’s reliance on its migrant workforce.
There is a growing consensus our health and care systems urgently need more cash to see them through the next few years. Those calls are not being heard by a prime minister who warily regards the NHS as a bottomless drain on resources, and has prioritised tax cuts for businesses and more affluent families over spending on public services. Yet public affection for the NHS leaves ample room for leeway: back in 2002, Gordon Brown achieved the unthinkable – a popular tax rise – to boost health spending. Recent polling shows more than half of the public would be prepared to pay more tax if it were earmarked for the NHS. Mrs May should take a leaf out of her predecessor’s book.
Patients who are overweight or obese are less likely to die in hospital after a heart operation than those who are a healthy weight, a study has found.
The results of the British Heart Foundation (BHF)-funded research suggest it is wrong to deny people surgery because they are overweight and that underweight patients could benefit from gaining weight prior to a heart operation.
A team at the University of Leicester collected data on about 400,000 adults in the UK and Ireland who underwent cardiac surgery between 2002 and 2013, categorising them into different weight categories, according to their BMI (body mass index).
Of those included, 11,511 patients died in hospital, including 4.4% of patients who were of healthy weight, compared with only 2.8% of those who were overweight and 2.7% in obese class I (with a BMI of 30 to 35). The study, published on Friday in the journal Circulation, found that 8.5% of patients who were underweight died in hospital.
Gavin Murphy, BHF professor of cardiac surgery at the University of Leicester, said: “We saw a 25% reduction in death by being overweight as opposed to being normal [healthy] weight. That’s a bigger effect on mortality than statins.
“It changes one of the most basic approaches behind surgery, which is that people need to lose weight before surgery. Obese patients are generally considered unfit for surgery. This study shows the very morbidly obese – with a BMI greater than 40 – did not have a greater risk. It shows that no patient should be rejected for surgery on the basis of body mass.”
The authors believe the study confirms the existence of the much-debated obesity paradox, whereby obesity can cause illnesses, such as heart disease or a heart attack but at the same time have certain protective effects.
Murphy said they found a linear association between increasing BMI and lower risk of acute heart failure or acute stroke but the relationship did not hold for all adverse outcomes post-surgery (infections, for example). How being overweight or obese protects patients who undergo surgery is unknown but the researchers plan to investigate this in future.
“If you imagine that having a heart operation is like climbing a mountain, you’re probably better doing that if you’re nutritionally nourished than if you’re under-nourished, if you’re having an energy surplus than having an energy deficit, although it’s probably a bit more complex than that,” said Murphy.
The researchers found that overweight or obese patients had greater protection regardless of age and even if they had experienced complications associated with obesity, such as hypertension, diabetes and coronary artery disease.
They also reviewed data from 557,720 further patients included in studies across Europe, the United States and Asia, finding similar results.
BHF’s associate medical director, Prof Jeremy Pearson, said: “We always recommend a healthy waistline, which significantly reduces lifetime risk of heart disease and therefore a person’s risk of needing cardiac surgery. However, this large study strongly suggests that being overweight can give patients added protection when facing major heart surgery, reducing their chance of complications or death before leaving hospital.”
A large number of NHS groups are believed to have placed restrictions on access to surgery for overweight people, although, in most cases this applies to elective procedures for non-life-threatening conditions such as hip and knee replacements.
Naomi Elster writes: “There isn’t currently any strong evidence that eating too much red meat causes cancer”, before noting that Cancer Research UK is a “reliable source … for advice and support” (The truth about cancer diets, G2, 16 January). However, responding to the WHO’s October 2015 International Agency for Research on Cancer report which classified red meat as “probably carcinogenic to humans”, Professor Tim Key, Cancer Research UK’s epidemiologist at the University of Oxford, said: “Cancer Research UK supports IARC’s decision that there’s strong enough evidence to classify … red meat as a probable cause of cancer.” Ian Sinclair London
• The letter headed “Standing in solidarity with Brazil’s Lula” (14 January) shows a remarkably one-sided view and a lack of concern for the facts. An example: “Investigating Lula, prosecutors have been unable to find any illegal activity committed.” This is nonsense. Lula has been charged on various counts including money laundering, being a member of a criminal organisation, influence peddling and misconduct. More than 50 Brazilian politicians, past and present and from various parties, have been charged with illegal activities and Lula is one of them. John Fenn London
• As was said of Wall Street corporations when the US supreme court granted them “personhood”, I’ll believe robots are people when the state of Texas executes one (Letters, 17 January). John Smith Sheffield
• I don’t know about corned beef as I don’t buy it, but Spam has replaced the old key opening with a ring pull, presumably to reduce hand injuries (Letters, 17 January). Michael Cunningham Wolverhampton
• I have crunchy peanut butter on Weetabix (Letters, 17 January). My family think I’m weird, though they appreciate my lack of conversation over breakfast. Lynn Alexander Barton le Clay, Bedfordshire
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Implanting two embryos during IVF can cut the chance of becoming pregnant by more than a quarter if one of the embryos is in a poorer state of health, new research suggests.
A study of almost 1,500 embryos that were implanted in women of all ages found that putting back a healthier embryo with one of poorer quality dramatically cut the chance of a successful pregnancy compared to just transferring one embryo.
Experts behind the study believe that the body tends to focus on the embryo termed the one of poorer quality and rejects a possible pregnancy, rather than focusing on the healthy embryo that would lead to a successful birth.
The research, being presented at the British Fertility Society annual conference in Edinburgh, involved data for 1,472 fresh single and double embryo transfers on day five after fertilisation (blastocyst stage).
The transfers were carried out between between June 2009 and December 2013 at the Nurture Fertility clinic in Nottingham. Embryos were graded by an embryologist at the time of embryo transfer using a standardised grading system in IVF.
The results showed that compared to transferring a single embryo, transferring two embryos where one was good quality and one was poor resulted in a 27% lower chance of achieving a pregnancy.
Transferring two embryos of good quality was also no better than one for achieving a pregnancy.
