Spice ruins lives and costs taxpayers a fortune. It doesn’t have to be this way | David Nutt

Last year I wrote to the health and home secretaries with suggestions on how antidotes for spice could be developed. Their replies revealed a complete lack of appreciation of the magnitude of the synthetic cannabinoid problem and lack of interest in the idea of an antidote.

Spice-induced “zombie” outbreaks in New York and in Manchester have hit the headlines in the past year. Use of these new damaging and powerful forms of synthetic cannabinoids is rife in our prisons and by homeless people, with estimates of up to 50 deaths last year. They can produce extremely strong psychotic states often with very violent behaviour. Sometimes a frozen unconscious state results. Either of these outcomes are health emergencies that consume vast amounts of police, prison officer and health professionals time, and so waste a huge amount of public money.

Spice is a generic term for the hundreds of synthetic versions of cannabis that are used instead of herbal cannabis. The first synthetic cannabinoids were made in the 1970s as potential medicines, but initial human testing found them to be so unpleasant and potent in their actions that none were marketed. Since then they have been sold as legal alternatives to cannabis, and called spice.

The problems with spice are multiple. The first is lack of any quality control: the amount of synthetic cannabinoid in each unit is not known. Second, these substances have little, if any, safety data. Third, many of them are much more potent than traditional cannabis, up to a hundred times more potent in the test tube and have never been tested in animals – let alone humans – so there is no data on real-world safety.

Most are not detectable by current testing processes which is why prisoners prefer them. This high potency means they are very profitable drugs. A spice solution costing a few pounds can be soaked into a single A4 sheet of paper, which, when dried, can be cut up into about 100 units, each of which will give a decent “hit” at £5 each.

The government’s response has been to ban these drugs in a series of amendments to the misuse of drugs act. So now all synthetic cannabinoids are illegal. But, as with other drugs, banning spice doesn’t stop its use. Heroin has been illegal for 50 years yet deaths reached an all-time peak in England and Wales last year.

So what should the government do about spice? First, it must recognise that this problem is not going to be dealt with by simplistic approaches such as more bans or more severe sentencing of users. We should understand that the authorities’ focus on herbal cannabis use is the main reason for spice emerging in the UK. So we should stop testing for cannabis in prisoners and others to encourage a move by users back to herbal cannabis.

The Manchester police commissioner has now publicly wondered if the problem has been exacerbated by the Psychoactive Substances Act which has taken synthetic cannabinoids out of “head shops” and into the underground marketplace. Perhaps we should develop a harm reduction strategy by allowing the sale of safer versions of synthetic cannabinoids, or even cannabis itself, back in head shops?

But to deal with the current epidemic of use we need urgently to develop cannabis antagonists as antidotes to spice for use by health professionals.

The success of naloxone as an antidote for heroin overdose is now well recognised to save lives, and is given to opioid users and their friends for this reason. Several antagonists at the cannabis receptor are known and one, rimonabant, has extensive safety data in humans. It was licensed in Europe a decade ago as a treatment to stop weight gain after people stopped smoking. However post-marketing surveillance found that in some people rimonabant was associated with an increase in depressive reactions, sometimes with suicidal thinking (though not suicides). This led to it being taken off the market for having too low a benefit-risk ratio for this medical indication. But for spice reversal these considerations do not apply – it would only be used once to reverse a bad reaction, and hopefully keep people from harming themselves or others.

The other approach is to develop the herbal antidote THCV. This is made in the cannabis plant alongside d9THC and many other cannabinoids. It has recently been shown to have antagonist actions against the psychosis produced by d9THC and so would almost certainly attenuate spice intoxication. Sadly, just a few months ago, the Advisory Council for the Misuse of Drugs refused to make it available for this purpose on the spurious grounds that a note in a 1974 paper said that when given intravenously in high doses it was a little like d9THC.

Surely it is time for government to push to develop such an antidote to spice if not for humane and health reasons then for economic ones?

Spice ruins lives and costs taxpayers a fortune. It doesn’t have to be this way | David Nutt

Rotavirus vaccine could save lives of almost 500,000 children a year

A vaccine capable of enduring scorching temperatures for months at a time could strike a decisive blow in the fight against rotavirus, preventing nearly half a million children around the world from dying of diarrhoea each year.

Médecins Sans Frontières (MSF) has hailed successful trials of the BRV-PV vaccine in Niger as a “game changer” in tackling rotavirus infection, which is the leading cause of severe diarrhoea globally and claims the lives of an estimated 1,300 children daily, most of them in sub-Saharan Africa.

According to results published in the New England Journal of Medicine, the vaccine has proven as effective as those currently used to treat severe gastroenteritis. Trials in Niger’s Maradi region successfully treated 4,000 children under the age of two.

Unlike existing vaccines, the BRV-PV vaccine does not require refrigeration and can remain stable for up to one year at 37C or six months at 40C. It is particularly effective against the strains of rotavirus found in sub-Saharan Africa, as well as affordable: at only $ 2.50 (£2), the vaccine could potentially be rolled out quickly in routine immunisation programmes.

“This is a game-changer,” said Dr Micaela Serafini, MSF’s medical director. “We believe that the new vaccine can bring protection against rotavirus to the children who need it most.”

Diarrhoea is the second largest cause of death in infants and children worldwide, primarily in low-income countries where access to clean water and sanitation is limited. Rotavirus is highly contagious, particularly among babies and young children, and can be spread by contaminated hands, objects such as toys and surfaces, and water and food.

Children in the world’s poorest countries account for 82% of rotavirus deaths, but vaccines make a significant difference. In Mexico, diarrhoeal deaths among children under five declined by as much as 50% after rotavirus vaccines were introduced.

