Concerns raised over weakened regulations on imports in potential post-Brexit trade deals
Concerns raised over weakened regulations on imports in potential post-Brexit trade deals
Using drugs or diet to reduce levels of asparagine may benefit patients, say researchers
Donald Trumps criticisms of the NHS suggest he knows little about our system or the one he presides over, says freelance journalist James Ball
As eating raw fish has become more popular, gruesome tapeworm tales have emerged. But how worried should sashimi lovers be and how else might we become infected?
Warning over wider global health impacts after findings reveal hundreds of tonnes of colistin the antibiotic of last resort are being shipped to Indias farms
The photographer became an addict after getting hooked on a prescription opioid. Now clean, she is waging war on the art philanthropists who have profited from the crisis
Doctors running 68 A&E departments tell PM patients are dying prematurely because staff are too busy to treat them
Patients are dying in hospital corridors during the ongoing winter crisis because the NHS is so underfunded and short-staffed that it cannot cope, senior doctors have warned Theresa May.
A&E units are under such intense strain that patients are at intolerable risk of being harmed by receiving poor care, specialists in emergency medicine from 68 hospitals have told the prime minister in a letter of unprecedented alarm.
In recent weeks some hospitals have become so overloaded that they have been looking after as many as 120 patients a day in corridors, with some dying prematurely as a result, the letter says.
The doctors, consultants who work in or run A&E units in England and Wales, have written to May to highlight the very serious concerns we have for the safety of our patients. This current level of safety compromise is at times intolerable, despite the best efforts of staff.
Conditions in many A&E units are so appalling that they could kill patients, claim the signatories, who work at both major teaching hospitals and smaller district general hospitals. They include Frimley health trust in Surrey, which May visited last week in an attempt to reassure the public that the NHS was coping well this winter.
As you will know a number of scientific publications have shown that crowded emergency departments are dangerous for patients. The longer that the patients stay in [the] emergency department after their treatment has been completed, the greater is their morbidity and associated morbidity, they write.
Their intervention came as new NHS figures showed that the percentage of patients being treated within four hours at hospital-based A&E units in England fell last month to its lowest-ever level 77.3%. The performance of all types of settings offering A&E-type care taken together, including walk-in centres and urgent care centres, was better but still the joint worst ever at 85.1% far below the politically important target of 95%.
Only three of the NHSs 137 acute trusts hit the 95% target, while 32 were at or below 70%. Blackpool teaching hospitals trust had by far the lowest performance, at 40.1%. The figures reinforced the warning to ministers on Thursday from NHS Providers that it would be impossible to deliver on their pledge that all hospitals would be achieving 95% by March.
Our emergency departments are not just under pressure, but in a state of emergency, said Dr Taj Hassan, the president of the Royal College of Emergency Medicine, which represents A&E doctors.
The NHS undertook unprecedented planning to help services cope with the annual spike in demand in December and January. Despite that, hospitals had a record number of emergency admissions last month 520,163, a 4.5% rise on the numbers admitted in December 2016.
A drive to free up 2,000-3,000 beds by 1 September, to avoid hospitals becoming dangerously full, appears to have failed. Separate NHS figures for last week show that 19 trusts were on 99% or 100% bed occupancy between 1 and 7 January. Three were completely full.
Average bed occupancy shot up last week to 95%, far higher than the 85% that experts say, and the NHS accepts, hospitals need to maintain in order to stop patients getting hospital-acquired infections such as MRSA or Clostridium difficile, or experiencing poor care.
Bed occupancy as high as 95% is a danger to patient safety, with around 7,000 fewer beds open than in the same period last year, said Hassan.
Drawing on their own experiences in recent weeks ,the doctors who signed the letter painted a stark picture of conditions inside A&E units. Common situations include over 50 patients at a time waiting beds in the emergency department [and] patients sleeping in clinics as makeshift wards.
A Department of Health and Social Care spokeswoman said in response to the letter: There has been a 68.7% increase in the number of A&E consultants since 2010, and the NHS was given top priority in the recent budget with an extra 2.8bn allocated over the next two years.
But we know there is a great deal of pressure in A&E departments, and we are grateful to all NHS staff for their incredible work in challenging circumstances. Thats why we recently announced the largest single increase in doctor training places in the history of the NHS a 25% expansion.
May stressed on Thursday that flu was a key factor in the intense strain that NHS services were facing. We have seen the extra pressures that the NHS has come under this year. One of the issues that determines the extent of that pressure is flu and we have seen in recent days an increase in the number of people presenting at A&E from flu, she said.