Nick Raine-Fenning, medical director and research lead at Nurture Fertility, said: “The current feeling is that a good embryo will be recognised by the body and will be captured for implantation. But a poor quality embryo should be rejected by your body, your endometrium will reject it. What our research suggests is that if you put a poorer quality embryo back with a good one, it’s more likely to compromise the chance of the good one implanting.”
He said he would recommend that any woman with a good embryo – especially older women – should just have one embryo put back in their body.
“In their first cycle I would absolutely recommend that women – even older women – have one embryo transferred and the second embryo is frozen for future transfer,” he said.
He added: “This research shows the importance of quality over quantity. It helps better guide the contribution and risk when considering replacing a second embryo. Most patients understandably expect adding a second embryo will increase or even double their chances but this has never been the case.
“We hope this research will help clinics further reduce the number of multiple births, whilst crucially keeping their success rates high.”
The research did, however, show that if women only had two poorer quality embryos, they still had a higher chance of falling pregnant than if just one embryo was transferred.
The regulator, the Human Fertilisation and Embryology Authority (HFEA) leads a campaign to persuade women of the benefits of having embryos transferred one at a time during IVF.
It points to research showing the risks of multiple births, including that twins are six times more likely to be born prematurely than single babies.
Long-term health problems of prematurity include breathing difficulties, cerebral palsy and other physical and learning problems, it says.
Runners who wear trainers with no cushioning and land on the ball rather than the heel of the foot significantly reduce the risk of injury, according to a study.
Researchers compared how quickly the force acts when runners’ feet hit the ground – known as the loading rate – which has been shown to influence injury risk.
The study of 29 runners, published in the Medicine & Science in Sports & Exercise journal, found significantly lower loading rates for those who wore so-called minimal trainers and landed on the ball of their foot, compared with people in normal running shoes, regardless of whether the latter landed on the heel or ball of the foot.
The lead researcher, Dr Hannah Rice of the University of Exeter, said: “So many people use running as a means of reducing the risk of chronic diseases, but about three-quarters of runners typically get injured in a year.
“Footwear is easily modifiable, but many runners are misguided when it comes to buying new trainers. This research shows that running in minimal shoes and landing on the balls of your feet reduces loading rates and may therefore reduce the risk of injury.”
Running continues to grow in popularity but injury rates have not fallen despite decades of research aimed at reducing them.
Runners in cushioned footwear tend to land on the heel – known as a “rearfoot strike” – while those who run barefoot are more likely to land on the ball of the foot – a “forefoot strike”.
Rearfoot strike runners experience an abrupt vertical impact force each time the foot hits the ground. The impact force is often missing when running with a forefoot strike, but previous research has shown that forward/backward and sideways forces can be higher with a forefoot strike, meaning the total force is similar.
Total force seems to be similar between foot strikes if wearing modern, cushioned trainers. “This seems to suggest that, for runners in traditional, cushioned running shoes, foot strike pattern may not matter for injury risk.
“However, we suspected that the same may not be true of runners who regularly use minimal shoes, which don’t have the cushioning provided by traditional running shoes,” Rice said.
“Our research tells us that becoming accustomed to running with a forefoot strike in shoes that lack cushioning promotes a landing with the lowest loading rates, and this may be beneficial in reducing the risk of injury.”
Any transition to new footwear or to a different foot strike pattern should be undertaken gradually and with guidance, she said.
The research was conducted at the Spaulding National Running Center at Harvard Medical School. “We found that when running in trainers with no cushioning and landing on the ball of the foot, the loading rate is lower than when running in cushioned shoes, however you land,” Rice said. “The loading rate is a useful measure, as it tells us how fast the forces are acting, and higher values have been associated with running injury. So in summary, our paper found that running in shoes that have no cushioning and landing on the ball of your foot may reduce the risk of injury in runners.” Minimal shoes, Rice said, have very little or no cushioning, a heel-toe drop of less than or equal to 4mm (0.16 inches), and a stack height of less than or equal to 16mm. “This is information which manufacturers and footwear shops should be able to provide,” she said.
Men are far less likely to seek medical support for a mental health problem than women, new figures reveal.
A survey commissioned by the Mental Health Foundation found that not only are men far less likely than women to seek professional support, they are also less likely to disclose a mental health problem to friends and family.
The YouGov survey, the largest of its kind, polling more than 2,500 people who have had mental health problems, showed 28% of men admitted that they had not sought medical help, compared with 19% of women.
The survey found that a third of women, compared with a quarter of men, had told friends or family about their mental health problem within a month of it arising. More than a third of men, compared with a quarter of women, either waited more than two years or chose never to tell friends or family about their problem.
Mark Rowland, director at the Mental Health Foundation, said the findings showed that there needed to be a cultural shift in the approach to the issue. “Mental health is so central to our experience of being alive that if we’re ever to rise to the challenge of preventing mental health problems, it will be because men feel more able to share when they are vulnerable,” Rowland said.
“This is not about being more of a man but being more in touch with our humanity.
“It takes courage to be open and honest about mental health, but when suicide is the leading cause of death for young men, we all have a responsibility to push for cultural change.”
Dave Chawner, 27, a comedian who lived with anorexia and depression for 10 years before seeking support, backed the findings.
“It’s important to talk about gender when we talk about mental health. It is more accepted for men to deal with stress, emotions and situations with anger. Anything else is interpreted as vulnerability and shut down.”
In the past year a number of campaigns have been launched to encourage men to talk about their mental health problems. Documentaries by the rapper Professor Green, Stephen Fry and the Bafta-award-winning actor Adam Deacon have all helped to draw attention to the issue as have the #RUOKM8 and #BoysDoCry social media campaigns.
Do you feel low on energy every afternoon? if you answer is yes, then here are some quick tips which will help you get energized in as less as 15 minutes. No, you don’t need a cup of coffee or energy booster drinks. They’re all natural methods.
So, follow these natural energy booster tips to keep your sluggishness at bay.
