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Archive for the ‘Health’ Category

Looking Back On 2012

Well, 2012 is almost over and it seems as though the world didn’t end in some Mayan catastrophe. So let’s have a look back at some of the highlights of what was an action packed year in so many fields.

Why not start with sport? And what a sporting year 2012 was, with Bradley Wiggins winning the Tour de France, Andy Murray taking his first Grand Slam title, Spain adding another international football trophy and Europe producing an incredible comeback to pinch the Rider Cup. Then there was the London Olympics, with more success for Wiggins and Chris Hoye on the track, new heroes including Jess Ennis and Mo Farrar emerging and more brilliant performances from the incomparable Usain Bolt.

Chelsea won their first Champions League trophy, Manchester City took the EPL in injury time of the very last game and Celtic won another league as well as reaching the last 16 of the Champions League with a great campaign that included a win over Barcelona. What an achievement for Sky Sports’ manager of the year Neil Lennon.

It was quite a year for sports then. But it did have its darker side too. Lance Armstrong was stripped of many titles after a doping scandal, racism in football remained a massive issue in many countries and Rangers FC went bust owing millions. (It’s the season of goodwill, so after a lot of debate I decided to include this here rather than the highlights …)

In world politics, we saw uprisings in the Arab Spring, Palestine admitted to the UN, a new leader anointed in China, the devastating effects of Hurricane Sandy and Obama beating Romney to the US Presidency. But the year ended with the tragic shootings at Sandy Hook Elementary School that bought gun control back to the top of the American political agenda.

Here in the UK we saw the phone hacking scandal, which led to the exposure of police, political and press collusion. The Leverson Report eventually recommended a new system of press regulation, but it remains to be seen if this will be implemented in full. And more banking scandal news saw the exposure of rate fixing as well as many more large bonuses.

It was not a good year for the British state, with many controversies that were once dismissed as left wing conspiracy theories being exposed as reality. Security service involvement in the murder of Irish lawyer Pat Finucane was finally confirmed, as was the torture of prisoners in Iraq. And the Hillsborough families finally saw official recognition of police cover up and lies in the aftermath of 96 Liverpool fans’ deaths.

Allegations of police conspiracy during the miners’ strike also refuse to go away, with many bogus charges and unsafe convictions being challenged. The full story of police behaviour and army involvement during the strike has still to come out.

In UK politics it was the year of the double dip recession, more government cuts and a proposed benefits freeze. But there is no economic plan B and so austerity will continue. The budget was a complete mess, with pasties and caravans suddenly in the news as Chancellor George Osborne was forced into a series of u-turns as his plans unravelled. The tax cuts for the rich remain in place though. And Tory divisions on Europe and marriage equality continue to dog David Cameron.

The Tories under Cameron and Osborne have continued to lose support while Nick Clegg and his Lib Dems remain trapped in the coalition knowing than an election would lead to massive losses. Labour has a large poll lead, but has Ed Miliband really captured support, or is this simply a protest against an unpopular government? For me he has still to set out a real alternative to the current shambles – but he has time to do so.

In Scotland the big news was the announcement that agreement had been reached for Westminster to transfer the power to hold a single question independence referendum to the Scottish Parliament. But the vote won’t actually take place until 2014. Strangely, given that success, it was actually a pretty bad year for Alex Salmond, who was forced to apologise to Parliament over wrongly denying education spending cuts and caught out by giving a misleading impression over the lack of legal advice on the EU. New Scottish Labour Leader Johann Lamont caused controversy by beginning a debate on universal entitlements, but overall she has made a decent start in her new position.

There were other big news stories in 2012. It was a bad year for the BBC with details of the Jimmy Saville abuse scandal emerging, to be followed by criticism of the Corporation’s role in the whole affair. Meanwhile the discovery of the Higgs Boson pushed scientific understanding forward, while the Olympics as an event were a massive success, but only after security failings almost derailed things.

The weather was even more of a talking point than ever, with everything from early droughts to late floods recorded. Who can say that there is not something to climate change? And, amongst the showers, much of the summer was spent on a series of events to try to persuade us that being ruled by the same person for sixty years is a good thing.

Abu Qatada finally left the country while Andrew Mitchell left the government after the Plebgate scandal, which won’t go away. Louise Mench left the Commons while Nadine Dorris left for the jungle, although unfortunately this was only temporary.