The trials in Niger – the first of their kind to be approved in an African country – were conducted by MSF’s research and epidemiology branch Epicentre, in collaboration with Niger’s ministry of health, the Cincinnati children’s hospital and the makers of the vaccine, the Serum Institute of India. According to MSF, the results demonstrated no safety concerns and as a result the vaccine is hoped to fill the current supply gaps of the existing rotavirus vaccines, RotaTeq and Rotarix, both of which require refrigeration.

The World Health Organization recommends that rotavirus vaccines should be included in all national immunisation programmes, and considered a priority in south and south-east Asia and sub-Saharan Africa. The BRV-PV vaccine is awaiting pre-qualification from the WHO before it can be rolled out.

Licensing the product could take up to 18 months, said Anna-Lea Kahn, a WHO technical officer looking at innovations for facilitating vaccine supply and delivery. During that period, WHO scientists evaluate data supporting the vaccine’s quality and safety, drawing on independent specialist help when needed.

Most difficulties with vaccine delivery tend to arise during the “last mile” of the vaccine supply chain, said Kahn. “That’s where it goes wrong the most: where being able to maintain the cold chain is hardest; where constraints are most pronounced, be it due to lack of electricity or lack of resources, or inability to maintain a cold fridge. There may be geographical barriers, too, presenting a logistical challenge.

“In these scenarios, not having to depend on the cold chain … can make a valuable difference in getting vaccines to those who otherwise might not receive it.”

Serafini said: “The success of this trial shows that research and development into vaccines that are specifically adapted for use in low-income countries yields results.”

A spokesperson for Gavi, the international vaccine alliance, said BRV-PV’s results were encouraging.

“Adding more flexibility to the cold chain could allow more vaccines to reach the hardest-to-reach locations, boosting coverage and giving many more children access to lifesaving vaccines,” the spokesperson said. “However, it is anticipated that an important consideration for the countries will be the final recommendations on temperature control conditions of the vaccine, which could be different than the conditions used during the clinical trial.”

Rotavirus vaccine could save lives of almost 500,000 children a year

To stop doctors ending their lives, we need to hear from those suffering | Ranjana Srivastava

The ceilings soar impressively high, the stained glass windows are exquisite, and the satin-adorned pews stretch majestically to the dignified altar. Amid the silence punctuated by the barest of sobs, I spot doctors whom I have long lost track of. And row upon row of nurses, still tight years later. As we wait for the service to begin, we imagine we are all silently interrogating our memories about each other. Time parted us for decades before we have gathered in such dreadful circumstances.

“I wanted you to hear it from me,” a colleague had said, audibly upset on the phone. I nearly collided with the pavement when I heard.

She was wonderful, the speakers confirm that morning. Her boss delivers an impassioned eulogy about an inspired clinician and a devoted mother to the children who sometimes tagged along on weekend rounds. Her best friend recalls their last conversation that ended with the doctor saying to the nurse, “Go home, don’t work so hard.”

Her husband quietly expresses gratitude for their years together and grief for the stolen ones. Her parents sit mutely, heads hung low, suddenly and irrevocably aged. A slideshow of pictures, depicting ordinary things – licking ice cream, dropping of the kids, medical graduation, the first day of internship – suddenly turned unmistakably poignant. The audience is frozen in a horrible dream.

Outside, there is more heartbreak. “We have to say goodbye to Mummy, just us,” the children’s father says softly. We, the gathered, hold our breath lest it makes a sound. Gently, under the flowers she so loved, she is lifted into the car. It’s soon a mere dot on the road. There are refreshments but the crowd disperses awkwardly, wordlessly, not trusting ourselves to speak.

We had known each other well enough in our early days, biding time on endless night shifts, watching dawn break, praying that the nurses would save the next page for the day crew. Later, our lives diverged, each assuming the other was successful, busy and content. The final time I saw her was shortly before she died.

It had been a fractious day; I felt brittle, from a distance she looked happy. What would have happened if we had stopped to talk?

If she had asked, “How are you?” I’d almost certainly have smiled, “Fine.”

And if I had asked, “How are you?”

Could she conceivably have replied, “Suicidal”?

After the gut-wrenching news of her suicide starts the inevitable soul-searching. It was a bad boss. No, a troubled marriage. Parenting had taken its toll. Or her disagreeable colleagues. She seemed so normal in the days leading up to it. No, far from it. She was upset, anxious, disillusioned. The only thing you learn is that for someone who was surrounded by observant and intelligent people, no one really knew much at all. No one knew what went through the mind of a vibrant and capable doctor in the prime of her life, who one day decided that life wasn’t worth living anymore.

Unfortunately, this isn’t the first time I have encountered the suicide of a colleague. Some I had known personally; others were brought close through mutual patients, and still others I would never get to meet because they had ended their life before starting a new rotation. In every instance, other doctors did not realise the depth of their colleague’s mental anguish. “I wondered about her but didn’t want to intrude,” someone ruefully recalled. “I didn’t think it was possible,” reflected another.

Four junior doctors have taken their lives in the past six months in Australia.In my busy hospital, I observe a roundabout of students, residents and specialists in difficulty. But how much difficulty? When they say they’re having a bad time, is it a bad week, a dreadful year, or a tortured life? Are they upset about a rejected grant or do they deem their very existence worthless? Forced smiles and tough hides abound in the workplace, where always being “fine” is a badge of honour. This is why it can be so difficult to distinguish doctors who will indeed be fine from those who need help.

There is ample evidence for the high rates of mental illness in doctors, several times greater compared to other professions and the general population. These figures are quoted so frequently at every orientation that awareness should not be an issue. Practically every institution has an employee assistance program that offers confidential help. Some offer free psychiatric evaluation and counselling. And as with other informal medical consults, many psychiatrists will help a colleague in distress, making access to high quality help less of an issue for doctors than many others.

Armed with knowledge and surrounded by advice, why do doctors commit suicide at an alarmingly high rate?