Crunch Fiber in the Morning
You are what you eat and it is good habit to fuel your body with the right foods. It is reported that people who skip breakfast are more likely to feel fatigue during the day. Go for foods that are enriched in fiber like oatmeal, eggs and multi grain toast. You may also include yogurt and berries in your breakfast. Eating foods packed with protein and fiber will keep you away from energy crash as the day wears on.
Do Yoga Or Meditation
Yoga is getting popular for a reason. It has multiple benefits and will recharge you up to survive the whole day. Some breathing exercises and meditation can help you put down your stress level and fight against the fatigue. You’ll get a burst of energy if you do yoga for just 10 minutes in the morning.
Go for a Short Walk
If yoga and meditation is not your cup of tea or you simply can’t do then a ‘thank you’ walk will do the work for you. When your are feeling tired then a short walk will boost your energy level up a notch. This is simple technique yet very effective when it comes to ease stress and fight fatigue.
You can also ride your bike or bicycle if you want. The idea is simple, just MOVE!
Hydrate Your Body
Dehydration is one of the main culprit when we are low on energy. It is the symptom of Fatigue. That’s why it is recommended that when you are low on energy then don’t drink coffee and other drinks, as they dehydrate your body even more. The alternative is to drink 1 or 2 glass of chilled icy water to keep yourself alert throughout the work.
Take a Short Nap
If you start your day early in the morning then it is quite normal to feel exhausted by the time it is noon. You may doze off for 15-20 minutes or 30 minutes if your work routine allows. This is very effective method and after the nap you will be able to focus more clearly on your work.
Make “Sun” Your Friend
When we are exposed to natural lights, we feel little more energetic. This is how humans body works. Try to let the sunlight come where you sit and spend most of your day. Not just these sun rays relieve you, but they will also charge you up with natural vitamin D.
Too much tension in our work life can hurt our personal life as well. The result in often anxiety, sleep deprivation, weight gain and stress. These natural ways of boosting your energy will help you complete your target of the day smoothly without getting being exhausted.
If you suffer from allergies, being around dogs can be a torturous experience. On the one hand, you might want to give them some loving pats on the head, but on the other, you know you’ll be sorry when your sneezing just. won’t. stop.
It might be tempting to shell out some cash for a hypoallergenic dog, but studies suggest that these pets can cause just as many symptoms as the regular kind because skin and saliva, in addition to hair, can cause symptoms. The only pets that truly won’t have you reaching for the tissue box have scaly skin.
RELATED: 20 Ways to Stop Allergies
But, if you do want to have a furry friend around, the following 9 dogs might be better for people with allergies.
Don’t have time to watch? Read the full transcript:
The only truly hypoallergenic pets have scaly skin. If you must have a furry pet, here are some that are said to be better for people with allergies.
Bedlington Terrier: They have curly, wooly coats and they weigh 17-23 pounds.
Bichon Frise: “Powder puff” dogs have a soft, silky undercoat and a coarse, curly outer coat. They weigh about 10-18 pounds.
Chinese Crested: They hardly shed and weigh 10-13 pounds.
RELATED: What to Do If You’re Allergic to Your Pet
Irish Spaniel: They have a curly coat and can weigh 45-65 pounds.
Kerry Blue Terrier: These dogs have a soft, dense coat and weigh 33-40 pounds.
Labradoodle: Labradoodles are created by crossing a poodle and a Labrador retriever. They can be Standard or Medium size and range from 30-65 pounds.
Maltese: They have long silky fur that should be brushed daily. They weigh 4-6 pounds.
Poodle: Poodles grow soft, curly fur and come in 3 sizes—Toy, Miniature, and Standard. Their weight ranges from 6-60 pounds.
Soft-Coated Wheaten Terrier: This dog has a long silky coat and weighs about 30-40 pounds.
A healthy diet is not about Instagrammed asparagus, glowing skin or a feeling of wellbeing – it’s about eating foods that help you to avoid disease. That simple message has been muddied by pseudoscience nutritionists and celebrity health gurus, clambering over each other to persuade you to buy their products.
With a healthy diet you can avoid risk factors such as being overweight, having high blood pressure and developing diabetes, which lead to serious cardiovascular diseases such as heart attacks and strokes. It’s concerning, then, with the burden of obesity and disease falling on the poor, that health is being packaged and sold through a soft-focus lens as an aspirational product beyond many people’s means.
Nothing could be further from the truth. The much-vaunted Mediterranean diet, for instance, is one of peasants. Born of a needs-must school of eating, it emphasises varied, seasonal, humble and largely plant-based ingredients: fruit and veg, fibrous carbs, legumes, nuts, a bit of meat, and healthy fats such as olive oil. Doesn’t sound too expensive, does it?
Most nutritionists and health gurus agree with doctors and scientists on the fundamentals of a healthy diet – the idea is to eat more protective foods and fewer damaging ones. Anything else is a selling point people use to stand out in the marketplace.
Here we look at the basic pillars of a healthy diet with ingredients and recipes that follow three guiding principles: they are accessible, inexpensive and simple to cook.
Fruit and veg
Fruit and veg are good for you, but even this message has been spun to make money.
They’re not good for you because of magical detoxifying properties. Whether it’s goji or acai berries or concentrated vegetable gloop, these things often come with scientific-sounding words, such as flavonoids and antioxidants, attached, usually just to sell you something.
Catherine Collins, dietitian at St George’s hospital, London, says that pseudoscientists latch onto the fact that there are chemicals in all fruit and veg which affect our health. “But they cherrypick scientific concepts and make simplistic, unproven associations with human health and specific outcomes to justify their viewpoint,” she says.
What we do know is that by eating fruit and veg you can lower the risk of disease. Because they contain artery-relaxing nitrates, familiar vegetables such as spinach, lettuce and radishes, can lower blood pressure. The potassium in green leafy veg, squash and mushrooms does the same. These vegetables might not be glamorous, but given that high blood pressure has overtaken smoking as the leading risk for disease and death you’d be foolish to push them to the side of your plate.
