Every weekday, millions of primary school children across the UK put their lives at risk. Break time brings relief for busy teachers and is often met with screams of delight as children run out onto the playground. But in many of our major cities, tens of thousands of children in hundreds of schools, nurseries and colleges are at risk as they inhale diesel pollution breaching EU air quality standards.
Across the UK, more than 40,000 people die prematurely from diesel pollution, at a cost of £20bn each year, according to the Royal Colleges of Physicians and of Paediatrics 2016 report. Now 50% of new cars are diesel, with each car producing many times more fumes than laboratory tests had previously indicated. The VW scandal has shown that the motor industry cannot be trusted and the royal colleges’ report finds that babies and children are particularly at risk. Foetuses in pregnant women exposed to air pollution are more likely to suffer effects to their lungs, heart and neurological development. Children in “clean air zones”, areas where the air quality problem is most serious, have a 10% reduced lung capacity and have more respiratory problems, together with effects on their nervous, immune and cardiovascular systems. This leads to physical and mental health problems in later life.
The government has compelling evidence to act now. Instead it fears the backlash of diesel drivers who bought their cars in good faith and are still encouraged to do so by lower vehicle tax rates. The public-health risks of diesel particulates have been well known since the days of Margaret Thatcher. However, the impact of nitrogen oxides and the scale of underestimated pollution from lab tests compounded by the sheer volume of cars has now become a public-health catastrophe. That’s why the demand for a new Clean Air Act grows. Meanwhile, the supreme court has demanded that the government produces a clean air strategy, to fulfil our EU air quality obligations. Today, I publish my clean air bill to give shape and ambition to the government’s plan.
Britain needs to take bold leadership. We already know that four capital cities – Paris, Madrid, Athens and Mexico City – have plans to remove diesel vehicles by 2025 and that the markets are investing in zero-emissions futures. Tesla, founded in 2003, produces just 76,000 electric cars and is valued at $ 49bn (£38bn) – $ 3bn more than Ford, founded a century earlier, which produces 6.6m vehicles.
The clean air bill is a route map to reach World Health Organization air quality standards by tackling emissions in our cities, ports and airports. It provides the signals and incentives for consumers and producers to change their behaviour to do so.
Rather than penalising diesel car-owners who bought in good faith, the bill calls for recall and refit of cars, fiscal incentives and scrappage schemes largely funded by manufacturers for drivers to switch to vehicles that produce fewer – or ideally, zero – emissions. It provides for a national electric and hydrogen refuelling network and gives local authorities a responsibility to measure and publicise pollution levels, in particular close to vulnerable groups such as children and the elderly. Councils will have powers to restrict access or introduce pollution charges if communities so wish, based on local evidence.
What’s more, new powers are proposed to combat diesel pollution belching into communities from idling ships in port by requiring a switch to port-provided electric power. The bill also addresses freight transport, pollution at airports and “cheat devices” installed on cars. Overall, the bill aims to make our right to clean air a reality.
Our first duty as parents is to protect our children. Break time, walking to the shops and football in the park shouldn’t be life-or-death decisions beyond our control. They needn’t be. For the sake of all our children, let’s do something about it now.
The therapy room is a patch of waste ground, and the therapist’s couch a wooden bench under a tree. The therapist is an elderly Zimbabwean woman, in a long brown dress and headscarf.
Her patients call her “Grandmother” when they come along to sit on her bench and discuss their feelings, their depression or other mental health issues.
Outside a clinic in Highfield, a poor suburb just south of Zimbabwe’s capital Harare, there are lots of grandmothers – trained but unqualified health workers – who take turns on the park bench to hear stories. They listen to the battered wife who has attempted suicide twice, the man who hates women after he became infected with HIV, the unemployed single mother driven to despair by the struggle of raising four children.
The benches are a safe place for people struggling with depression, which in the Shona language is called kufungisisa, “thinking too much”.
It is a world away from conventional approaches to mental healthcare, but the Friendship Bench project has changed the lives of an estimated 27,000 Zimbabweans suffering from depression and other mental disorders.
The grandmothers, all of whom are trained to improve a patient’s ability to cope with mental stress, listen and nod, offering only an occasional word of encouragement.
One in four Zimbabweans suffers from some form of mental illness, but there are only 13 psychiatrists in a country of about 15.6 million. A solution had to be found, and it came in the way of a bench and the tradition of respect for African matriarchs.
Clinics screen their visitors for mental illness through a locally developed tool called the Shona Symptom Questionnaire. It has 14 questions, such as “Have you been struggling to sleep?” and “Have you been worrying too much?”
Patients scoring above the cut-off level are referred to the friendship bench. Those who go to the grandmothers are five times less likely to have suicidal thoughts, according to Dr Dixon Chibanda, co-founder of the scheme.
“When they first get to the bench, we use an intervention which we call kuvhura pfungwa [opening of the mind]. They sit and talk about their problems. Through that process, the grandmothers enable that patient to select a specific problem to focus on, and they help them through it,” he says.
Through at least six one-on-one sessions with the health workers, the patients are encouraged to speak about their problems and their mental illness.
Traditionally, elderly women play the role of counsellor for younger members of the community. On the bench, however, the grandmothers listen more, and lecture less.
“We used to talk a lot, ‘Do this, do that’. But now we ask them to open up, open their minds and hearts,” says Sheba Khumalo, a grandmother.
Chibanda says it is mostly women that visit the bench. “From our recent study, we found that 40% of those coming to the bench who show depression are victims of domestic violence. Whether that violence is caused by the economic situation is something that we have not looked at.”
In conservative Zimbabwe, just getting people to open up about their mental health is a victory in itself, says Joyce Ncube, another of the grandmothers.
“Many died just because they had nobody to tell their problems to,” she says, settling on to the wooden seat for a session with one of her patients. “When people keep things inside, their problems start.”
Maria Makoni is a 49-year-old unemployed mother of three who began therapy earlier this year.
“In our culture, you are ridiculed for speaking about your mental health,” says Makoni.
She is tense, but lights up when she speaks about the grandmothers. “I was desperate to find someone to talk to about my problems. When I speak to them, I feel like a load is lifted off my heart.”
When Makoni first found her way to the friendship bench, she was surprised to find she was one of many with similar problems. Now she is volunteering to bring more to the bench. “I am ready to speak to as many people as I can.”
Grandmothers working with the Friendship Bench project chat before counselling sessions begin. Photograph: Cynthia R Matonhodze
For many Zimbabweans, poverty – more than 70% of people live below the poverty line – and unemployment are a source of despair. In such a deeply superstitious and religious society, mentally ill people are sometimes seen as possessed; many are dragged to exorcism sessions at charismatic churches or traditional healers.
Chibanda says such beliefs need not be a hurdle, provided the intervention is packaged well.
“The term ‘opening of the mind’ does not sound medical at all. We have used those words to package a scientific intervention, and this is why it’s acceptable.”
The programme has had to pick its words carefully, as the grandmothers are meant to be more friends than doctors. The scheme was initially called “mental health bench” but nobody came. “The minute we changed it to friendship bench, it became acceptable, even though we are essentially providing the same thing,” says Chibanda.
Researchers say the friendship bench may be a blueprint for mental healthcare in developing countries. In Zimbabwe, the programme will now be rolled out to 60 other clinics across the country.