I sometimes fear it may be because as a profession, we are reluctant to swallow the evidence. And if we can’t accept the evidence we can’t help ourselves or others. We can have an intellectual discussion about anxiety, depression or suicide and we can apply the knowledge to our patients but but identifying vulnerability in our own self is altogether different. No matter how many times we hear it, it still doesn’t seem possible that we, or someone like us, could have a mental illness. The consequences seem so vast, the repercussions so numerous that perhaps it’s better to not know the truthful response to “Are you OK?”

Doctors say that the disclosure of mental illness poses a real threat – to license and insurance, career and reputation.

Discrimination, bullying and harassment in medicine are unfortunately never far from the headlines but thanks to brave people who have risked their career, a victimised doctor has more support than ever before. Nonetheless, a career in medicine means always having to keep up with something, whether it’s the latest research, the newest drugs, the next exam or the upcoming promotion. Doctors would like to be perfect at all of these and are genuinely puzzled when life deals them disappointment. It seems ludicrous now but I was dumbfounded when I got my first mark that wasn’t a distinction. Twenty years later, I realised nothing had changed when my registrar failed his specialist exam and told me that “even the walls” were laughing.

When doctors are depressed, their sense of personal failure is compounded by the suspicion that they somehow lack the ability to pull themselves together. The “well” among them can’t understand how the same stressful hospital ward, the same demanding colleagues, the same rocky tenure track can make some of us angry, others sleepless, and yet others suicidal.

In these pressured times, few doctors would be strangers to a variation of the message, “Heard you’re sick. There’s no cover so let us know whether to cancel your patients.” There is no call more disheartening than one that professes to care about the doctor but can seem like a veiled complaint that says, “If you’re sick, we all suffer.” But while it’s quite easy to tell your colleagues that you have pneumonia or a migraine, doctors say that the disclosure of mental illness poses a real threat – to license and insurance, career and reputation. The diagnosis invokes not only sadness but also ignominy, which may be why there are so few well-publicised stories of doctors with mental illness.

For much of my career, I have watched policies, promises and campaigns about combating mental illness and suicide in doctors. Our knowledge is evolving and with it, ways of managing mental illness, but with many lives lost each year, we don’t have the luxury of time.

Since we can’t always read the suffering of our colleagues, humanity in all our professional dealings and concern and compassion for every colleague must be a priority. As well as this, a healthy dose of introspection about how we judge doctors with a mental illness and why we judge them differently, arguably more poorly, than our patients.

When it comes to mental illness, we hear a lot from the experts but not enough from the sufferers. But in fact, nothing would be more welcome than the insights of doctors who have endured mental suffering and worse, been on the brink of suicide. What healed them and who helped them? What could their colleagues have said or done differently at the time? What workplace adjustments would have meant the most? These stories are clearly among us – hearing them could illuminate the dark corners of our understanding and help link theory and practice.

As a profession, we must do more than lament our dead colleagues. Dealing effectively with mental illness and halting suicide among doctors requires curiosity, compassion and practical support. Most importantly, it requires the humility to realise that in the long span of a career, none of us is immune and that those doctors whom we help today could end up saving our life tomorrow.

• In Australia, the crisis support service Lifeline is on 13 11 14. In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255.
  

To stop doctors ending their lives, we need to hear from those suffering | Ranjana Srivastava

The Chokeables has saved babies" lives – here"s how we made it | St John Ambulance

So far, we know of 54 babies whose parents say wouldn’t be alive today if it wasn’t for The Chokeables, St John Ambulance’s first aid film teaching people how to save a choking baby in just 40 seconds.

We’re delighted our film has won charity film of the year, announced at Bafta on 15 March. So what’s the secret of its success?

Before making the film, we carried out research that revealed parents are the people most interested in first aid and what they worry about most is their baby choking. Over 40% of parents had seen it happen, 58% said it was a serious concern and yet 79% didn’t know what to do.

Our previous campaigns had been aimed at getting people to take first aid seriously but our audiences just weren’t taking the next step and learning it.

We realised we needed to teach directly – beam the advice into parents’ lives in a way they couldn’t ignore. And the tone needed to be spot on. Parents don’t want to be browbeaten and made to feel guilty. It’s hard enough being a parent. What we needed was an upbeat, engaging, shareable lesson.

Enter the geniuses at Bartle Bogle Hegarty. They realised that the lesson would come across best if taught by common household items that could potentially choke babies – the kind of things most parents would find under their sofas, like a toy or a pen lid. They crafted a script around the idea that these characters were so fed up with babies choking on them that they have decided to teach parents what to do.

We used animation to make the topic less scary, and pulled in the big guns with David Walliams and Johnny Vegas voicing the characters.

[embedded content]

This was all quite a feat considering the film needed to be 40 seconds long. Our tip with charity films is the shorter the better, to get as many people as possible watching to the end, but also to air it on TV in a cost-effective way.

I wanted a name for the campaign to help parents connect with the characters, and identify the campaign easily so it could trend on social media. Heaps of chocolate and one brainstorm later, The Chokeables was born.

When it came to sharing and promoting the film, we developed close relationships with key media to help create a buzz before we released the video. We focused in particular on those who could help us reach a high proportion of parents, such as ITV’s Good Morning Britain and Mumsnet, as well as nationals like MailOnline and the Mail on Sunday. Facebook was crucial as mums use it to share parenting tips, and we also worked with the mums who’d saved their babies so that even more parents could find out what to do.

Social media was key and we created a Thunderclap so people could mass share the video, flashmob style, as well as social media competitions to increase further engagement, such as a messy baby photo competition with first aid kit prizes. We also produced a whole suite of baby first aid advice videos to inspire further learning.

We entered The Chokeables into the inaugural Charity Film Awards, when entries opened in 2015. The awards have been set up to recognise the best videos created by or on behalf of UK charities, whether for raising awareness, changing attitudes and behaviours or fundraising.

Over 375 charities entered for the first round of public voting. More than 43,000 people voted and the resulting shortlist went to a panel of judges. They whittled it down to the finalists, including household names such as the RSPCA, Barnardo’s, the RNLI, Alzheimer’s Society and Great Ormond Street children’s hospital.