Fats
That saturated fats aren’t as bad as once thought has led to PR spin that has only confused matters. A prime example is coconut oil. With no good evidence that eating coconut oil regularly will keep you healthy, inaccurate marketing has used interesting theoretical health properties to make it more desirable.
Saturated fats such as butter, if enjoyed sensibly, are neutral to your health: they are not protective like olive oil but are not damaging like trans fats or excess sugars. It’s unsaturated ones from whole food sources such as oily fish, nuts, seeds and olive oil that should be your fats of choice.
Where evidence is strongest is with boring olive oil. There’s no need to fork out for the expensive stuff, the economical extra-virgin type will do fine. Watch out for processed spreads and fats branded as omega-3 fortified and mayonnaise with 5% added olive oil. If you’re eating it in a bid to be extra healthy, you’re wasting your time.
Oily fish can be a little trickier – its shelf life can make it difficult to squeeze into a busy family’s schedule Its expense, too, can be prohibitive. Unless you’re Richard Branson or a grizzly bear with a fishing rod, you’re unlikely to be able to eat as much salmon as you’d like, but there are options that aren’t so hard on the wallet.
Grilled mackerel in the summer is always a winner. Cornish sardines are increasingly popular since their rebranding (they were once the more drab-sounding pilchards). Canned fish such as traditional sardines can be store-cupboard superstars but tuna, although classified as oily when fresh, loses much of its omega-3 when canned.
Avocados, nuts and seeds are another good supplementary source to top up your intake. Know where to buy them and they don’t have to be expensive. Ignore them altogether and they can cost you a healthy heart.
Carbs
It seems we have a limited capacity for understanding what bad foods are. As fats have benefited from a PR makeover, carbs have been put in the stocks. Restricting your carb intake is an effective way to lose weight, but to vilify a whole food group by banishing them forever would be to make the same mistakes all over again.
Good carbohydrate sources are unrefined, fibre-rich ones such as oats, wholegrains, quinoa, sweet potatoes, squash and legumes, all of which release their sugars slowly. Bad carbs are refined ones such as the white flour used to make white bread and pasta: the refining process takes out all the fibre and leaves you with easily digestible sugar.
There’s only one problem: refined carbohydrates are delicious. We’ve evolved to crave energy-dense foods so don’t deny yourself – just manage how much refined carbohydrate you eat. You can do this by eating a cauliflower crust pizza but, if you’re anything like us, you’ll end up wanting to throw that pizza in the bin after a few bites. If you want pizza eat a proper one, just don’t make it a habit.
Brown pasta, too, is about as fun as eating cardboard. Italians don’t eat it so why should you? You can have regular pasta, but limit it to about a quarter of your plate and balance it with other fibre-rich elements such as vegetables that will slow down your digestion and limit the spikes in sugar your liver turns into harmful fats.
An obvious way to avoid sugar spikes is to avoid sugar. But there’s no point splashing out on apparently healthy alternatives such as agave nectar, honey or date molasses. These alternatives, says Nita Forouhi, a diabetes clinician-scientist at the MRC Epidemiology Unit, University of Cambridge, are marketed as “having antioxidants or a lower GI [glycemic index] value, but there’s no convincing evidence to support swapping table sugar for any of them for health benefits – they are all ‘free sugars’ which as a rule we should limit”.
Protein
The apparent health benefits of protein have been thrust into our faces one Instagrammed workout at a time. This link between protein and health, though, is the embodiment of the misunderstanding of what health is: it’s not about six packs and bubble butts, it’s about the avoidance of disease and premature death, admittedly unsexy but undeniably important factors that eating more protein will not improve.
That’s not to say proteins aren’t important. They’re the building blocks of what makes you (muscles and bones), what holds you together (skin and cartilage) and what keeps everything ticking along (enzymes and hormones).
Eating meat is an easy way to get your protein – the animal does all the hard work and concentrates the nutrients for you – but it can be expensive, you can’t eat it if you’re a vegetarian, and if you eat too much of it you won’t have space left for more protective foods.
Although meat is not essential for health, for many it’s a key part of any meal. The good news is that we can get those satisfying umami flavours we crave as often as we want without breaking the bank or eating too much. As with many peasant dishes of the Mediterranean diet, cooking techniques such as stewing and braising stretch the flavour to other ingredients, such as fibre-rich vegetables. You can also use cheaper cuts such as shin and skirt steak: just go for quality over quantity.
Vegetarians, fear not: fibre-rich beans and pulses (legumes), while being a great source of protein, are associated with long-term health protection and so should also be a go-to food for meat eaters. Nuts and seeds, too, can bulk out a salad and their protective fats will leave you fuller for longer.
Other than low-quality processed meats there are no bad proteins. Try to trade up excess meat for more protective foods whenever you can – a healthy diet will protect you from disease more than a six-pack ever will.
Green mango salad (som tum mamuang)
Green mango salad (som tum mamuang). Photograph: Tara Fisher for the Observer
South-east Asian cooking transforms a salad from a side dish to the main event, giving a perfect opportunity to eat more fruit, veg, healthy proteins and nuts. These textures together with the taste explosion of sweet, savoury, spicy and sour dressing mean you won’t miss unrefined, fibreless carbs.
Mangoes are also rich in a protective, soluble fibre that will slow down the digestion of the entire meal. Add chicken left over from a roast for extra thrift.
Serves 2 as a main course fine green beans a handful peanuts a handful, toasted and crushed red onion ½ (or whole shallot), finely sliced cucumber a handful, finely sliced at an angle red chilli 1, with seeds tomatoes a handful, quartered mint and coriander 1 tbsp of each, chopped, stalks included, leftover roast chicken torn strips (other good options are prawns, griddled and sliced, or chicken breast) mango 1 large, under-ripe
For the dressing (the important bit) chilli 1-2 garlic 1 large clove palm sugar 1 tbsp (you can substitute honey or normal sugar) fish sauce 2 tbsp lime 1, juiced extra-virgin olive oil
This salad is easiest to make with a Japanese mandoline, but there are other options if you don’t have one: you could use a combination of a knife and a potato peeler or a cheap julienne peeler.