Several famous names did leave on a more permanent basis. Celebrity deaths in 2012 included first man on the moon Neil Armstrong and veteran actor Jack Klugman. Singers Levon Helm, Davy Jones, Robin Gibb, Donna Summer and Etta James all took a final bow, as did musicians Jon Lord and Ravi Shankar. Jack Ashley, MP and tireless campaigner for the disabled and architect Oscar Niemeyer also died, as did other big names such as Larry Hagman, Vidal Sassoon and Gore Vidal.

So 2012 was quite a year – and I’m sure there were a few other stories that I missed out on. Whatever your particular highlight was I hope it has been a good one for you.

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It is surely no surprise to anyone that the European Commission has entered the debate on the SNP government’s policy of introducing a minimum price for alcohol. So this is a fight that the Scottish government would have been expecting – but is it one that Alex Salmond actually wants?

The European Commission has argued that minimum pricing would be in breach of trade laws that promote competition in the EU. Bulgaria, France, Italy, Portugal and Spain – all producers of alcoholic drinks – have all lodged objections too. And the Scotch Whisky Association is pursuing an action through the Court of Session questioning the legality of the policy.

Minimum pricing would increase the price of cheaper bottles of spirits to around £14. A quick look at the Asda website showed they are selling own brand vodka at £10.27 a bottle and whisky at £11.96.The logic is that higher prices would decrease the amount that people could afford to drink.

Health experts predict that this could save 50 or 60 lives every year. I have my doubts as to the impact on hardened drinkers. Addicts will always find the money they need – after all heroin isn’t exactly cheap and many beg, steal or borrow to get the funds they need. But higher prices might reduce the amount that some people drink, and that can’t be a bad thing.

The new Cabinet Secretary for Health, Alex Neil, is not for backing down. “The European Commission is in favour of addressing alcohol abuse and have asked us to consider their points, which we will. We are confident that we can demonstrate that minimum price is justified on the basis of public health and social grounds and I will continue to press the case for minimum pricing in the strongest possible terms,” he said.

So it seems that there will be a fight. But does it suit Alex Salmond and his government to be seen as standing up against big bad Europe to defend what is a generally popular policy? With one eye on the referendum that is to come – and we all know that is Salmond’s absolute priority – I think that it does.

There are those within Salmond’s own party who disagree with the notion of independence in Europe, arguing that a truly independent country cannot exist within the EU. So putting some distance between the Scottish Government and Europe is no bad thing for Salmond right now.

And any situation where Salmond can be seen as standing up for Scotland on an international stage is a gift. The First Minister loves to be seen as an important figure beyond the confines of Scotland and will take any opportunity to play on the world stage. Especially when he can play the underdog, standing up for what he will argue is Scotland’s right to set its own policy.

So a challenge from the EU is no bad thing from an SNP perspective. If they were to win it would be seen as an endorsement of their approach and a victory worthy of celebration. A defeat would not be a disaster as it would be used as fuel for the independence argument – Salmond would find a way to blame the UK as the member state of the European Union, I’m sure.

One last thought. Did this expected EU challenge play a part in the decision to move Nicola Sturgeon from the health brief? It leaves Alex Neil to deal with alcohol pricing while Sturgeon is free to concentrate on arguing for independence.

 

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Scotland has a new Mental Health Strategy.

The Scottish Government’s strategy for the period 2012 – 2015 was launched earlier this month. There was none of the fanfare that usually accompanies these launches, although that might be due to the timing: mid summer, in a parliamentary recess and post Olympics.

The document was finalised following extensive consultation with user and carer groups, and the Scottish Government is to be commended for producing a strategy that takes on board many of the issues that were raised. User and carer involvement is, quite rightly, at the centre of the strategy, which is very much a working document rather than a lofty statement of ambitions.

The overall tone is of building on successes while recognising that there are also weaknesses to be dealt with. It is realistic, and in times of declining resources it simply had to be. There are no promises of massive new investment in mental health – but then did we really expect there to be?

There is a lot about self management and preventative action, what people can do to improve their own mental health and the challenges that issues like unemployment and poor physical health can play. The recovery approach and anti-stigma work will also continue.

The strategy recognises that measures to improve quality of life can also improve the mental health of many people. It sees that medical treatment is only one part of the fight against mental illness. And it also accepts that government is not the only agency with a role to play here: many of the services that play such important roles are delivered by other public sector bodies and often by the voluntary sector.

The Strategy outlines 36 Commitments from the Government across seven key themes, which emerged from the consultation process. These are:

  1. Working more effectively with families and carers;
  2. Embedding more peer to peer work and support;
  3. Increasing the support for self management and self help approaches;
  4. Extending the anti-stigma agenda forward to include further work on discrimination;
  5. Focusing on the rights of those with mental illness;
  6. Developing the outcomes approach to include personal, social and clinical outcomes; and
  7. Ensuring that we use new technology effectively as a mechanism for providing information and delivering evidence based services

So what will we see happening in the world of mental health over the next few years?