“This bench is filling that gap we have in providing affordable care,” says Prosper Chonzi, director of health for the City of Harare. “We are glad to see it is being applied to other cities in the country.”
When justice is done, we should be glad. But the champagne-swigging jubilation that greeted the reduction of “Marine A” Alexander Blackman’s murder conviction to manslaughter on the grounds of diminished responsibility, went far beyond the acknowledgment that this was an appropriate outcome. To many of his supporters he is a “hero soldier” persecuted for shooting dead an injured Taliban fighter in Afghanistan. The judgment, however, was no exoneration: he killed a defenceless man, tried to make sure it was not witnessed, and attempted to cover up what he did. The judges considered mitigating factors, including his combat stress disorder. Nonetheless, they concluded that his crime was a severe one, that he held substantial responsibility for it, and that his dismissal from service was justified.
Drum-beating coverage of “our brave boys” veils the fact that British troops, like any others, are capable of terrible violations of the laws of war and the dictates of basic decency. Perhaps the catastrophe of Iraq, and the consciousness of the toll it took overwhelmingly on Iraqi civilians but also on coalition forces, has sensitised the public to the immense pressures facing soldiers and the often limited support they receive. More often than not, such abuses occur when there is an absence or failure of leadership. Another marine – briefly Blackman’s commanding officer – described the leadership and oversight in place as shockingly bad, and insisted he was not a single rotten apple. The answer is not to give soldiers a free pass to abuse and kill by attacking attempts to hold them to account, but to ask who else is responsible and how such behaviour can be prevented in future.
Blackman knowingly broke the rules of war (“I just broke the Geneva convention,” he told comrades). These are not a matter of etiquette, but morality; not a luxury, but a necessity. It is precisely because of the extremity of the situation, and the pressures upon troops, that clear rules are needed. They protect both civilians and soldiers. It took more than a century of campaigning to establish such standards. That they have often been ignored is a reason to uphold them vigorously, not to lower them.
It is not only that the end cannot justify the means. Believing that it can often leads to a different end, whether on the soil of Afghanistan or in the skies over Mosul. The fight against Islamic State there has seen a frightening acceleration of civilian casualties. Too many Iraqis and Syrians are dying in coalition strikes that are supposed to save them; and that fact, besides causing untold tragedy, is likely to fuel future radicalisation.
The increase in deaths began in the last weeks of the Obama administration – around the time that procedures were changed to make calling in strikes easier – but has gathered pace. It may reflect a tactical change in response to the heavy punishment that Iraqi forces took as they reclaimed eastern Mosul; and, around Raqqa, perhaps poor on-the-ground intelligence. But many fear that the Trump administration’s announcement of a review of the rules of engagement has been enough to lower the threshold in reality.
Western intervention in recent wars has been couched largely in moral terms. Intentions are not enough. Blackman told the fighter he killed: “It’s nothing you wouldn’t do to us.” But being better than the Taliban, let alone Isis, is no kind of baseline.
About three in every 10 people in Britain think social workers help with household chores like cooking and cleaning, with personal care like washing and dressing, and with childcare. Two in 10 reckon they will nip to the shops for you. Asked to choose from a given list of professionals they consider important providers of mental health support, 69% of people identify psychiatrists and 65% GPs – but only 41% pick social workers.
These findings come from a ComRes survey commissioned by Think Ahead, the fast-track training graduate scheme for mental health social workers, to mark this week’s World Social Work Day. As Lyn Romeo, England’s chief social worker for adults, comments with a certain understatement, “there is still more to do to communicate the crucial role of social workers”.
That was to have been the role of the short-lived College of Social Work, set up by ministers in 2010 with plans for it to grow to become a royal college on a par with those for the most esteemed professions, but shut down in chaos five years later. News that the College of Occupational Therapists is to become royal – richly deserved, by the way – has rubbed a good deal of salt into that wound.
There is a fresh plan, however. From 2018, part of the brief of a proposed new regulator for social workers in England will be “to promote and maintain public confidence” in the profession. The mandate for the organisation, provisionally titled Social Work England (SWE), is contained in the children and social work bill currently before parliament. After a rocky start, it enjoys broad support.
One reason SWE is being welcomed is that it will give social work its own regulator again after six years under the generic Health and Care Professions Council. A second is that ministers accept it cannot be self-financing, at least in the short term, and are underwriting it by £16m in its first two years. And the most significant reason is that an initial idea for it to be run direct by Whitehall has been ditched.
Just how independent it will be remains moot: a quango accountable to government, not parliament, it will need ministerial approval of the professional standards it polices. But the social work world sees the lifting of the spectre of regulation by a government department as a clear win.
Another success being celebrated is the withdrawal of clauses from the bill that would have allowed councils to seek exemptions from children’s social care law to test innovative ways of working. Critics saw the idea as erosion of vital safeguards and mounted a strong, successful campaign against it – but the issue was almost certainly settled when Eileen Munro, the leading social work academic often cited by ministers in support of professional reform, opposed it.
However, real tensions remain between the government’s social work reform vanguard led by Isabelle Trowler, chief social worker for children, and the bulk of the sector establishment, with plans for accreditation tests for children’s social workers looming as a new flashpoint. But there is a sense of a thawing in relations.
Herbert Laming, sector elder statesman and crossbench peer who led both the seminal inquiry into the death of Victoria Climbié, which published its report in 2003, and a review of child protection six years later following the Baby P affair, hopes the thaw continues. He tells me: “What social work needs above all at this time is a bit of tender loving care.”
In a lecture on Wednesday at the University of Suffolk, Lord Laming will spell out the enormously high expectations that society has of frontline workers’ skills and judgment when dealing with vulnerable children and adults. The task, he will say, has been made infinitely more difficult by austerity, which is why he joined the call for withdrawal of the exemption clauses at this point even though he understood and backed the case for innovation.
Social workers are crying out for support and encouragement, Laming says. He is surely right. There has been too much stick and not enough carrot in the mix of late.
Should you ever be concerned about glycemic index or its glycemic load?
Low-carb diets, such as the Atkins, South Beach and Paleo will always emphasise the fact that high-glycemic foods raise your blood sugar and insulin, stimulating your appetite and promoting overeating and obesity.
Yet evidence now shows that glycemic index makes no difference to your weight and blood sugar levels.
What is the glycemic index?
The glycemic index (GI) measures the rise in blood sugar levels in a person over the two to three hours following the eating of an amount of food that contains 50g of carbohydrate.
Expressed as a percentage, the GI of pure glucose sugar is 100% while that of for instance of an apple is 39%.
Many mainstream nutritionists will tell you to eat foods that are low on the glycemic index for a more stable blood sugar level and to help heal health conditions, such as Candida and hypoglycemia.
But there is one big problem with the GI: it does not take into account the amount of carbohydrate in any particular meal.
So to make the GI more relevant to daily eating, the idea of the glycemic load or (GL) was introduced.
What is the glycemic load?
The GL figure is found by multiplying the GI of the food times the available carbohydrate content of a serving of that particular food and then dividing by 100.
So for example, a watermelon ranks as 72 on the glycemic index, which is classed as being high.
Taking a 100g serving size of watermelon, which has just 5g of available carbohydrates in it, its glycemic load or GL would be as follows: 72 x 5/ 100 = 3.6. So the GL is just 3.6 for a 100g serving of water melon.