The beans will need blanching in salted boiling water for around 3-4 minutes until they are tender but retain a little bite. Drain and “refresh” by cooling with cold water – it’s nice if they are warm but not hot in the salad.
Toast the unsalted peanuts in a dry non-stick pan until they have a golden colour. Roughly crush – best done by bashing in a mortar and pestle.
Slice the onion, cucumber and chilli and quarter the tomatoes. Finely chop the herbs and include the fragrant coriander stalks as well as the leaves. Add the chicken (or prawns) and incorporate all together in a large bowl with the sliced mango, green beans and crushed, toasted peanuts.
The dressing is best made in a mortar and pestle, although you can pulse the ingredients in a blender.
Add together the dry ingredients and bash into a smooth paste – the sugar helps with abrasion. Now add the wet ingredients and stir them together.
Dress the salad and allow it to sit for 2-3 minutes for the flavours to marinate. Then pile high on a large serving plate and enjoy.
Mortar and pestle pesto pasta, courgette tagliatelle and baby spinach
Mortar And Pestle Pesto Pasta, courgette tagliatelli. Photograph: Tara Fisher for the Observer
Ready in 20 minutes. The simple, fresh flavours and textures complement each other perfectly: hot peppery notes (raw garlic and olive oil), mellow comforting richness (pasta, parmesan and pine nuts) and clean perfumed bite (basil, spinach and courgette). A mixture of pasta and courgette “tagliatelle” keeps the comfort and satisfaction of pasta but packs in more veg alongside other protective ingredients such as garlic, nuts, extra-virgin olive oil and dark green leafy spinach. With the fat from the cheese giving additional satiety, you won’t miss that extra pasta, especially if you pair with a simple sliced tomato and onion salad dressed with a little olive oil and balsamic vinegar.
Serves 2 courgettes 2, medium linguine pasta 100g (50g per person) baby spinach 2 large handfuls garlic 1 large clove basil leaves a big bunch pine nuts 2 small handfuls (dry toasted) fresh parmesan a handful, grated extra-virgin olive oil salt and black pepper
Make the courgette tagliatelle by taking long length slices of the courgette with a mandoline (largest tooth setting) or a potato peeler until you get to the soft water centre. Keep the soft cores, you can finely chop and add them as they are with the tagliatelle.
Boil the pasta in plenty of salted water. Wash the spinach, drain and place in a large bowl.
Make the pesto while the pasta is cooking. We like to make the pesto in a mortar and pestle for that chunky, fresh-made texture but you can add all the ingredients straight into a blender or food processor.
Bash a whole peeled garlic clove with a pinch of salt for extra abrasion until a paste. Add the basil leaves and do the same. Add the toasted pine nuts and parmesan. Drizzle in olive oil to loosen the mixture. Bash and stir away until you have a chunky mixture that’s loose enough to stir into your pasta.
The pasta should nearly be ready. Throw in the courgette tagliatelle for the final 2 minutes or just enough to soften but retain a slight bite.
Drain and immediately add the hot pasta into the bowl with the spinach and stir. The heat of the pasta will wilt and soften the spinach. Now add your pesto and mix thoroughly. Season with black pepper and a final fresh sprinkle of parmesan. You don’t need to add any additional salt as the cheese and other elements have enough.
Stuffed coquina squash and sweet roasted beets
Stuffed coquina squash and sweet roasted beets. Photograph: Tara Fisher for the Observer
The soft coquina squash with chewy, candied edges, the concentrated sweetness of roasted beetroot, and the warming, meaty filling make this dish one of our favourites. The squash and legumes, being high in fibre, are the good type of carbs that prevent spikes in blood sugar and subsequent fat storage, the slow-cooked meat stretches that umami satisfaction through the filling, allowing you to use less meat and pack in more protective veg. The roasted beets, too, are rich in artery-relaxing nitrates that can lower blood pressure (it’s why athletes drink beetroot juice to improve their endurance).
Serves 4 (makes enough sauce for 8-10, freeze leftovers for another meal) minced beef 500g extra-virgin olive oil onion 1 large celery 2 sticks carrot 2 large, skin on courgette, sweet pepper, aubergine 1 each garlic 4 large cloves large chillies 2 (leave seeds in if you like it hot or add more) salt and pepper tomato puree 2 large tbsp tomatoes 2 x 400g tins bay leaves 3 ground cinnamon 1 tsp green lentils 100g chickpeas 1 tin beetroot 12 small, uncooked large coquina squash 1
Use a large heavy cast-iron casserole dish that can be placed in the oven. Preheat the oven to 160C/gas mark 3.
Over a moderate high heat brown the minced beef in a little splash of olive oil until the edges are crispy and golden brown. While the beef is cooking chop the onions, celery, carrot, and other vegetables along with the garlic and chilli – use a food processor if you have one.
Remove the browned beef with a slotted spoon and add the chopped vegetables to the pan to soften in the same oil. When the veg looks softened and the onions are translucent add back the beef.
Season the mix now with salt and black pepper. Add the tomato puree and cook out together for another 2 minutes
Now add the tinned tomatoes and equal amount of water (by rinsing out and filling the tomato tin). Add the bay leaves and bring back to simmer.
Transfer to the oven to slowly cook for 3 hours to develop a beautiful melting texture and deep umami flavours. Portion out around half to cool and freeze for an easy meal another day.
Add a teaspoon of cinnamon and the green lentils (rinsed, boiled for 10 minutes, drained) and chickpeas (rinsed and crushed to a pulse) for the final 30 minutes of cooking.
Now to the squash and beetroot. Individually wrap in foil and bake the beetroots, leaving the skin on, for an hour at 180C/gas mark 4 or until a knife passes through the flesh easily. (It’s fine to turn up the heat on the base sauce for the last hour if you’re cooking both at the same time.) Cut and deseed the squash, leaving skin on, season and drizzle with olive oil and roast for an hour or until the flesh is deep orange and the edges are darkened. The tip of a knife should pass easily through the thickest bit of the squash. When cooked and cooled, the skin of the beet will slide off easily; dress with a splash of balsamic if you like. Scoop some flesh out of the squash, mix with the filling, pile high and enjoy.