The very first Commitment is that the Scottish Government will commission a 10 year on follow up to the 2004 Sandra Grant Report, which reviewed the state of mental health services in Scotland. This will be carried out next year for publication in 2014.

The detail of who will carry out this major review and with what exact remit will come later. This is the strategy after all, and the fine print on how it is implemented is to follow. But we can expect service user and carer involvement in the review, and it will provide another opportunity for us to put forward our perspective.

There is a Commitment to involve families and carers more fully in policy development and service delivery. This is to be welcomed and discussions have already started on how best to progress this work. It is fair to say that many carers’ organisations are not experts in the mental health field and focus primarily on the carers of those with physical illnesses. It is also the case that many partners, parents and friends of those who have mental illnesses would not call themselves carers: they provide support and love but don’t necessarily see themselves as care givers. This all needs to be carefully thought through – but many of the national mental health voluntary organisations offer support to carers as well as to those with mental illness and are therefore well placed to help shape the discussion.

E-health is an area where much progress is being made and the Commitment to develop a Scotland-wide approach to improving mental health through new technology is to be welcomed. There is much that can be done through better use of technology and I look forward to seeing some innovative ideas emerge.

There are several Commitments relating to children and young people, including better support for parenting programmes, developing specialised services for children in care and reducing the number of young people admitted to adult mental health wards. These are all positive developments and the priority given to addressing mental health issues as early as possible is an encouraging step.

And Commitments relating to older people include greater use of psychological therapies and better integration with general adult services. While there is a necessary focus on tackling dementia in service delivery it is good to see a recognition that this is not the only challenge that older people can face.

Work to identify new models of crisis care is an important Commitment. This will involve investigation of home treatment and other service delivery models, recognising that hospital admission should not be the only option available. There are several voluntary organisations that will have an interest in this area of work, and several other European countries already offer a crisis house model.

There are also Commitments relating to specific areas like alcohol and mental health, work in prisons, veterans and also better linkage of mental health services to local government, which is especially important as health and social care systems are integrated.

The final Commitment made is that systems will be put into place to co-ordinate, monitor and performance manage progress against all of the commitments made. This is not to be a document that gathers dust on a shelf, but one which really does drive progress. The method by which this work is carried out, and of course how progress is reported, will be important.

My overall response to the Strategy is a positive one. The commitments on service user and carer involvement and the emphasis on self management are welcome. There is, of course, an important role for primary care services in mental health, but there is also a great deal we can do in communities to reduce the likelihood of hospital admissions.

Mental health issues blight the lives of many people, and can have a big impact on their families and friends too. There is much that can be done to make life better, and many of the positives from this new Strategy involve designing new services that better meet the needs of those affected.

I’m looking forward to seeing a great deal of progress being made over the next few years.

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A Toe Becomes A Thumb

What do you do when someone manages to cut off his thumb? Just chop off his big toe and sew in onto his hand!
That’s exactly what happened to 29 year old James Byrne from Bristol after he severed the thumb on his left hand while sawing through a piece of wood.

Attempts to save Byrne’s thumb failed and so plastic surgeon Umraz Khan came up with the novel solution. After discussion, it was agreed that the loss of a big toe would be less problematic than being without a thumb and so the operation went ahead.

Frenchay hospital in Bristol is a regional micro-surgery centre and has an international reputation for patients needing this sort of complex surgery. Khan led two teams of surgeons and anaesthetists: one working on Byrne’s toe while the other worked on his hand at the same time.

Khan said: “It is quite a rare thing to do and is a very complex micro-surgical procedure which involves re-attaching the bone, nerves, arteries, tendons, ligaments and skin of the toe to the hand.”

And what does Mr Byrne think of it all? Well, he is delighted.

“The aesthetics of it don’t bother me. I am just happy that it works. My work as a paver would have been destroyed without the use of my hand because I couldn’t pick up a brick without a thumb but now I hope I can be back at work in a few months,” he said.

Thumbs up then!

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Is Chocolate Good For You?

Eating high levels of chocolate could reduce the risk of coronary heart disease and stroke by about a third according to a review of previous research, published by the British Medical Journal.

But the researchers warned that excessive consumption of chocolate would result in other illnesses, and the British Heart Foundation said there were better ways to protect the heart.

Scientists from Cambridge University compared risks to the brain and heart in groups of people who reported eating low levels of chocolate, fewer than two bars per week, with those eating higher levels – more than two bars per week.