A second round of public voting for the people’s choice award has seen more than 66,000 people vote for the winner – the Soi Dog Foundation’s film about Cola the dog, who was given custom-made prosthetics after his front legs were amputated.

To win the overall award for film of the year for The Chokeables is just incredible. We’d put everything into this and hoped it would make an impact, but the success has knocked us sideways. Not only have we taught millions of people how to help a choking baby but it’s helped people feel that St John Ambulance is relevant to their lives.

The video continues to receive millions of views whenever it’s re-posted on social media. I love these stats but nothing beats getting a message from a mum who has saved their baby thanks to our video. There’s no greater reward than knowing we’ve reassured parents and helped all those babies.

• Emma Sheppard is head of communications, St John Ambulance. The Chokeables won film of the year at the 2016 Charity Film Awards.

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The Chokeables has saved babies" lives – here"s how we made it | St John Ambulance

Close cancer loophole now to save children’s lives | Letters

Children and young people are being denied the latest cancer treatments by outdated European regulations. Pharmaceutical companies are able to use a loophole in EU legislation to avoid trialling cancer drugs in children – despite evidence that these treatments could work. An analysis of European Medicines Agency data by the Institute of Cancer Research shows that since 2012, the loophole has been enacted to prevent 33 new cancer drugs from being evaluated in children. There is evidence that at least some of these treatments could be effective against children’s cancers.

Children’s cancers are rare, and there is little financial incentive for companies to develop drugs for them. The current EU paediatric regulation could do much more to ensure that children benefit from the dramatic advances in treatment we are seeing for adult cancers. The regulation is badly out of date. It allows pharmaceutical companies to opt out of running paediatric trials simply because the adult cancer a drug targets does not occur in children. But these days, scientists understand that it is a cancer’s genetic causes – rather than where it happens to grow in the body – which are the most important factor in determining which treatments work.

Children are missing out on a range of treatments that could effectively target the genetic changes within their cancers. Children and young people deserve the same access to new drugs as adults. The European commission is carrying out a consultation on the paediatric regulation and we believe this is our chance to change the rules to ensure potentially effective cancer drugs have to be trialled in children. If this loophole is not closed now, children could miss out on new cancer treatments for years to come.
Professor Paul Workman
Chief executive, Institute of Cancer Research
Cally Palmer
Chief executive, Royal Marsden
Siobhan Dunn
Chief executive, Teenage Cancer Trust
Cliff O’Gorman
Chief executive, Children with Cancer UK
Professor Bobbie Farsides
Chair, Nuffield council on bioethics working group on Children in clinical research: ethical issues
Amanda Walker and Ray Mifsud
Founders, Abbie’s Army
David and Sara Wakeling
Founders, Alice’s Arc
Lynn and Lynn Lucas
Founders, Chris Lucas Trust
Karen and Kevin Capel
Founders, Christopher’s Smile
Diego Megia
Founder and president, CRIS Contra el Cancer
Lola Manterola
Founder and president, CRIS Cancer Foundation
Martin and Sian Waite
Founders, Elin Rose Appeal
Mark Proudlove
Founder, Faye’s Wish
Dr Jennifer Kelly
General practitioner and founder, Grace Kelly Ladybird Trust
Samantha Wearne
Founder, Jack Mylam Foundation
Andrew and Jo Williams
Founders, Lucas’ Legacy
Richard and Nikki Bowdidge
Founders, Tom Bowdidge Foundation
Clinton and Adele Prince
Founders, Tom Prince Cancer Trust
 

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Close cancer loophole now to save children’s lives | Letters

Steve Hewlett’s legacy could be to save lives by raising cancer awareness | Letters

Everyone who heard Steve Hewlett’s moving account of his oesophageal cancer will be sad to know that, for him, there was no cure (Report, 21 February). But I write as the wife of a survivor of this disease. My husband, now 81, was diagnosed in November 2011.

After a course of chemo, he was operated on to remove the tumour just five years ago, one of thousands who are full of thanks to the oncologists and surgeons who saved their lives. The specialist nurse at the hospital where my husband was treated told us that this cancer is becoming more common, particularly for men, and the UK incidence is probably the highest in Europe.

I do want to point out that this month is oesophageal cancer awareness month, when pharmacists and GPs aim to make people realise that it is not normal to have to continually take over-the-counter remedies for stomach acid. In that case, people should see their GP so that further investigations can be put in train. As for all cancers, early diagnosis, before any cancer has spread, gives the best chance of a cure.
Susan Chesters
Winchester

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Steve Hewlett’s legacy could be to save lives by raising cancer awareness | Letters

Why no one lives forever

There’s lots of talk about anti-aging research today, but with all the promises of longevity and even immortality,

I doubt if anyone considered the consequences of human beings if we lived forever. The more you think about it, the scarier it becomes.

Think of the people who currently hold power in medicine, pharmaceuticals, media and government.
Imagine if they never died. If you really think about it, one of the best things about some people is the fact that they will be pushing up daisies.

Imagine the shape of things if the old-school science “God’s” lived forever?

Imagine clinging to beliefs that are full of holes.

Imagine society as we know it today never moving forward unless the cronies currently in power assume the on-the-back, with legs pointing upward, position?

This, in my opinion, is why a civilization that could give its population the ability to live forever would be doomed to eternal gangrene through stagnation.

For a species to be successful there has to be mortality.

Consider this: Imagine if there were an anti-aging vaccine that cost $ 100.00 and you could go to the doctor’s office, get the shot and never age another day, even if you live forever.

Without a doubt, a huge segment of the population would jump on this without bothering to consider the ramifications.

There would be a severe population crisis in the world because new people would continue to be born all the time, but no one would be dying of old age.

In a very short period of time it would become apparent, to all of the adults who attained eternal youthfulness, that the fixed resources on the planet could only support a fixed number of people, necessitating  the establishing of a birth control program that would make China’s look provincial.