Mediterranean fisherman’s stew: leek, courgette and cod with chilli and lemon seasoning
Mediterranean Fisherman’s stew: leek, courgette and cod with chilli and lemon seasoning. Photograph: Tara Fisher for the Observer
Humble and sweet courgette and leek, a rich tomato sofrito sauce and subtle white fish highlighted with lemon, parsley and chilli. The plentiful courgettes and leeks become the base of a genuinely healthy meal. The combination of olive oil, tomato, garlic and onion forms the base of the sofrito sauce, a mainstay of Mediterranean cooking. When combined, these ingredients might have a synergistic, protective effect but, most importantly, they give that delicious flavour that transports you to the Italian Riviera. We’ve gone for cod because it’s the nation’s favourite, but experiment with your choice of oily fish.
Serves 4 courgettes 4 large leeks 2 large garlic 4 chunky cloves extra-virgin olive oil salt and black pepper tomato passata 500g dried chilli flakes cod loin skinned and filleted, three nice chunks each parsley a handful, including stalks lemon wedges
Cut the washed courgettes and leeks into rounds (approx 2cm thick). Slice the garlic.
Heat a good glug of olive oil in a non-stick pan and add the sliced veg. Season with salt and pepper.
Turn the temperature down so that the veg sweat without colouring. Make a cartouche with some greaseproof paper (YouTube it for a quick tutorial) and pop on top. This slow-cooking process accentuates the natural sweetness of the veg. Check on them in 10 minutes and add a splash of water if drying out.
After about 20 minutes when the veg have softened add the passata. Sprinkle a pinch of dry chilli. Re-cover and cook until meltingly soft (around 40 minutes).
Cut the chunky fish fillet across the length with a sharp knife into scallops. Taste the sauce – grind some extra pepper and if required add more salt. Pop the fish scallops around the dish on top of the sofrito sauce. Re-cover and cook for 10 minutes.
Finely chop the parsley and sprinkle over the dish with extra chilli and a squeeze of lemon to finish.
Enjoy scarpetta style with a sensible mop of crusty wholemeal bread, eat light with green side salad or throw in some borlotti beans and cook as a stew.
Aromatic braised chicken, hidden veg and quinoa hot pot
Aromatic braised chicken, hidden veg and quinoa hot pot. Photograph: Tara Fisher for the Observer
One pot and you’re good to go. The braised, browned and caramelised meat intensifies and spreads the meaty flavour allowing you to sneak in plenty of protective fibre and veg. Quinoa? Because it’s not that fancy any more and with its low glycaemic index it’s better than eating refined carbs.
Serves 4–6 (good to make a big batch, you’ll want the extra)
chicken 8 skinless, boneless thighs extra-virgin olive oil onions 2 large leek 1 large (or add a third onion) garlic 6 cloves ginger a thumb-sized piece chillies 4 red or green (seeds out for a milder version) tomato puree 2 large tbsp honey 1 tbsp soy sauce 6 tbsp star anise 1 chestnut mushrooms 2 handfuls Chinese leaf cabbage ½ a head quinoa 50g per person spring onions 4, chopped
Use a heavy cast-iron dish in an oven (preheated to 160C/ gas mark 3) for the best, slow-cooked meltiness. You can also just simmer on the hob.
Roughly chop the chicken into large strips and brown over a high heat with a splash of olive oil. Don’t overcrowd the pan and if necessary brown the chicken in two batches. Stir occasionally but you are aiming to get some crispy caramelised bits on the edges and bottom of the pan to add umami intensity to the dish.
Peel, half and roughly chop the onions into large strips. Do the same with the leek and wash thoroughly to get rid of any muddy bits in the layers. Add to the pan with the browned chicken and start to soften.
Peel and roughly chop the garlic and ginger together with the chillies. Leave the seeds in if you like spice or remove if you prefer perfumed warmth. Add to the pan with the tomato puree. Cook together for another couple of minutes.
Now add the honey, soy sauce, star anise and enough cold water to barely cover (around 2 glasses usually). Bring to a simmer and scrape around the bottom of the pan to dislodge any crispy bits. Place in your preheated oven to slow cook and braise for the next 2 hours.
After 2 hours remove, stir and check the hot pot. You should have a reduced, intensely umami-flavoured sauce. You want this to be strong because it will become diluted by the water in the additional veg. Now add your washed and sliced mushrooms and Chinese cabbage. Return to the oven for another hour.
Towards the end, boil the quinoa separately until the seeds open. Drain and then add straight into the hot pot and stir together. Fish out the star anise and taste for final seasoning – add a final splash of soy sauce if you like. Garnish with finely chopped spring onion for a fresh finish.
Ali Khavandi is a consultant cardiologist. alikhavandi.com; daramohammadi.com
We know that pain thresholds vary from person to person – one person’s nudging inconvenience is another’s unbearable distraction – but the colour of your skin, in the US at least, can be a factor in deciding whether or not you receive pain medication.
New research from the US shows that black patients who arrive at emergency rooms complaining of back or abdominal pain are significantly less likely to be given opioid painkillers, such as codeine, than their white counterparts, even when pain levels and insurance coverage are the same. Pain is the most common reason Americans visit the ER, and the researchers in Boston looked at five years’ worth of records across the country for patients who had complained of general pain with an unclear cause.
This effect has been found across healthcare settings – black children with appendicitis are significantly less likely get any painkillers for moderate pain or opioid-type drugs for severe pain. Doctors from the University of Pennsylvania reviewed 20 years’ worth of studies in 2012 and found the same, calling this “the treatment gap”. The review’s lead author, Dr Salimah Meghani, says that to stop the disparity, doctors need to be educated about its cause, and this is most likely unconscious bias. The problem, she says, “may be addressed by helping health providers identify their blind spots”.