So should eating certain foods with regards to them having a higher GI or GL values be of any concern to you and your health?
Well, the answer is no!
Let me explain why.
How quickly sugar enters the bloodstream is not actually the most important factor here and should not be something to be concerned about when eating healthy, natural, whole foods.
Why fruit is good for your healthy blood sugar levels
Another great aspect about the consumption of fruit is that it promotes the satisfaction of the appetite.
This is because the natural elevation of the blood sugar level after eating them is one of the key mechanisms that the human body uses to satisfy appetite and reduce food intake.
When you consume whole foods like fruits for example, they contain not only the carbohydrates that your body needs to be healthy, but also all the other nutrients essential to your health, including fiber.
Fiber slows down the absorption of sugar from the foods (whole fruits and vegetables for example) that you eat, into the bloodstream, which allows for the controlled and healthy release of the hormone insulin, that transports the sugar from your blood into your body’s cells.
Eating a healthy level of fat in your diet (but not high levels of fat) is also very important in this equation as it will allow for a healthy level of blood sugar to always be maintained.
It should be noted that dehydrated/dried fruits will contain much more concentrated sugars, which could cause blood sugar issues for some people.
The same goes with the drinking of fruit juices, which contain no fiber and so very quickly enter the bloodstream.
But for the average healthy person eating a healthy plant foods diet with plenty of fruit and low levels of fat in it, this should not be an issue.
The mistake low carb dieters and promoters are making is thinking that the GI and GL foods are actually relevant to a healthy way of eating.
At best the GI and GL are a nutritional curiosity and at worst a misleading and potentially health damaging way of looking at what foods we should or should not be eating.
If you want to live healthily and eat the best foods to support your body, then it is best to forget both the GI and GL and instead focus on eating healthy, natural whole plant foods together with a healthy level of fat in your diet.
This will naturally help bring you the health you deserve, including normal blood sugar levels.
There’s absolutely no reason to fear fruit!
About the author: Yulia Tarbath is a Certified Nutritionist at Rawsomehealthy, author, parent and international speaker with nearly 8 years of experience on a raw foods, vegan lifestyle. With over 70,000 followers around the world, Yulia and her husband Paul are authorities on living a balanced, nutritionally sufficient plant-based lifestyle. Through their videos, blogs, coaching and online programs, they are supporting both women and men around the world in cleansing and healing their bodies naturally, as well as achieving the shape and health of their dreams. Sign up to their FREE 5-day raw food menu plan here.
Despite the fact that the heart disease is the number one cause for death of women in the US, there is still a common misperception that it is a guy thing. Often women fear breast cancer more although they are eight times more likely to die of the heart disease. As per Pamela Ouyang, MBBS, director of the John Hopkins Women’s cardiovascular health center, “The message is getting out more but women still need help to understand their risk factors”. Now let us check out if any of these heart health mistakes often made by women apply to you.
Believing You’ll ‘Know’ When You Need to Get Your Blood Pressure Checked
Its great to be in tune with your body, but this approach will alone has its limits. Women often tell the doctor, “I got dizzy, so I knew my blood pressure was high”. You won’t know when you have high blood pressure or high cholesterol which are silent conditions.
How to proceed: Get the blood cholesterol, blood pressure and blood sugar measured regularly by your doctor. These tests can flag your risk for future heart trouble.
Installing an Exercise Bike in the Home
Having a bike or a treadmill itself is great. The trouble is that you have to use it often and that’s where many women go wrong. Hence, they decide to embark on a new exercise program which is not that fun, convenient and so far after an initial push as they slack off.
How to Proceed:Pick up an activity which is fun for you or so you’ll want to do it often such as running with a friend or walking around the mall.
Smoking Weight Down
Keeping your weight in a normal range is great for your heart. But using cigarettes for weight control snuffs out the good effects. This is because smoking is a leading cause of the cardiovascular disease.
How to Proceed:Control your weight with exercise and diet. Do not count on e-cigarettes, either. According to Dr. Ouyang, “They may not be as healthy as it has been hoped initially as it is still nicotine”.
Not Knowing the Warning Signs of Heart Trouble for You
A heart attack can be present differently in women than it does in men. Expecting a chest crushing episode, women will ignore other danger signs.
How to Proceed: If you notice abdominal pain, nausea, difficulty breathing or other bothersome symptoms which are unusual for you. Therefore it is important to consult with your doctor.
Avoiding Hormone Replacement Therapy at Menopause Because It’s Bad for the Heart
Some women may suffer unnecessarily through intense hot flashes and sleep disturbances. While it’s no longer believed that the hormone replacement therapy can help protect the heart at menopause, it doesn’t mean you need to avoid it. Ouyang says, “For most women in their 50s, the established cardiovascular risk is low and it is safe to take hormones”.
How to Proceed: If you need to take hormones for menopausal symptoms relief. Try a prescription at the lowest possible dose for the shortest period of time.
Thinking Certain Health Problems of Pregnancy Ended with Your Child’s Birth
Though your baby may no longer be inside you, but your heart, arteries and other organs still are. If you have hypertensive issue in pregnancy such as preeclampsia, pregnancy induced hypertension or gestational diabetes, then you are at increased risk of heart problems later in life.
How to Proceed: Always inform a new doctor about your full health history so that he/she has necessary information to consider your individual needs.
Family doctors with heavy workloads are to receive specialist help to cope with the stress of their jobs in a groundbreaking new NHS initiative.
All 55,000 GPs in England will be able to seek counselling or medication from mental health nurses and psychiatrists in a £20m scheme to keep them healthy. The NHS GP Health Service will be trialled in 13 areas and then rolled out nationally if it proves its worth.
NHS England is encouraging family doctors who have become addicted to drink or drugs as a result of difficulties in their personal or professional lives to refer themselves for treatment.
The GP Health Service is the first support system of its kind in the world, aiming to tackle anxiety, depression and feelings of hopelessness among doctors. It is hoped that GPs who get emotional and psychological support will be less likely to go on sick leave or quit the profession because they feel they can no longer withstand the pressures involved.
Professor Sir Bruce Keogh, NHS England’s national medical director, told the Observer: “Being a GP is tough. It requires a deep knowledge of medicine and an ability to separate the serious from the trivial, coupled with compassion. As the number and complexity of consultations grows, so does the stress of the job. This takes its toll.
“Both sickness and early retirement rates are rising. These pilot schemes aim to offer help on both fronts to key members of the profession who contribute so much to the lives of so many. Helping struggling GPs means a happier, healthier workforce and in turn a greatly improved service for patients,” he added.
Dr Helen Stokes-Lampard, chair of the council of the Royal College of GPs, said: “Being a GP can be incredibly stressful, so it’s no wonder the intense resource and workforce pressures currently facing our profession are increasingly taking their toll on the mental health and wellbeing of family doctors.”
The new scheme is based on the Practitioner Health Programme (PHP), which has been offering mental health support to both GPs and hospital doctors for the last nine years. NHS England is giving the Hurley Group of GP surgeries, which runs the PHP, almost £20m over the next five years to provide the same help to any family doctor who feels they would benefit.