You can see where this is going.

Limiting new births would stop bringing new blood and new ideas into our civilization.
All the “immortals” would hang around forever consuming all the resources and passing new laws to restrict births even more.

Meanwhile, all their outdated ideas, beliefs and power monopolies would never go away either.
Talk about “The Curse of the Mummy”! Why so, you ask?

Because it is in the rebirth of new ideas and philosophies that give us any hope of improving things in the future, that’s why. If we keep doing things as they’ve always been done, we’re not gonna get different results, our lifestyles and quality of life will not improve, and our chances of survival as a species would not be better.

Yes, people love the romantic idea of living forever, but where would the consideration be to consider the consequences if, indeed, immortality was cheap and readily available for everyone?

The good news is that anti-aging technology is impossible to master and time waits for no one.
So, our best course of action is to pass on what we have learned and then get out of the way so those learning’s can be improved upon and new ideas can emerge, that hopefully, will translate into doing a better job of protecting the resources of our planet than we did.

To die is not only an important natural cycle, it’s also the most important thing that will happen to many people in positions of power today.
Has anybody noticed, regardless of age, how incredibly lame many of our current politicians are? Would you really want them around forever?

Also, if no one died, imagine how hard it would be to find a parking space.

Rest in peace!

Source:
www.scientificamerican.com
www.quora.com
www.researchgate.net

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

Why no one lives forever

Let’s talk about cancer: the Manchester project that aims to save lives

Security guard Gilbert Morris will stop at nothing to talk to other black men like himself about cancer screening. He once defused a late-night fight in a Manchester club by asking five scuffling men whether they had had their prostate tested.

“It was like I had a magic wand that lowered their aggression,” laughs Morris. “They stopped in their tracks and put their fists down. Two of them said their fathers had prostate cancer and another’s uncle had it. We ended up sitting round the table talking about their fears of having their privates looked at.”

The success of this 51-year-old six footer in communicating the risk of cancer is being harnessed by health chiefs in Greater Manchester as part of the launch of a social movement to sign up 20,000 people as cancer champions.

The idea, led by Greater Manchester Cancer Vanguard Innovation, (part of Greater Manchester Cancer – the cancer programme of Greater Manchester’s devolved health and social care partnership), is to use people power to create a cultural shift in one of the UK’s cancer hot spots, and make it normal to talk about screening, healthier lifestyle options and catching symptoms early.

Working with the voluntary sector, the aim is to sign up 5,000 cancer champions by autumn 2017, and to reach 20,000 by 2019. Mobilising this cancer army is one of a series of measures to cut premature cancer deaths in the area by 1,300 by 2021.

Gilbert Morris developed prostate cancer in his 40s and couldn’t find anyone to talk to about it. Photograph: Karen Wright

The cancer death rate in Greater Manchester is 10% higher than the national average, according to Cancer Research UK figures. Manchester comes bottom out of 150 local authorities for premature deaths (under 75 years). Cancer experts reckon that around 40% of cancer deaths could have been prevented by screening or lifestyle changes, the potential for saving lives in Greater Manchester is great, since 6,700 people died of the disease in 2013.

Cancer champions programme director, Jenny Scott, explains: “By creating champions we will create support for active lifestyle changes. We need to engender people’s interest and then it will spread like a wave. I hope that people will soon be chatting about what they can do – whether it be at the bus stop or a football match.”

This radical approach is the result of a realisation that health systems are not having an impact in many sectors of society.

Morris’s story underlines this. He developed prostate cancer in his 40s and could not find anyone to talk to about it. He volunteered with the Manchester-based Black Health Agency to highlight the heightened risk of the disease in the African-Caribbean community. As his experience shows, the mention of prostate cancer can stop people in their tracks.

Morris says: “Doctor does not always know best, because some men never go to the doctor. I will speak to men anywhere – at a street corner or a bus stop. I am not embarrassed about talking about it, because if I can save one life I have done my job.”

He joins 1,000 plus existing volunteers willing to become cancer champions. More will be recruited through formal links between local authorities, Action Together and Voluntary Sector North West. Interested individuals will be put in touch with voluntary organisations across the 10 local authority areas, and receive advice and training. Workshops and publicity campaigns are planned. A web platform is also being built where people can become a champion and share their experience.

The rewards of volunteering are rich according to cancer champion Zoe Ashworth, a 29-year-old single parent from Stockport. She spends around three hours a fortnight at a nearby GP surgery in a deprived area calling people who have not returned their bowel cancer screening kits.

“Volunteering gives me real personal satisfaction,” says Ashworth. “Of all the people I have called, every single one has agreed to receive a screening kit. My friends will not listen to anybody else, but they can’t get away from me!”

Findings from the cancer champions project, will be combined with other data and public health information, to create a national dashboard to help prevent avoidable deaths across the rest of the UK. It will also be shared with cancer alliances being set up all round the country.

Leading Greater Manchester’s social movement projects, Ben Gilchrist, sees the cancer champion work in the context of a step change in society, in which many people no longer take their health messages from a health system.

He is clear that volunteering is not a replacement for NHS and public services, or a cost-cutting measure but the “right thing to do” to empower communities.

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Let’s talk about cancer: the Manchester project that aims to save lives

Drug firms ‘put lives of cancer patients at risk’ as out-of-patent prices are inflated

Drug companies have been accused of profiteering by raising the prices of out-of-patent cancer medicines that cost just pence to make, inflating the bills of the cash-strapped NHS by hundreds of millions of pounds.

Academics say the prices of 14 cancer drugs have increased by between 100% and nearly 1,000% over the past five years in the UK. These are all generic drugs where the patent has expired, which means they can be made for little more than the cost of the raw ingredients.