In April, another study found that half the white medical students surveyed believed at least one false statement about black people having “thicker skin”, “faster-coagulating blood” or “less sensitive nerve endings”. Medics who believed one of these facts also rated black pain lower when viewing case studies. Authors of this research believed it was down to these entrenched ideas about “biological differences” between races that may be informing doctors’ decisions on when to prescribe.
Dr Austin Leach, a pain medicine consultant who serves on the council of the British Pain Society, says there is no biological reason for different prescriptions. “Physiological studies suggest that pain perception is the same across ethnicities,” he says, adding that there is no evidence that this happens in the UK. Some races are predisposed to certain illnesses – the rate of strokes for African Americans is double that of the country’s white population – but the treatment of pain should be the same.
In this latest study, researchers claim that a particular type of unconscious bias – assuming that black patients are abusing meds – is to blame, despite the fact that opioid abuse is more prevalent in white communities.
The study’s lead author, Dr Astha Singhal, a professor at Boston University, says the key point is that they found a discrepancy only in vague pain-related conditions, commonly associated with drug-seeking behaviour, rather than conditions with obvious causes, such as bone fractures. “While the disparity we found is surely not a good thing, it might have indirect advantage to the black patients of minimising their exposure to opioids,” she says.
The theory that black communities are being “shielded” from opioid addiction by not being prescribed the drugs in the first place is a controversial one. Other studies have shown that diagnosis of issues from back pain to cancer is slower for black patients. The line is unclear to many doctors, including Singhal. “It raises the question – is it still an advantage if the cost is bearing untreated or undertreated pain?”
We know that pain thresholds vary from person to person – one person’s nudging inconvenience is another’s unbearable distraction – but the colour of your skin, in the US at least, can be a factor in deciding whether or not you receive pain medication.
New research from the US shows that black patients who arrive at emergency rooms complaining of back or abdominal pain are significantly less likely to be given opioid painkillers, such as codeine, than their white counterparts, even when pain levels and insurance coverage are the same. Pain is the most common reason Americans visit the ER, and the researchers in Boston looked at five years’ worth of records across the country for patients who had complained of general pain with an unclear cause.
This effect has been found across healthcare settings – black children with appendicitis are significantly less likely get any painkillers for moderate pain or opioid-type drugs for severe pain. Doctors from the University of Pennsylvania reviewed 20 years’ worth of studies in 2012 and found the same, calling this “the treatment gap”. The review’s lead author, Dr Salimah Meghani, says that to stop the disparity, doctors need to be educated about its cause, and this is most likely unconscious bias. The problem, she says, “may be addressed by helping health providers identify their blind spots”.
In April, another study found that half the white medical students surveyed believed at least one false statement about black people having “thicker skin”, “faster-coagulating blood” or “less sensitive nerve endings”. Medics who believed one of these facts also rated black pain lower when viewing case studies. Authors of this research believed it was down to these entrenched ideas about “biological differences” between races that may be informing doctors’ decisions on when to prescribe.
Dr Austin Leach, a pain medicine consultant who serves on the council of the British Pain Society, says there is no biological reason for different prescriptions. “Physiological studies suggest that pain perception is the same across ethnicities,” he says, adding that there is no evidence that this happens in the UK. Some races are predisposed to certain illnesses – the rate of strokes for African Americans is double that of the country’s white population – but the treatment of pain should be the same.
In this latest study, researchers claim that a particular type of unconscious bias – assuming that black patients are abusing meds – is to blame, despite the fact that opioid abuse is more prevalent in white communities.
The study’s lead author, Dr Astha Singhal, a professor at Boston University, says the key point is that they found a discrepancy only in vague pain-related conditions, commonly associated with drug-seeking behaviour, rather than conditions with obvious causes, such as bone fractures. “While the disparity we found is surely not a good thing, it might have indirect advantage to the black patients of minimising their exposure to opioids,” she says.
The theory that black communities are being “shielded” from opioid addiction by not being prescribed the drugs in the first place is a controversial one. Other studies have shown that diagnosis of issues from back pain to cancer is slower for black patients. The line is unclear to many doctors, including Singhal. “It raises the question – is it still an advantage if the cost is bearing untreated or undertreated pain?”
Rhiannon Beauregard, 33, is visiting New York for a few days. But the sex and marriage therapist is not here for a vacation, to see the sights or visit friends in the city where she once went to college. She is here to freeze her eggs.
Beauregard lives in Austin, Texas where she runs her own practice, but has opted to come to New York to use the services offered by Extend Fertility. The clinic is the first of its kind – focusing only on egg freezing and not offering any other fertility services and treatments such as in vitro fertilization. By doing that, the clinic has been able to cut costs of its services to $ 5,000 while offering personalized service to each one of its clients.
One of the barriers to egg freezing becoming mainstream is the cost. The procedure was still deemed to be experimental until just a few years ago and was mostly an accepted way to extend fertility for older women, cancer patients or those diagnosed with fertility disorders.
Since it is considered to be an elective procedure, egg freezing is typically not covered by health insurance. The average cost of the procedure is about $ 10,000 with an additional $ 2,000 to $ 5,000 for the necessary medication and another couple of thousand dollars for storage. If the frozen eggs are actually to be used for IVF later on, that would cost an additional $ 12,000.
Related: Silicon Valley tries egg-freezing perks. How about just hiring more women?
Altogether, that adds up to more than $ 25,000 – not exactly chump change. Aware of the costs, two years ago, Facebook and Apple announced that they would cover up to $ 20,000 in costs for any female employee that wanted to freeze their eggs.
While Extend Fertility is unable to cut the costs of medicine (the clients are required to pay for it on their own) or the future costs of IVF, its founders hope that by cutting the cost of the initial procedure in half they will make the procedure accessible for more women.