Dr Clare Gerada, a partner in the Hurley Group, said that 80 of 100 doctors the PHP has treated for addiction problems have been able to go back to work afterwards. Similarly, 75% of those with bipolar disorder have returned to the frontline after receiving up to six months of treatment themselves.
The PHP helped one GP, who only wanted to be known as Dr S, who was already struggling to meet demand for patient consultations and neglecting his family life after one of the partners in his busy urban practice retired, when he received a complaint from a patient. That led to Dr S having sleepless nights and feeling that he had let down his partners. His morale declined, he lost his confidence and eventually handed in his notice. After getting help from the PHP, though, he came back to work.
“I had lost my love for the GP job, a job I had wanted to do all my life. I thought it was time to walk away but thanks to PHP I now feel I have brought the enjoyment back into the role,” he said.
“I am relishing my responsibilities and enjoying every day. I would have been a GP on the rubbish heap if it wasn’t for this kind of support service.” He now helps his colleagues at the surgery manage what many GPs describe as the relentless demands on their time and the need to make key decisions about patients’ care and treatment.
GPs will refer themselves to the service. Each of the 13 pilot areas will have a regional network of experienced doctors and therapists. Callers will receive a telephone assessment within 48 hours and then a more detailed face-to-face assessment close to their home, but not at their surgery to protect their privacy. Staff will deal with a range of mental health conditions, although they will leave existing NHS services to handle eating disorders and serious depression.
GPs in Oxfordshire caused a row last week when they revealed they were examining ways of boosting their funding, for example by charging patients for providing appointments outside of normal surgery hours and carrying out minor surgical procedures, such as vasectomies.
Official NHS figures last week showed that the number of full-time equivalent GPs working in England had fallen over the last year, despite the government’s pledge to recruit 5,000 more by 2020.
NHS Digital revealed that the family doctor workforce comprised 34,495 full-time equivalent GPs in September, 97 fewer than a year earlier.
Stokes-Lampard warned that high vacancy rates in GP surgeries were having “a real human impact on our entire practice teams and our patients. We are already running on empty and in many cases working at the absolute limit of what is safe,” she said.
As many people return to work after Christmas full of good intentions, leading dentists are urging them to make one more resolution for the new year: eat less cake in the office.
The faculty of dental surgery (FDS) at the Royal College of Surgeons has urged employers to tackle workplace “cake culture” which is contributing to the obesity epidemic and poor oral health.
The faculty is urging companies to swap biscuits for fruit and nuts in meetings, scrap the most sugary treats from vending machines and make low-sugar options more available and visible, while employees should stop snacking and eating birthday cake and other treats throughout the week.
“We need a culture change in offices and other workplaces that encourages healthy eating and helps workers avoid caving in to sweet temptations such as cakes, sweets and biscuits,” said the dean of the faculty, Prof Nigel Hunt.
In 2015-16 around 63% of adults in England were classified as either obese or overweight and nearly 64,000 over-18s were admitted to hospital because of tooth decay. According to the FDS, 40% of people made a resolution to lose weight last year, and 24% said they wanted to eat more healthily.
The office had become one of the main places where people consumed excessive amounts of sugar thanks to rewards from bosses and colleagues celebrating special occasions, said Hunt.
The faculty has produced a series of tip for workers to cut back on sugar.
It says they should avoid snacking and keep sugar as a lunchtime treat, reduce portion sizes and introduce a “sugar schedule”, so if birthdays happen throughout the week, cakes are only doled out on Fridays.
Only eating sugar at lunchtime can help keep teeth healthy as each time sugar is consumed it fuels acid formation, which softens tooth enamel and leads to decay, according to the faculty. Less frequent sugary snacks means the teeth “come under attack less frequently”.
It urged more companies to employ the “nudge theory” tactics used by companies such as Google, which places confectionery in opaque containers, uses smaller plates and makes healthy foods more visible – resulting in its New York employees eating 3.1m fewer calories over seven weeks.
The FDS also called on the government to restrict sugary food and drink price promotions and consider forcing supermarkets to replace high-sugar foods at the point of sale with healthier alternatives, using legislation if necessary.
The government plans to introduce the soft drinks industry levy in April 2018 which will apply a charge to makers and importers of soft drinks that contain more than a certain amount of sugar.
A healthy society, surely, is one that helps its children feel safe and secure. If this were a banal proposition, it wouldn’t even have to be stated. Yet there are plenty of people who would contend that it’s not up to society to make kids feel safe. That, they will announce with tremendous self-satisfaction, is the job of their parents. It’s as if they don’t even know that humans are social animals, and that it is the ability of humans to think and act from social motivations that fostered civilisation.
For these folks, any sign that children are struggling in Britain today is sneeringly dismissed as more evidence of generation snowflake’s feeble lack of resilience. This aggressive, sloganeering refusal to engage with the feelings of vulnerability of others, but instead to mock and belittle them? That in itself is a statement of intent. It is an assertion that helping young people to feel safe and secure is not in the least their business. On the contrary.
Research by the NSPCC, gathered through freedom of information requests, warns that serious cases of self-harm among young people have jumped by 14% in the last three years, with 19,000 children and young people treated in hospital in England and Wales in the last 12 months. People self-harm when they crave the primitive distraction of physical pain from the insistent complexity of emotional distress. The respite is brief and dangerous. Often, it piles shame and guilt on to a chaotic heap of negative emotions that has already proved overwhelming: snowflakes dissolving in their own sticky blood.
The fact that these children choose to harm themselves rather than others is a sign that they feel plenty of shame about their fears already, for which they blame themselves. Often, children report that they couldn’t talk to their parents because their parents were too busy. What they tend actually to mean is that they’re worried and upset because they know their parents are worried and upset, and they don’t want to add to the burden.
But if it’s the job of parents not to be worried and upset, so that they can help their children, then you have to ask why it’s such a great idea to consider human competition rather than human collaboration as the magic fountain from which all good things gush. It’s always too simplistic to theorise about how a vast range of individual and particular crises are all down to one thing. Yet the list of the usual suspects that’s aired when mass psychological struggle hits the headlines does include a lot of stuff that has competitive elements.
Any sign that children are struggling is sneeringly dismissed as more evidence of generation snowflake’s feebleness
There’s the pressure to look attractive, the pressure to succeed at school, the pressure to be popular, the pressure to get a job, to get a home. If I were growing up now, I’d be terrified. I was pretty terrified in the 1970s, when I’d no idea how much more demanding and complex life was going to get. Are children wrong to feel these pressures? Can any parent honestly tell them that none of it matters and that life has a way of turning out OK?
Yet all this is just a backdrop to the existential struggles of life. Children still have to deal with private catastrophe – bereavement or abuse, illness or trauma – as well as global horror: the horrific evidence of human aggression and the suffering it causes, there on your phone all day, every day. All this, alongside the sheer effort of becoming yourself in an era that idolises individualism.
Left and right, politically, they both do this. The left champions identity, the right champions robust economic self-sufficiency. Do we give children time to find out who they are, among the blanket demands that they should Be Themselves? We don’t give them time and we certainly don’t give them much in the way of psychological tools or support. After all, therapy costs money in this economically competitive world.