But, say experts who presented their findings at the European Cancer Congress in Amsterdam, generic drug companies have been price-gouging, just as Turing Pharmaceuticals was found to have done in the US with Daraprim, a 70-year-old drug used in Aids treatment. The price rose from $ 13.50 to $ 750 to universal outrage and became an issue in the presidential election. Turing CEO Martin Shkreli was dubbed the most hated man in America.

Andrew Hill from the department of pharmacology and therapeutics at the University of Liverpool, said the price increases in the UK would be costing the NHS a huge amount of money at a time when it has said it may have to ration 20% of the very expensive new cancer drugs coming on the market. “This figure will probably be in the high hundreds of millions of pounds per year, or possibly £1 billion,” he said.

He and co-author Melissa Barber, from the London School of Hygiene and Tropical Medicine, funded by the World Health Organisation and the Open Society Foundation, could not calculate the exact costs to the NHS because they did not have access to data from hospitals, where cancer drugs are usually prescribed. But they also looked at the increase in prices of all types of generic drugs – not just cancer – that are prescribed by GPs and pharmacists and found that the NHS paid £380m more in 2015 than it had five years earlier, as generic companies pushed up their prices. The hospital bill is likely to be much more.

Hill said the rises were going unnoticed because they were “under the radar”. The NHS was not keeping an eye on the steady increases year on year. “They are not negotiating well enough,” he said. “They should be looking at any company that starts raising the price of any drug.”

Among the drugs with price rises is melphalan for ovarian cancer, a drug invented by the UK company GlaxoSmithKline and then passed with a number of other cancer drugs that were going out of patent to Aspen Pharmaceuticals, a South Africa-based generics company, in 2009. GSK took a 16% shareholding in Aspen at the time.

Hill and Barber say the price of melphalan in the UK went up from 55p for 2mg in 2011 to £1.82 in 2016, a rise of 230%. The NHS did not contest it, unlike in Italy. There, Aspen negotiated a deal in 2014 to raise the price of the drug by up to 1,500%, having threatened to stop supplying the ovarian cancer drug to patients altogether. The Italian competitions authority fined the company nearly $ 5.5m last October for its behaviour. “The negotiation strategy adopted by Aspen was so aggressive as to reach the credible threat of interrupting the direct supply of the drugs to the Italian market,” said the authority’s report.

Australia, New Zealand, France and Brazil have also faced shortages of Aspen’s drug, says Hill. Aspen did not return calls asking for the reason for the shortages.

In France, three women died after being given an alternative drug to melphalan. The drug, cyclophosphamide, should have been safe, because it was used before melphalan came on the market. An investigation is now under way into what happened.

The biggest price rise in the UK that the team found was also for an Aspen drug. The cost of busulfan for chronic myeloid leukaemia to the NHS rose from 21p for 2mg in 2011 to £2.61 in 2016, an increase of 1,143%.

Aspen’s share price rose more than 650% from 2009 to last year. GSK sold its shares in Aspen in three tranches – the last one in September – netting about £1.5bn.

The multinational giant Pfizer was fined £84m in the UK in December for conspiring with a generic company, Flynn Pharma, to raise the price paid by the NHS by 2,600% for an anti-epilepsy drug that came off-patent. The Competitions and Markets Authority said it had exploited the fact that the NHS had no alternative, because no other company was making it. In the wake of that case, a bill is going through parliament to give the Department of Health powers to investigate when the price of a drug goes up without clear justification.

Sarah Wollaston, the Tory MP who chairs the health select committee, said the research findings were concerning. “It is unacceptable for drug companies to artificially inflate the cost of drugs. This will inevitably result in less funding being available for other vital treatments,” she said.

Ian Banks, representing the patient organisation the European Men’s Health Forum at the conference, said the price rises were more than outrageous. “Behind these statistics there is a patient not getting treatment that could save their lives or at the very least improve their quality of life. That is unacceptable,” he said.

Mia Rosenblatt from Breast Cancer Now said: “We’d be extremely concerned by any suggestion of companies raising the price of tamoxifen and other generic drugs, which would only add to the current strain on the NHS.

“Part of the understanding – by health bodies – of the high cost of new drugs is based on the knowledge that there is a limited time for drug companies to see return on their investments and that these drugs will be available at a much cheaper rate in due course.

“Significant driving up of the prices of generic drugs would be of real concern and we therefore support the government’s activity to address this possibility through the Health Services Medical Supplies Bill.”

The British Generic Manufacturers Association said that most of the drugs highlighted in the study had no competition, because there was only one supplier. “That is because the total market size is too small to be attractive for generic companies to enter, since they would not recoup the million-pound plus costs of developing, testing and registering a new generic medicine,” it said in a statement.

Hill countered that the cost of developing a new generic drug is not high and that cheaper versions than those sold to the NHS could be imported from India.

Drug firms ‘put lives of cancer patients at risk’ as out-of-patent prices are inflated

How price-gouging of opioid overdose cure costs lives: "There"s never enough"

Ben Dunkle died at the age of 20, abandoned in a carpark by panicked friends who had no idea how to save his life as he overdosed on heroin.

“I’m certain that if they had been carrying naloxone, they wouldn’t have run away,” said his mother, Aimee Dunkle.

After Ben’s death, Aimee made it a mission to get naloxone, an antidote that can bring overdosing opioid users back from the brink of death within minutes, into the hands of as many people as she could. In February she founded the Solace Foundation in southern California to distribute the naloxone among addicts, many of them homeless, their relatives and friends. She says the group has saved at least 365 lives.

But Dunkle said she could have saved more if it were not for the surging cost of the drug which has prompted accusations of pharmaceutical companies profiteering from the US’s opioid epidemic. Costs for pre-filled syringes doubled in 2014 and are three times the price of 15 years ago, while injectors used to administer the spray have increased to more than five times the price in two years.

“More people are dead now than would have been otherwise,” said Dan Bigg, director of the Chicago Recovery Alliance, an important distributor of naloxone in the city. “How many is hard to count, but programmes that would have started didn’t because of the cost of naloxone. Programmes that would have expanded didn’t because of the price of naloxone. To the extent pricing is an impediment, it will prevent this being used as a lifesaving medicine.”