And their results showed that the, “highest levels of chocolate consumption were associated with a 37% reduction in cardiovascular disease and a 29% reduction in stroke compared with the lowest levels”.

Dr Oscar Franco, one of the researchers, said that chocolate was also known to decrease blood pressure. He told the BBC the findings were “promising”, but needed further research to confirm any protective effect.

Victoria Taylor, senior heart health dietician at the British Heart Foundation, said: “Evidence does suggest chocolate might have some heart health benefits but we need to find out why that might be.”

So further research is required to find out what about chocolate is providing these beneficial outcomes, and potentially to discover if one type of chocolate is better than another. Other studies have shown that plain chocolate can be good for you – but only in small amounts, unfortunately.

The Cambridge study also warns that chocolate can lead to weight gain and Type 2 diabetes. It suggested that chocolate could one day be used to protect from heart problems and stroke – if the sugar and fat content of chocolate bars was reduced.

Chocolate without fat and sugar? Doesn’t sound too appealing, does it?

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A report published in the British Journal of Sports Medicine on research carried out in Australia claims that every hour of TV watched after the age of 25 may shorten your lifespan by 22 minutes.

So, if you believe the assertion, anyone who spends a lifetime average of watching three hours a day can expect to lose around three years.

According to one of the report’s authors, Dr Lennert Veerman, from the School of Population Health at the University of Queensland, it puts long hours spent in front of the television “in the same ballpark as smoking and obesity”.

“While smoking rates are declining, watching TV is not, which has implications at a population level,” he said.

But is television really that bad for us?

Looking a bit deeper into the story there are a couple of things that might help to explain the headlines.

Firstly, it is the lack of exercise that would appear to be the problem here, not watching television per se. Several hours a day sitting reading or working on a computer would presumably produce the same results. And television time can be balanced out with exercise – I suppose you could even do both at the same time.

There could be other factors too. Anyone watching excessive amounts of tv may well snack on unhealthy foods as they do so, and would also be less likely to cook healthy meals. So diet could play a part in the overall picture.

The second issue is confusion between cause and effect and correlation; something that seems to be creeping into many newspaper reports of late.

People whose mobility is affected by illness or disability, or those who choose sedentary lifestyles, may well watch more television than average. And their life expectancy may be shorter than average in the first place. So there is a connection between watching a lot of TV and lower life expectancy – but that is very different from proving that one causes the other.

An example: it is easy to observe that drivers use their windscreen wipers when it rains. The more cars you will see with the wipers on, the heavier the rain. So does this prove that using windscreen wipers causes rain? I think not.

Watching excessive television can’t be said to be good for you. But it certainly doesn’t kill you either.

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Sue Rabbitt Roff, a researcher at Dundee University, has caused a storm in medical circles by suggesting that a legal trade in human kidneys should be established.

In a Personal View article, published on the British Medical Journal website, she suggested a move towards a system of paid provision for live donors’ kidneys, with those offering their organs to be given £28,000.

Dr Roff, a senior research fellow at Dundee’s department of medical sociology, said that a regulated payment system run under “strict rules” would not resemble the illegal markets that exist in many countries.

It’s one way to pay off the student loans, I suppose. But how long would it take for those desperate for money to put themselves at risk for the equivalent of a year’s salary or more? And, while humans can survive with a single kidney, the risk to many types of infection increases, potentially storing up health problems for later in life.

It is currently illegal to pay for organs for transplantation under the Human Tissue Act. The act also makes it a criminal offence to attempt to buy or sell organs for transplant.

A spokeswoman for the Human Tissue Authority (HTA) told the BBC that the organisation must, “continue to ensure that living organ donation is something people enter into freely and without financial reward”.

And Dr Tony Calland, chairman of the British Medical Association’s medical ethics committee, argued that organ donation should be “altruistic and based on clinical need” and that there was a “small but significant” health risk to living kidney donation.

There are currently 725 people in Scotland waiting for a new kidney but the number coming up for transplant has plateaued at around 200 in recent years. And in the UK as a whole, three people a day die while on the kidney transplant list.

So there is clearly a need to increase the number of kidneys available for those requiring transplants. But to suggest that a trade be established in human body parts is a somewhat gruesome solution.

It is perhaps not surprising that the idea has been raised. The solution to so many issues seems to be to throw money at the problem. This is a step too far for me, though. There is, quite simply, something intrinsically wrong in selling human body parts.

I hope that the responses from most medical sources are strong enough to ensure that this idea goes no further.

 

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