We need to feel part of something bigger than ourselves, and sometimes I think Brexit is best understood as an expression of that yearning. Young people, on the whole, felt like part of Europe because they’d grown up with it. Maybe older people just felt like their own place in the world had just become so much harder to locate in their hearts once they weren’t simply British. And how people viewed Europe in their daily lives also raised the spectre of competition; people coming here looking for work, and helpless employers, themselves governed by competition, quite unable to do anything other than pay the lowest wages possible.
I’m not saying that vulnerable young people self-harm because hashtag Brexit. That would be too simple. But I am saying that it may reflect the fact that there is too much competition in the world and not enough caring support. Competition can be a great driver of achievement, but so can collaboration. The corrosive thing about competition is that it fosters fear of failure, which has to be countered. Balance is everything, and that’s what we don’t have. People are afraid and ashamed of their fear; so it festers, and explodes in anger and resentment. It’s fertile ground for demagogues who offer glib, bogus answers and, boy, do they plough it.
You can choose to see “generation snowflake” as a bunch of wimps, or you can observe that there is plenty going on in the world to traumatise a sensitive child – or adult. Then you can think a bit about how traumatised people make bad decisions, and conclude that the aggression, the fear, the shame, the self-harm – it has to stop. The very essence of what it is to be human – to be able to look after one another and help one another find solutions to our problems – is what is at stake, and children feel it.
It is drizzling and cold in Salford, but a class of eight- and nine-year-olds from Lewis Street school in Patricroft are buzzing as their teachers lead them down the streets of terraced houses between classes. They stride through a park, dodging an abandoned car seat, to swipe lanyards against three street sensors before returning to lessons.
It’s called “going fobbing” in Salford – walking or cycling to sensors on lampposts all round the city and swiping them to get points. It’s part of a health and community building scheme called Beat The Street (BTS) and it’s taken Lewis Street by storm. Pupils and parents have travelled 3,288 miles (scoring a mighty 66,490 points) on fobbing expeditions over two months to outwalk all Salford’s other 23 participating schools and 13 community groups.
Patricroft is a struggling area, where unemployment is high and the number of people describing their health as bad or very bad is well above the national average. But there’s a clear sense of purpose here as the warmly wrapped youngsters line up to swipe their fobs near the school. “I did all the 50 fobs in three days over half term,” says one little girl excitedly. Her teacher reveals that this previously inactive child now goes to an after-school sports club almost every night of the week.
The school has undergone a mini revolution. A detailed and constantly changing online content plan, social media and incentives such as tickets to local amenities, keep the players engaged – not to mention the sense of competition.
Rachael Hall, the school’s sports coach, says: “I’ve never known anything like it – children are going out walking every evening and weekend. Teaching assistants take the children out at lunchtime three times a week and take whole classes out twice a week. I’ve had parents telling me how happy they are to be spending time with their children going fobbing rather than sitting in front of the TV.”
She says a little boy with cerebral palsy with walking problems has made big progress because of the peer pressure to participate in BTS. Another pupil has become so fascinated by the project that he has taken to writing down where he has been, which has improved his school work.
‘I’ve never known anything like it – children are going out walking every evening and weekend.’ Photograph: Beat the Streets
This is exactly what Beat the Street founder and Reading GP, Dr William Bird is after – galvanising whole communities, with the health message almost a side issue. He says: “I want to get the whole of the UK walking, starting with the cities where it is easiest. Walking creates vibrancy – take it away and you create a flat and dying city full of underpasses where no one wants to go.”
Intelligent Health, which Dr Bird set up to operate BTS, works by turning a town or community into a game where people of all ages earn points by walking, cycling or running between sensors placed on lampposts. In the process, no-go areas are opened up to pedestrians, people have fun together and develop healthier habits.
Jennifer Dodd, engagement manager for BTS in Salford, has convinced 5,500 people to take part so far – (though not a patch on Belfast which boasted 36,000 players). She says: “People are not seeing BTS as exercise but as a fun way of going out with the family. We are not saying to people ‘go and join a gym or get yourself to an exercise class’ we are saying ‘go out and meet your friends’.”
Part of her work has been to link fobbing with community events – such as the Eccles Makers Market – where BTS participants could gain extra points on the day of the event at a temporary sensor set up nearby.
The two-month games are preceded by three months’ community engagement, where people such as Dodd work with GPs, local NHS organisations, community groups, sports clubs and schools to build up the enthusiasm. Then the activities requested by a community are set up, whether that be women-only bike riding classes in Asian-dominated Wandsworth in Birmingham, or just the incentive to walk into town for previously immobile elderly members of Banham Drive, Sudbury. There elderly residents walked more than 1,500 miles together and have now set up organised walks.
BTS is proving successful in health terms according to results from 53,000 participants. During the game phase the proportion of adults meeting the physical activity guidelines increased from 46% to 57% and the percentage of adults reported walking on five to seven days per week increased from 47% to 61%.
Government research shows that those who fulfil the recommendation of 150 minutes per week of exercise will improve 23 different long-term conditions including diabetes and dementia, reduce the risk of developing several cancers and even stimulate the brain chemicals that reverse ageing, says Bird.
Intelligent Health’s research shows that people are put off by the NHS’s health messages, because they feel they are being lectured. So the year-long health programmes targeting areas of deprivation put the emphasis on enjoying activity with others – and last year 175,198 peopletravelled more than 1.5m miles with BTS in 21 areas.
The scheme is not working for everyone, though. Head of Lewis Street School, Gemma Lavelle, says: “Even though BTS has raised our activity levels we know that some parents have not signed up. What do we have to do to get some of the really hard-to-reach families involved?”
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There are many options available for people who desire to lose weight. Amongst these options is dieting. While many people may not like dieting, it works. However, dieting only works when it is done right. Many people unknowingly sabotage their effort to lose weight by certain actions. If all your dieting effort proofs abortive, you might be guilty of one or more of the mistakes below:
Rewarding Yourself after workout
Quite a number of people are guilty of giving themselves a treat after a workout. Doing that, most of the times, tend to cancel out the benefits of the efforts invested in the workout. Punishment could be a better incentive for exercise that reward based system.
Doing the same routine always
You can’t repeat the same thing and expect different results, says Albert Einstein. This applies to workout as well. To make the most of your exercise plan, vary the intensity, time and frequency of your workouts.
Ignoring Weightlifting
Most people, especially women, are usually tempted to stick to cardio alone. However, to get the most out of your workout program, strength training is needed as well. This will keep your metabolism up and burn fat like magic.
Succumbing to Workout Fatigue
Fatigue is one of the most common excuse people give for not exercising. On the contrary, exercise energizes you. Ignore the tiredness and take a walk for about 10 mins. You might end up going longer.
Drinking fruit Juice or Sport Drinks
Most fruit juices are made with artificial ingredients mixed with water and made to taste like fruit. Fruit juice might not be the best thing on the food list of anyone keen about dieting. This is because all the nutritional values you get with original fruit has been removed from fruit juice. The high proportion of sugar in most fruit juice also makes it ineffective for dieting. The sweet taste of fruit juice also increases the tendency to over-drink fruit juice. If you are serious about your dieting effort, go for original fruits instead of fruit juice or sports drinks.
Every day weighing
You don’t expect your weight loss to be magical, do you? Thus, expecting to see changes every day via measurement is just absurd. Everyday weighing has the tendency to increase your frustration level. Instead of hopping on the scale every morning, make it a weekly thing. The result will be motivating instead.