Deaths from opioid overdoses surged again last year to more than 30,000, driven by a sharp increase in the use of heroin and fentanyl.

Heroin deaths were up 23% on the previous year to 12,989, more than the number of lives claimed by guns used in murders, according to data released by the Centers for Disease Control and Prevention (CDC) on Thursday. The sharpest increase came from lives claimed by even more powerful synthetic opioids, such as fentanyl, the drug that killed Prince, which were up 73% to 9,580 deaths, although some of those deaths were in combination with heroin. But prescription opioid painkillers, containing drugs such as oxycodone, remained the biggest killers, taking 17,536 lives.

Medical studies say that most heroin users first become addicted to prescription drugs. It is how Ben Dunkle came to die.

Ben Dunkle in 2012. Photograph: Courtesy of the Dunkle family

Overdoses are so widespread that the National Center for Vital Statistics found drug-related deaths are dragging down life expectancy for white adults.

After 15 years of steadily rising deaths from opioids, what the CDC has called an epidemic has finally forced its way on to the political stage with $ 1bn in treatment and prevention legislation passed by Congress. It has also resulted in ever-widening access to naloxone as more police forces carry it and states liberalise access by making it available without a prescription. But increased demand for the antidote has coincided with a sharp rise in cost.

Naloxone is most commonly administered by injection or spray. Kaléo, a Virginia company, has increased the price of its naloxone auto-injectors, sold as Evzio, from $ 690 for a kit of two to $ 4,500 in less than two years. Amphastar of California nearly tripled the price of syringes pre-filled with naloxone.

“When we started in 1996, a 10cc vial of naloxone was $ 1.63. Now that 10cc vial is almost $ 300 at Walgreens here,” said Bigg. “Has the price been raised well beyond what it costs to make in an obscene way for such an important lifesaving drug? Yes.”

Robert Childs, director of the North Carolina Harm Reduction Coalition, one of the largest non-profit distributors of naloxone in the US, said his organisation has spent about $ 220,000 this year giving out more than 13,000 naloxone kits to police officers and others working with those at risk of overdose.

“If naloxone wasn’t the price it is, we would be able to buy a lot more and get a lot more out there to high-risk populations,” he said. “There’s a public health crisis with opiate and opioid-based drug overdoses, and the response has often been to increase the price which is probably the worst response you can do.”

The increased demand and rising prices has resulted in a surge in income from naloxone for drug companies, up 400% since 2011 to $ 82m last year.

“It’s one thing to charge more for snow shovels when there’s a blizzard, but this is a public health emergency,” said Dr Andrew Kolodny, co-director for opioid policy research at Brandeis University. “When you have an epidemic of people dying of opioid overdoses, [this] should be readily available. We shouldn’t have pharmaceutical companies profiteering.”

Doctors writing in the New England Journal of Medicine called for government intervention to control the price of the drug, saying that cost is discouraging use of naloxone. They said that legislation has greatly expanded access to the antidote but that the price remains an obstacle.

“We believe that such policies should explicitly call on manufacturers to reduce the price of naloxone and increase transparency regarding their costs, particularly those related to the development of new formulations,” it said.

“The message to lawmakers is drug prices are an increasingly important problem for patients,” said one of the article’s coauthors, Dr Joseph Ross, an associate professor of public health at Yale University and a primary care physician.

•••

Aimee Dunkle took one look at the young man slumped on a bench in a Santa Ana carpark three weeks ago and knew she had only minutes to act.

“The giveaway for me was he was drooling. He was breathing very shallowly. I recognised him and called his name. There was no response,” she said.

The man was overdosing on heroin and benzodiazepines, a lethal combination. Dunkle pumped a shot of naloxone – also known by the trade name Narcan – into him.

“I gave him the first shot of Narcan and no response. I gave him the second shot and he woke up. He was groggy, but he was up almost immediately. Someone had dialed 911 but before law enforcement arrived he was walking away,” she said. “It was exhilarating to save a life for the first time but then I realised this is how Ben died, sitting in a car, slumped over.”

Most of the manufacturers distribute a limited amount of free supplies to community groups and emergency services like Dunkle’s or sell naloxone at a discount.Dunkle said her group received free auto-injectors from Kaléo, but when they ran out she could not afford to buy more even at the discounted price for non-profits.

“There’s no way I can even contemplate buying it,” she said. “We sometimes get some financial donations. One time I had about $ 1,500 that had been donated and I bought $ 1,500 of Narcan. Then I had to select who to give it to. Not who was at most risk but who was most likely to witness an overdose. For a mother that’s lost a child, that’s a hellish decision to have to make: who gets the kits and who doesn’t.”

Supplies dried up for three weeks in September. Dunkle said that inevitably meant lives were lost.

“Our waitlist was over 70 people and that meant people died because we didn’t have it,” she said.

But financial donations mean she now has supplies to see her through the first half of 2017 distributing 70 naloxone kits a week. Still, that falls well short of demand.

“There’s never enough,” she said.

naloxone

The rising costs have drawn scrutiny in Congress. Senators Susan Collins and Claire McCaskill wrote to five pharmaceutical companies in June asking them to explain their pricing of naloxone.

A spokesman for McCaskill said that in meetings the companies defended the increases as necessary to cover the cost of new delivery systems. Naloxone, which has been on the market since 1971, is no longer covered by a patent and is cheap to produce. But pharmaceutical companies do have patents on how the drug is administered, such as by spray or auto-injectors, a spring-loaded syringe.

“In meetings, generally speaking the companies have argued that the price increases are due to new and more efficient delivery systems,” he said. “The question is, are these new bells and whistles effective?”

Manufacturers said the introductions of nasal sprays and auto-injectors are easier and safer to use than regular syringes. But Bigg questions whether those modifications justify the cost given that both means of delivery were already commonly used with other drugs.