Hours after she spoke, new figures from Public Health England confirmed that flu was putting a sharply increased burden on GP surgeries as well as hospitals.
Last week 758 peple around the UK were hospialised because of flu, up from 421 the week before. Of those, 240 were so sick they had to be admitted to an intensive care or a high dependency unit, up from 114. The number of people consulting a GP with flu-like symptoms almost doubled.
A further 27 people died of flu-related symptoms last week, three more than the week before, taking the toll of deaths this winter to 85.
This world authority in psychiatry, consulted by US politicians, argues that the presidents mental fitness deserves scrutiny
Eight months ago, a group of us put our concerns into a book, The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President. It became an instant bestseller, depleting bookstores within days. We thus discovered that our endeavours resonated with the public.
While we keep within the letter of the Goldwater rule which prohibits psychiatrists from diagnosing public figures without a personal examination and without consent there is still a lot that mental health professionals can tell before the public reaches awareness. These come from observations of a persons patterns of responses, of media appearances over time, and from reports of those close to him. Indeed, we know far more about Trump in this regard than many, if not most, of our patients. Nevertheless, the personal health of a public figure is her private affair until, that is, it becomes a threat to public health.
To make a diagnosis one needs all the relevant information including, I believe, a personal interview. But to assess dangerousness, one only needs enough information to raise alarms. It is about the situation rather than the person. The same person may not be a danger in a different situation, while a diagnosis stays with the person.
It is Trump in the office of the presidency that poses a danger. Why? Past violence is the best predictor of future violence, and he has shown: verbal aggressiveness, boasting about sexual assaults, inciting violence in others, an attraction to violence and powerful weapons and the continual taunting of a hostile nation with nuclear power. Specific traits that are highly associated with violence include: impulsivity, recklessness, paranoia, a loose grip on reality with a poor understanding of consequences, rage reactions, a lack of empathy, belligerence towards others and a constant need to demonstrate power.
There is another pattern by which he is dangerous. His cognitive function, or his ability to process knowledge and thoughts, has begun to be widely questioned. Many have noted a distinct decline in his outward ability to form complete sentences, to stay with a thought, to use complex words and not to make loose associations. This is dangerous because of the critical importance of decision-making capacity in the office that he holds. Cognitive decline can result from any number of causes psychiatric, neurological, medical, or medication-induced and therefore needs to be investigated. Likewise, we do not know whether psychiatric symptoms are due to a mental disorder, medication, or a physical condition, which only a thorough examination can reveal.
A diagnosis in itself, as much as it helps define the course, prognosis, and treatment, is Trumps private business, but what is our affair is whether the president and commander-in-chief has the capacity to function in his office. Mental illness, or even physical disability, does not necessarily impair a president from performing his function. Rather, questions about this capacity mobilised us to speak out about our concerns, with the intent to warn and to educate the public, so that we can help protect its own safety and wellbeing.
Indeed, at no other time in US history has a group of mental health professionals been so collectively concerned about a sitting presidents dangerousness. This is not because he is an unusual person many of his symptoms are very common but it is highly unusual to find a person with such signs of danger in the office of presidency. For the US, it may be unprecedented; for parts of the world where this has happened before, the outcome has been uniformly devastating.
Pathology does not feel right to the healthy. It repels, but it also exhausts and confuses. There is a reason why staying in close quarters with a person suffering from mental illness usually induces what is called a shared psychosis. Vulnerable or weakened individuals are more likely to succumb, and when their own mental health is compromised, they may develop an irresistible attraction to pathology. No matter the attraction, unlike healthy decisions that are life-affirming, choices that arise out of pathology lead to damage, destruction, and death. This is the definition of disease, and how we tell it apart from health.
Politics require that we allow everyone an equal chance; medicine requires that we treat everyone equally in protecting them from disease. That is why a liberal health professional would not ignore signs of appendicitis in a patient just because he is a Republican. Similarly, health professionals would not call pancreatic cancer something else because it is afflicting the president. When signs of illness become apparent, it is natural for the physician to recommend an examination. But when the disorder goes so far as to affect an individuals ability to perform her function, and in some cases risks harm to the public as a result, then the health professional has a duty to sound the alarm.
The progress of the special counsel Robert Muellers investigations was worrisome to us for the effects it would have on the presidents stability. We predicted that Trump, who has shown marked signs of psychological fragility under ordinary circumstances, barely able to cope with basic criticism or unflattering news, would begin to unravel with the encroaching indictments. And if his mental stability suffered, then so would public safety and international security.