Not Snacking
I know what you are thinking – that Snacking is bad. However, selective snacking could help drop the pounds. Research revealed that people who consume several small meals a day are less likely to get hungry and overeat. Thus, snacking, especially with protein-rich ones, is a good way to keep your metabolism firing on all cylinders.
Ditching Breakfast
While avoiding a meal could be tempting as a way to drop fat, the repercussion could be negative. You might be hungry for the rest of the day leading to bad food and snack choices for lunch and dinner. A breakfast high in fiber and protein would likely reduce hunger all through the day.
Setting Unrealistic Goals
Desiring to lose 25 pounds in your very first week is just being unreasonable. Such unrealistic goal tends to lead to frustration even when you are making great progress in your dieting effort.
Over-relying on Weight Loss Supplements
There is no doubt that weight loss supplements work for losing weight. In fact, the different categories of weight loss supplements offer different kinds of benefits for people that desire a quick weight loss fix. However, depending majorly on weight loss supplements without complementing it with workout and dieting could be the perfect recipe for failure!
Being conscious of the above will go a long way in guiding you against failure in your weight loss journey.
Women in the Republic of Ireland and Northern Ireland who have obtained abortion pills online in defiance of the law overwhelmingly express gratitude and relief that they were able to end an unwanted pregnancy, a new study shows.
Their only regret, according to a paper published in the British Journal of Obstetrics and Gynaecology, is that they are having to do something that is illegal in their country. They express anger and disappointment that they could not access a safe, legal abortion and felt they were treated as second-class citizens.
“Abortion is a huge decision for some women to make. It’s shameful that we are met with brick walls and judgment in our own country,” said one.
Abortion is illegal in both countries but since 2006, the Netherlands-based organisation Women on Web has been offering medical consultations online and dispatching in the post the two pills – mifepristone and misoprostol – that will terminate a pregnancy within the first 10 weeks.
The organisation offers the service around the world and has seen a sharp increase in women seeking help from countries in Latin America, where abortion is also illegal, after the link was made between Zika virus infection in pregnancy and brain damage in babies.
Packages shipped to Ireland are stopped, so women travel to Northern Ireland to collect them instead. It is not illegal to buy or sell the drugs, but it is to use them to bring about an abortion.
In April, a woman in Northern Ireland who took the pills and was reported to the police by her two flatmates was given a three-month suspended sentence by Belfast crown court. The case sparked protests and demonstrations of solidarity from other women who announced they too had resorted to the abortion pills and challenged police to arrest them.
Women with an unwanted pregnancy in Ireland previously had to travel to the UK if they wanted to have an abortion. Between 1970 and 2015, 180,797 women from Ireland and 61,311 women from Northern Ireland made the journey. Many still do rather than break the law by bringing about an abortion at home.
But the study, carried out by Abigail Aiken and her colleagues at the University of Texas at Austin, found that many of the women who went online for help could not afford to travel or to take time off work or the costs of childcare.
“These barriers create a stark health inequity: women with financial and social resources can access offshore termination of pregnancy, while women who lack such resources cannot,” says the paper.
The study found that 5,650 women sought help from the site between 2010 and 2015. Most (85%) were between 20 and 30 years old and were mothers (63%).
The most common reason for choosing to terminate pregnancy (reported by 62% of women) was not being able to cope with a child at that point in their lives. Nearly half – 44% – cited having no money to provide for a child, and 23% felt their family was already complete. Nearly a third – 30% – felt they were too young to have a child or wanted to finish their education.
Almost all – 97% – said they felt accessing and using the medication at home was the right thing for them and 98% said they would recommend it to other women in a similar situation. The most common feeling they reported after completing the procedure was relief (70%), followed by satisfaction (36%). Over a quarter – 26.8% – said they were happy and 22% said they were pleased. The vast majority – 94% – expressed gratitude that they could go online and obtain the pills.
“There is a very negative perception of a home abortion,” said Aiken, an Irish-born assistant professor at the US university. “People regard it as desperate and a last resort. But women say it is very helpful for their health, wellbeing and autonomy. The only negative thing is that they have to do it outside of the law.”
The website asks women to make a donation to its costs, suggesting €70 to €90. Over a third – 35% – said they found it difficult to find the money. Nearly a quarter (24%) said they did not get enough emotional support from family and friends.
One of the women surveyed told the researchers: “There is no way I could have afforded to travel to England, pay for the procedure, stay in a hotel, and have someone there to support me. Thanks to this service, I was able to have a safe abortion in an environment where I felt comfortable and with my partner there to support me. Thank you for enabling women to have control over their own bodies.”
Others said that without access to home abortion, they would have considered suicide. “I can’t thank you enough – you have saved my life,” said one. “I would have had to resort to desperate measures. You will never understand how grateful I am.”
Many times in our lives, we get the choice to achieve something through hard work and perseverance….or to take the easy scenic route instead. When it comes to sustainable weight loss, specifically, taking the scenic route is never the right option. To attain a healthy, strong body, only hard work and dedication will get you there.
But sometimes, we can’t help but go to extreme measures to achieve our weight loss goals-we’re only human, after all.
Below are 5 examples of diets that were once popular (in part to their too-good-to-be-true concepts) but have been proven to be anything but effective (and best to avoid trying out altogether!)
1. The Apple Cider Vinegar Diet
Apple cider vinegar is a natural tonic known for its many health benefits (healing a cold, stuffy nose, hiccups and indigestion for starters) but one of its most well known perks is its ability to aid in weight loss. Apple cider vinegar can help suppress your appetite and increase your metabolism, making it a popular kitchen staple. However, the Apple Cider Vinegar Diet requires a person to drink 3 glasses of apple cider vinegar with cayenne pepper and honey a day.
While a tablespoon of apple cider vinegar can prove to be highly beneficial for your overall health, 3 glasses of this drink is more likely to be determinantal to your body. The level of acidity a person ingests in 3 glasses could be potentially dangerous and lead to digestive pain, nausea, teeth erosion, bone loss and low potassium levels. Avoid making this your go-to drink and stick to a maximum of 2 tablespoons of apple cider vinegar a day for optimum benefits.
2. The Tapeworm Diet
This one is pretty insane. There is a diet in existence that consists of people ingesting a real live tapeworm in order to spare themselves calories.The tapeworm supposedly feeds on the food a person eats before it’s absorbed into the body. This fad diet was one of the first of its time, dating back all the way to the 1800s!
Having a parasite living in your body is very risky to begin with. You can’t know for sure the tapeworm won’t move to other parts of the body and relocation in a new area of the body can lead to several side effects that include nausea, diarrhea, headaches and in extreme cases, stomach pain and death. A tapeworm isn’t easy to remove either. Besides all of those factors, having a tapeworm live inside your body for too long can also lead to severe malnutrition.
3. The Military Diet
The Military Diet became very popular last year as bloggers found out about the diet that allows you to eat hot dogs for a meal. Yes, really. The Military Diet doesn’t actually have any ties to the military; it simply consists of a strict 3 day meal plan followed by 4 days of normal eating.
The Military Diet focuses on eating small quantities of high fat food, something that might prove to have more negative results than positive.
The Military Diet’s fat burning combinations don’t have any scientific merit and the 3 days a person spends eating small quantities of food are likely to make you feel more hungry than satisfied. Your better option is to stick to a well balanced diet plan that doesn’t require you to go hungry or avoid entire food groups.