“It’s expensive either way. We know that,” says Joshua Klein, co-founder and chief medical officer of Extend Fertility. He points out that $ 5,000 is still half as expensive as $ 10,000 and adds that the Extend is “working with financing partners” so that those interested could opt to pay $ 200 or $ 300 a month for a while instead of a one-time payment. “We are trying to be innovative and thoughtful about that,” he says.
Joshua Klein, co-founder and chief medical officer of Extend Fertility. Photograph: Extend Fertility
Should women view egg freezing as some kind of down payment on their future? Klein would prefer that they think of it an investment for both the future and the present. Many women worry about meeting the right guy because “they hear that biological clock ticking loudly”, he says. That ticking is a stress factor in their lives. By freezing their eggs and knowing that they have preserved their fertility, they can silence that ticking and receive the immediate benefit of “peace of mind”.
On 8 August, two days before the clinic officially opened, Beauregard was on the fourth day of her pill regiment.
Beauregard has to inject herself daily with some very expensive drugs. Prior to starting the regimen, she had to come off her birth control pills, which resulted in a couple of days of feeling “weepy”. She is bloated and on the mornings that she goes in for checkups at Extend, she ends up watching an ultrasound of her uterus – staring at her eggs instead of a baby.
However, she says, the staff at Extend have been extremely supportive. Every client is assigned their own fertility specialist and is available to accompany them to all of their meetings. The Extend office, just a block or two south of Central Park, also does not resemble a typical fertility clinic. The walls are light blue. The rooms look more like small conference rooms with round tables and a handful of chairs. There are no big tables with stirrups, no posters with uteri or models of babies nestled in a uterus.
A meeting room at Extend Fertility. Photograph: Courtesy of Extend Fertility
“Even the way this room is set up, we are trying to build into our experience the idea that this is not an illness thing, that we are not trying to cure a disease,” says Klein, sitting in one of the meeting rooms. “Here we don’t want to make people feel that they have a problem. They are just a woman living in the 21st century, coming to the doctor about preserving options for the future. It shouldn’t feel like a problem.”
For some, it might be a combination of the two. A while back Beauregard was diagnosed with polycystic ovary syndrome (PCOS) – an disorder that affects hormone production and can affect woman’s fertility in women of reproductive age. She was 32 at that time and single.
“I didn’t really have any plans to go out and find me a partner to have a child with,” she says. She began thinking about what would happen over the next 10 years. PCOS can lead to complications during pregnancy, increased chances of miscarriage, infertility and high levels of estrogen, which can cause cancer of the uterine lining.Beauregard realized that if she wants to have children in the future, she might have to undergo treatments such as IVF at that time. “I started to think about what the difference would be between now and later and the biggest difference between now and later is that after 35 my eggs start to … age, I guess, for the lack of better term.”
Klein agrees.
“We know without a shadow of the doubt that when you freeze eggs when you are younger, you are going to be putting away something that’s much, much, much more likely to be helpful for you than if you wait to do it as a reactionary measure when you are older,” he says.
According to him, the profile of women interested in egg freezing is slowly shifting from “panic-mode 40-year old” to “a proactive smart-thing-to-do-because-I am-a-young-aspiring-woman 30-year-old”. Fertility company EggBanxx, which targets younger career-focused women with slogans like “Lean in, but freeze first!”, estimates that by 2018, 76,000 women will have frozen their eggs.
Beauregard says she would have eventually considered freezing her eggs even without the PCOS diagnosis.
“Since I am single now I don’t want to put that kind of pressure on a new relationship,” she says. “If I hadn’t frozen my eggs, it would be one of the first things we talk about: ‘Hey, how do you feel about kids? Because we have to start making decisions in the next four to five years.’ I feel like a lot of pressure has been lifted off of me.”
Related: I had my eggs frozen. I wish someone had told me how difficult it was | Eleanor Morgan
The cost was the only thing that made Beauregard think twice. While researching her options, she often felt that this was a moneymaking scheme for doctors and clinics.
The $ 5,000 price tag at Extend seemed affordable in comparison. Despite that, the procedure and the drugs cost all her savings.
“Most women in their mid-30s do not have a large savings to fall back on and because we do not have any other support like a partner. The big risk for me was less about the procedure and more about ‘OK, I don’t have any savings left’,” she says. Then laughing, she continues: “There is a risk of walking out into the world with some eggs in the bank but no money.”
‘I drained my savings to do this.’ Photograph: Royalty Free/Getty Images
Beauregard admits she underestimated the cost of the drugs, which she assumed would be a few hundred dollars. It turned out to be closer to a couple of thousand dollars, instead. Additionally, she has to pay for storing of her eggs. At Extend, storage for one year costs $ 450. For five years, it’s $ 2,000 and $ 3,500 for 10.
To Talia Zapolanski, freezing her eggs is akin to an insurance policy.
Zapolanski, who worked in finance for 11 years and now works for a real estate investment firm, had been thinking of doing this for about a year and had gone in for a consultation at another hospital before being referred to Extend by a friend of one of the clinic’s doctors.
“I definitely know that I want children. That’s something I feel strongly about. I haven’t found the right person yet. I am not dating anyone now and I don’t know when I will find the right person,” says the 33-year-old New Yorker. “You start hearing a lot more about egg freezing these days and I thought I would look into it. It seems like a good idea. Hopefully I will be able to, when the time comes, get pregnant and have kids the natural way but you never know.”
Egg freezing should not be one of those things that we don’t talk about, according to both Beauregard and Zapolanski.
“When I was telling people that I was freezing my eggs, a lot of people didn’t know what to say. It makes people uncomfortable – eventually they will get curious about it, but a lot of people are a little dumbfounded that I am so open about it,” said Beauregard. “I want to make sure that people feel comfortable talking about these options.”
Zapolanski says she has encouraged “no less than five friends to go do the same”.
Recently, when she was visiting Los Angeles, she shared with a friend from college that she recently froze her eggs.
“She kind of paused and looked at me in shock that I had shared that and she said: ‘I am glad you said that, I am about to go through the process and I am so nervous about and I have nobody to talk to’,” she said. “It’s a very taboo subject.”