An Irish company, Adapt Pharma, which makes a widely used naloxone nasal spray with a trade name of Narcan, denied that the patent was a means to price gouge. It said the spray “is designed, tested and approved so that anyone in the community can deliver a proper dose in non-medical conditions”.

“It’s not as simple as just putting naloxone into the device and selling it,” said Mike Kelly, president of Adapt’s US operations. “To obtain Food and Drug Administration approval, we must consistently meet the standards set by the FDA.”

The list price for the spray is $ 150 for the two shots typically administered to someone who overdoses on opioids which Adapt notes is considerably cheaper than a rival, the Ezvio auto-injector, with a retail price of $ 4,500 for a pack of two.

Kelly said the company discounts the cost for community groups and the police by 40% and that a majority of patients using a prescription can obtain it through health insurance for $ 10.

“We have made it our mission to provide more access and availability than ever before – including donating more than 50,000 doses of Narcan nasal spray to increase awareness and experience with the product and naloxone generally,” he said.

Mark Herzog, vice-president of corporate affairs at Kaléo said the six-fold increase in the list price of Ezvio was made in order to cover the cost of ensuring anyone with insurance and a prescription can obtain the drug cheap or free. The company responded to the senators’ letter by claiming that the real barrier to naloxone access is “lack of insurance coverage or unreasonable coverage restrictions”.

The company said it has donated more than 150,000 auto-injectors to public agencies and community groups. Other drug manufacturers did not respond to requests for comment including one of the largest naloxone sellers, Hospira, which has raised the cost of a vial of the drug by 1,700%.

How price-gouging of opioid overdose cure costs lives: "There"s never enough"

Construction project rebuilds lives after brain injury and mental illness

At first glance it’s just another construction site. On one side of the yard, a group of men in hard hats stand around a large electric saw, watching the foreman demonstrate how it works. Further along, another group are wielding hand saws. The sound of banging and clashing comes from inside a half-finished wooden structure.

But this isn’t your average building site and these are no regular builders. They’re patients on day release from three low secure mental health facilities within the Abertawe Bro Morgannwg University (ABMU) health board in Wales.

The group is here at Down To Earth, a not-for-profit education organisation based near Swansea, as part of the Building Community project, funded by the Big Lottery’s people and places grant, which aims to engage hard to reach and vulnerable adults and young people through participation in practical, educational and community-based activity.

Paul, who didn’t want to tell the Guardian his surname, is one of today’s workers. It’s his fifth time on site, and so far he’s enjoyed learning skills such as sawing, measuring and team work, all of which are designed to boost confidence and mental wellbeing.

“It makes me feel better,” he says. “I feel like I’ve done something worthwhile.”

His occupational therapist technician, Freya Jones, from the Taith Newydd mental health unit at Glanrhyd hospital, says it’s having a huge benefit on the group. “I’ve really seen an improvement in confidence in the guys since they’ve been here.”

‘Wellbeing can be delivered through an educational and community regeneration approach …’ Composite: Down to Earth

This anecdotal evidence is supported by clinical research funded by ABMU and Swansea University, which is measuring the effectiveness of this kind of work on both psychological and physiological wellbeing, as well as the healthcare impact of the project’s approach.

“Wellbeing and healthcare isn’t just doing some gardening or singing in a community choir,” says Down To Earth founder Mark McKenna.

“We want to show that wellbeing can be delivered through an educational and community regeneration approach, so you don’t separate out healthcare from education or healthcare and education from community regeneration. It’s an integrated, cross-sector approach.”

Another study is being undertaken with a group of brain injury patients from Morriston hospital in Swansea. In their case, the emphasis is on neuro-rehabilitation, with four factors under consideration: depression and anxiety levels, quality of life and wellbeing. In all four areas, the results have been significant and positive.

Alan Gee is a prime example of the project’s success. Just over three years ago, the 56-year-old father of four fell from a height while cleaning the stables at his home in Pembrokeshire. He landed headfirst on the concrete floor, fracturing his skull in 12 places.

Less than a fortnight later he was discharged from hospital, but the recovery process was only just beginning. Battling memory loss, slow mental processing, fatigue and mood swings, Gee spent a year doing little more than lying on the sofa, heavily medicated with painkillers.

Then, in 2014, he was referred to Down To Earth and joined the first group of brain injury patients to work on the construction of the training centre. The experience is one he believes transformed his life.

Everyone in the project hopes it will be the start of a new way of providing practical community-based healthcare solutions. Photograph: Down to Earth

“It’s like coming in and having an arm put round you and someone saying it’s alright,” he says. “People understood. A lot of people with serious brain injury become defined by it. People stick them in a box. Projects like this get you out of that box. You become the new you – you don’t have to be ‘the brain injury person’.”

His neuropsychologist, Dr Zoe Fisher, has nothing but praise for the work Down To Earth is doing.

“It’s really bridging the gap between the health service and the community,” she says. “Usually, we’re confined to a hospital; if you don’t have access to real life situations, you can’t help people through them.

“You can’t do neuropsychology to someone, you do it with them. There’s no them and us in this project, everybody just gets involved. It helps us achieve the same objectives in a more holistic way than in the hospital.”

Everyone involved in the project hopes it will be the start of a new way of providing practical community-based healthcare solutions – including Gee’s wife, Michelle.

“It wasn’t just somewhere Alan came to spend some time,” she says. “The way he was when he came home each time, to me that growth was rapid. We could start to see him finding himself again.

“This shouldn’t be seen as alternative; it’s the future. It has to be. Medication is fantastic and it has a time and a place, but it doesn’t create the future.”

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Construction project rebuilds lives after brain injury and mental illness

Expedition medicine: save lives ... and go places

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What kind of situations might you face?

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

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

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

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

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

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

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

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

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

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

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

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Expedition medicine: save lives ... and go places