4. The Baby Food Diet
This one is exactly what you imagine it to be. The baby food diet consists of eating mainly pureed baby food that you can find in grocery stores. Baby food is essentially mashed fruits, vegetables and meats, and provides infants with the nutrition they need when they don’t have the teeth yet to chew solid foods. While not harmful on its own, many supporters of the baby food diet replace 1-2 meals of regular meals with jarred baby food.
The amount of nutrients and calories in a jar of mashed mush may be enough to sustain a baby, but it’s definitely not enough for a fully-grown adult. The baby food diet is unhealthy because it deprives individuals of the recommended nutrient and calorie intake per day, causing the body to go into starvation mode and actually prevent a person from losing weight.
5. The Low Fat Diet
There are many versions of this type of diet available and they’re all comprised of the same low fat meal plans that lead to cravings and hunger pains. There’s nothing wrong about being mindful about fat- the thing to keep to remember is that fat isn’t the bad guy.
When you avoid fat, your mind starts to crave low fat carbohydrates like pretzels, crackers and white bread- foods that lead to a rapid blood sugar crash and even more cravings. Change it up and choose foods that actually have a healthy fat intake (e.g- plain yogurt with fruit or fresh salad with olive oil and vinegar dressing) to feel satisfied and notice results.
Conclusion
Most effective diets are ones that combine healthy eating and regular exercise to get the results you want. Fad diets or meal plans with a central focus on one food group aren’t an effective long term solution and they certainly don’t consider your overall health. No amount of food deprivation or binge eating will get you the results you want. Your best bet is a well-balanced meal plan, exercise and a healthy lifestyle. Good luck!
“Do you ever hang on to the sink to help you get up off the toilet?” Not necessarily a conventional conversation piece, but occasionally a question I ask in a personal independence payment (PIP) appeal tribunal.
I’m one of a three-person tribunal that hears appeals from disabled people who have been refused either PIP, disability living allowance or attendance allowance; three benefits that are designed to help meet the extra costs of living with a disability or long-term condition.
I sit on tribunals an average of two to three times a month, and am the so-called disability-qualified panel member. The other two are a lawyer and doctor, and between us we decide whether someone meets the criteria for a benefit award and will have their appeal upheld.
When deliberating the case above (let’s be original and call him Mr Smith, a middle-aged man with a musculoskeletal disorder), the doctor mildly chided me for asking such a direct question, suggesting that I had perhaps led the claimant to a “yes” answer, and pointing out that the claimant had said nothing on his form about needing help to get off the toilet.
As panel members, we have to be impartial. I reminded him that many people don’t understand how they should fill in the form and struggle to follow the logic of how the decisions are made about who gets benefit. Many people who come before us haven’t even thought about, let alone got, advice from a benefits expert (which they should always do, if they possibly can). Any half-decent adviser would have found Mr Smith needed help getting off the loo.
It’s part of my job to look at a claim from a disabled person’s perspective. I can ask questions about how someone has filled in the form and get an understanding of the implications of what they have (or haven’t) said.
My personal experience of disability gives me some insight into the kinds of questions to ask to get relevant information about people’s conditions that make their day-to-day life difficult.
Most appellants who come to the tribunal are nervous. Tears and distress are common, even though tribunals are pretty informal. Having someone on the panel who isn’t a doctor or a lawyer does make things easier for many claimants and they are more likely to open up.
I help increase the general knowledge base of a tribunal. It’s not a “jury of their peers”, because there are not 12 of us, but it does at least nod to that principle by having a disability expert on the panel.
Although the vast majority of panel members I’ve sat with over the years are good people, everyone can have bad days, doctors and lawyers included. Three-person tribunals add checks and balances to the benefit appeal process, with room to challenge and probe decision-making and reasoning.
Sometimes we can’t give an award because the rules don’t let us, and that can be frustrating. Often we are genuinely shocked because the quality of assessments are so incredibly bad that we can’t believe that someone has been forced to appeal to get a benefit they clearly qualify for. Some assessments would be laughable if the consequences weren’t so serious.
Mr Smith got his benefit, unanimously agreed by the panel, because of my question. Was the decision the right one? Yes, of course. Would he have got it if I hadn’t been there? I don’t think so.
It’s clear that her symptoms are advancing and that she was right on the futility of further chemotherapy. She is having trouble staying awake, her appetite is deteriorating, and she is weaker by the day. This may well be our last appointment.
“We can get rid of a number of your medications,” I say, frowning at the long list that her daughter says is proving increasingly difficult to administer.
“Let’s do that,” she says joyfully.
So in one of my favourite acts, I slash half her list, explaining why as I go along.
But she stops me at the statin, an anti-cholesterol drug she was prescribed 20 years ago for a barely elevated cholesterol detected on an insurance test.
“I need that so I don’t die from a heart attack.”
“Not quite,” I say soothingly. “Statins exert their benefit over many years and we agree that now, it’s more important to maintain comfort.”
“I can’t imagine my day without my statin,” she declares, leaving me to wonder somewhat enviously how her cardiologist managed to evince such devout compliance for a questionable cause.
Just then her husband pipes up. He is a sprightly 74, still working, and unlike his wife, detests medications, including the statin he was prescribed after a serious heart attack some years ago.
“Well, I’ve decided that at 75, I am swapping the statin for sausages. From what I hear, the two are as bad as each other.”
She has heard this before because the wife adds with a smile, “At 75 or when I die, whichever happens sooner.”
I urge the husband to discuss his decision with his doctor before stopping treatment, I tell my patient to stop her statin and I bid them both a fond goodbye.
As they leave, I find myself thinking about many recent conversations I have had with patients about statins. With cancer patients who have a limited life expectancy, stopping the statin is both safe and right. But during my stints in general medicine, where we treat heart attacks, strokes and dementia, the answer is more nuanced.
Does everyone need a high-dose statin? How many will experience side effects? Is lifestyle modification a reasonable starting point or should every patient be commenced on a statin? The reality of most hospital management is that a drug is prescribed and the patient finds out as an afterthought. But if a statin, once started, is likely to become a lifelong drug, what considerations are important beforehand?
Many patients have heard of statins but awareness does not mean familiarity and it certainly does not mean being informed. For every person who trusts a doctor’s recommendation to take a statin, someone else suspects a conspiracy theory fuelling the prescription of the world’s highest-selling drug.
For the patient who wants to know more, things can get complicated. A cursory internet search warns that statins make women (but not men) more aggressive, accelerate ageing, damage stem cells, worsen heart disease, cause dementia and are “unhealthy and unethical” to prescribe.
Alongside are studies asserting that statins significantly reduce the incidence of heart attacks and strokes and improve mortality. Their benefits are evident within the first year of intake and accumulate over time, making them among the few drugs to have a dramatic impact on health outcomes. Considering that heart disease is the number one killer in many parts of the world, this is no ambit claim. But pity the hapless patient trying to make an informed choice – it’s hard to know which “expert” advice to heed because everyone sounds knowledgeable.
Very few patients needed to stop statins due to adverse effects.
When I recently prescribed a statin to a young woman with a heart attack and a host of coronary risk factors, she expressed concern. I explained that no drug was without side effects but a new, rigorous, non-industry funded, meta-analysis by the clinical trial service unit of Oxford University, shows that the benefits of statins have been underestimated and harms exaggerated. The results were published in the Lancet medical journal.
Treating 10,000 high-risk patients with a low-cost, generic statin for five years prevented 1,000 strokes and heart attacks and treating 10,000 lower-risk patients prevented 500. Of 10,000 patients, five might suffer muscle aches, up to 100 may develop diabetes and five to 10 may suffer a brain haemorrhage but these side-effects have been included in the estimate of the absolute benefit.
Very few patients needed to stop statins due to adverse effects. It may not be the absolute final word but the meta-analysis concludes that many problems have been misattributed to statins, therefore planting fear in the minds of those at high cardiovascular risk and dissuading them from taking a potentially life-saving drug.
But how did these rare toxicities garner so much attention in the first place?
In October 2013, the British Medical Journal, as part of its mission to promote rational prescribing, published a paper quoting the incidence of statin-related side effects being as high as 18% and thus concluding that statins did not provide an overall health benefit to those patients deemed at low risk. But the 18% figure was based on flawed research and it was apparent that even in the quoted research, the figure was closer to 9%, but without the inclusion of a placebo-controlled group, which meant even the 9% could not be genuinely attributed to statins. (The meta-analysis says that statins are “no less well-tolerated than placebo”).
Seven months later the BMJ corrected the erroneous statements but did not retract the entire paper. Sir Rory Collins, the lead author of the Oxford meta-analysis, warned at the time that without full retraction, doctors and patients would continue to be misinformed. It turns out he was prescient.
Medical journal editors … owe it to society to publish papers that “first do no harm”.
Misleading media reports followed and led to increased reticence among doctors to prescribe or even discuss statins and increased unwillingness among patients to take them. Statins were already being under-used but a new wave of adverse media meant a further reduction in use.
In the UK, 200,000 patients stopped taking statins. 60,000 fewer statin prescriptions were dispensed in Australia following a now-withdrawn television program. If those patients avoided statins for the next five years, researchers estimated that a few thousand would suffer a fatal heart attack or stroke. For a disease that kills 17 million people around the world each year, an ounce of prevention is not to be sniffed at.
So what does the statin saga teach us? For one, it underlines the power of the media and in turn, the responsibility of health reporters and newspaper editors to think twice before exploiting health news to suit their audience.
“Beloved grandma loses mind to cholesterol drug” and “How statins ruined my life” might be guaranteed click-bait but responsible reporting might instead discuss the dreadful statistic of one Australian dying of cardiovascular disease every 12 minutes and how to prevent it. Statins are no panacea but combined with diet, exercise and curbing cigarettes and alcohol, they have a role.
Second, it reminds medical journal editors that they owe it to society to publish papers that “first do no harm”. If Big Pharma can’t be trusted to provide unbiased data and to base advice on sensational tabloid fare makes a mockery of medicine, doctors must put their faith in someone to provide credible information.
There is an old joke that the majority of academic papers are read only by the author and the editor – this may be a little harsh but busy clinicians mostly flick through abstracts and note key points rather than read even a fraction of the million scientific papers published annually with an interrogating mind. It is up to journal editors to simplify the task and spell out the difference between interesting research and findings that transform patient care.
Finally, better health arises from better health literacy. In a free society, patients are allowed to make poor choices but the media shouldn’t facilitate it. Just this week an acquaintance asked me what I thought of her daughter’s “courageous” bid to not vaccinate her child for fear of “giving her autism”. I reminded her that the fraudulent data had long been exposed and retracted but she said she had seen it on the net and that was that. Dashing my hopes, she next took on statins.
“What do you make of the controversy?”
“There is no controversy,” I replied. “Read the report.”
“You would say that, wouldn’t you?”
Then, after a pause, “But seriously, did you see the story about the old lady who went mad on her statin?”
No, I didn’t. But newspaper editors, please take note!
It’s 5am. An hour ago the bed manager called me and asked me to ask a suicidal woman, who had already been in a busy London A&E department for 11 hours, if she would agree to being admitted to a hospital in Manchester.
I didn’t think it appropriate to wake someone at such a time in the morning but allowing her to sleep was not an option because we need the bed space. I approach the patient; she’s already awake. “I haven’t slept all night, it’s so noisy here” she tells me. “I feel awful; can’t I just go home?” I apologise and explain that the only available psychiatric bed is in Manchester. “No, it’s too far from my family”. I tell her I understand. She starts to cry; I want to cry with her. She feels depressed and worthless and I haven’t been able to help. How am I, as a psychiatric nurse, caring for her and helping lift her out of the awful dark place she finds herself in? I think about people who are in physical pain and ask myself whether we would expect them to wait without any treatment for over 11 hours.
Related: Working in mental health is not like fixing broken legs
I remember a recent patient who had been in the department over 24 hours waiting for a psychiatric bed. He was socially isolated and was hearing voices telling him to end his life. We moved him to a noisy cubicle which made the voices worse. He was in distress, I tried to reassure him. He told me: “I just want to go home, it is making me worse being here”.
I was told later that he had left the department. I frantically called him and fortunately he answered to tell me he had returned home. He said he was frightened but that it was worse in the hospital. I felt immense guilt – this isn’t why I became a nurse. What if he becomes ill again in the future? He will feel reluctant to return to A&E, the place that his community mental health team tell him to go to be safe.
A young man with autism, who has been in our mental health assessment room over 24 hours, is suffering from psychosis. The walls are bare, the air conditioning has broken, the lights, which are movement sensitive and without a switch, remain on throughout day and night making rest impossible. He is covered in sweat and he is terrified. The long wait and his surroundings make him increasingly more distressed. He is eventually sedated – not for the treatment of his condition but rather to alleviate the stress we have caused him.
I tell both him and his mother that the nearest psychiatric bed is 200 miles away. His mother starts to cry; due to the nature of his condition, he finds change very difficult.
Some of the other nurses have children and start to cry themselves. The treatment and care we offer is not of the standard we would expect for our own family and loved ones. The patient’s mother tells us she doesn’t want to leave his side. We talk to senior management, but there is nothing that can be done.
Related: Working as a mental health nurse in today’s NHS drained me of compassion
I watch as the young man is separated from his mother and forced into secure transport – a cage in the back of a vehicle, with a narrow sideways facing seat, and without adequate leg room; it’s hardly fit for a brief journey, let alone one of four hours. I feel ashamed. We have failed this young man and his family.
We take a referral for a patient who wants to end their life. My heart sinks because the bed manager has told us there are no beds. I have to look the patient and their family in the eye and apologise over and over again. I see patients who are acutely disturbed, suffering because of our inability to provide them with appropriate care. We try our best, but there are only two of us on duty – sometimes we have four people waiting for an inpatient bed and 10 patients waiting to be seen. We have to rely on security, who try but are not trained in mental healthcare and sometimes add to the patient’s distress.
I witness human suffering every day and am often amazed by patients’ own resilience in the face of such adversity. Hospital staff are their family, their voice and if we don’t raise this issue for them, it will continue because it is those who speak the loudest in the NHS that are often heard. Our patients already feel worthless and as though they are a burden; if we continue to reinforce that, rates of mental illness and suicide will continue to increase.
• In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.
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