The colonic irrigation and coffee enemas promoted on Paltrows website Goop are not merely unnecessary, they are potentially dangerous, writes obstetrician and gynaecologist Dr Jen Gunter
It seems January is Gwyneth Paltrows go-to month for promoting potentially dangerous things that should not go in or near an orifice. January 2015 brought us vagina steaming, January 2017 was jade eggs, and here we are in the early days of January 2018 and Goop.com is hawking coffee enemas and promoting colonic irrigation.
I suspect that GP and her pals at Goop.com believe people are especially vulnerable to buying quasi-medical items in the New Year as they have just released their latest detox and wellness guide complete with a multitude of products to help get you nowhere.
In this extract from his new book, Johann Hari, who took antidepressants for 14 years, calls for a new approach
In the 1970s, a truth was accidentally discovered about depression one that was quickly swept aside, because its implications were too inconvenient, and too explosive. American psychiatrists had produced a book that would lay out, in detail, all the symptoms of different mental illnesses, so they could be identified and treated in the same way across the United States. It was called the Diagnostic and Statistical Manual. In the latest edition, they laid out nine symptoms that a patient has to show to be diagnosed with depression like, for example, decreased interest in pleasure or persistent low mood. For a doctor to conclude you were depressed, you had to show five of these symptoms over several weeks.
The manual was sent out to doctors across the US and they began to use it to diagnose people. However, after a while they came back to the authors and pointed out something that was bothering them. If they followed this guide, they had to diagnose every grieving person who came to them as depressed and start giving them medical treatment. If you lose someone, it turns out that these symptoms will come to you automatically. So, the doctors wanted to know, are we supposed to start drugging all the bereaved people in America?
The authors conferred, and they decided that there would be a special clause added to the list of symptoms of depression. None of this applies, they said, if you have lost somebody you love in the past year. In that situation, all these symptoms are natural, and not a disorder. It was called the grief exception, and it seemed to resolve the problem.
Then, as the years and decades passed, doctors on the frontline started to come back with another question. All over the world, they were being encouraged to tell patients that depression is, in fact, just the result of a spontaneous chemical imbalance in your brain it is produced by low serotonin, or a natural lack of some other chemical. Its not caused by your life its caused by your broken brain. Some of the doctors began to ask how this fitted with the grief exception. If you agree that the symptoms of depression are a logical and understandable response to one set of life circumstances losing a loved one might they not be an understandable response to other situations? What about if you lose your job? What if you are stuck in a job that you hate for the next 40 years? What about if you are alone and friendless?
The grief exception seemed to have blasted a hole in the claim that the causes of depression are sealed away in your skull. It suggested that there are causes out here, in the world, and they needed to be investigated and solved there. This was a debate that mainstream psychiatry (with some exceptions) did not want to have. So, they responded in a simple way by whittling away the grief exception. With each new edition of the manual they reduced the period of grief that you were allowed before being labelled mentally ill down to a few months and then, finally, to nothing at all. Now, if your baby dies at 10am, your doctor can diagnose you with a mental illness at 10.01am and start drugging you straight away.
Dr Joanne Cacciatore, of Arizona State University, became a leading expert on the grief exception after her own baby, Cheyenne, died during childbirth. She had seen many grieving people being told that they were mentally ill for showing distress. She told me this debate reveals a key problem with how we talk about depression, anxiety and other forms of suffering: we dont, she said, consider context. We act like human distress can be assessed solely on a checklist that can be separated out from our lives, and labelled as brain diseases. If we started to take peoples actual lives into account when we treat depression and anxiety, Joanne explained, it would require an entire system overhaul. She told me that when you have a person with extreme human distress, [we need to] stop treating the symptoms. The symptoms are a messenger of a deeper problem. Lets get to the deeper problem.
I was a teenager when I swallowed my first antidepressant. I was standing in the weak English sunshine, outside a pharmacy in a shopping centre in London. The tablet was white and small, and as I swallowed, it felt like a chemical kiss. That morning I had gone to see my doctor and I had told him crouched, embarrassed that pain was leaking out of me uncontrollably, like a bad smell, and I had felt this way for several years. In reply, he told me a story. There is a chemical called serotonin that makes people feel good, he said, and some people are naturally lacking it in their brains. You are clearly one of those people. There are now, thankfully, new drugs that will restore your serotonin level to that of a normal person. Take them, and you will be well. At last, I understood what had been happening to me, and why.
However, a few months into my drugging, something odd happened. The pain started to seep through again. Before long, I felt as bad as I had at the start. I went back to my doctor, and he told me that I was clearly on too low a dose. And so, 20 milligrams became 30 milligrams; the white pill became blue. I felt better for several months. And then the pain came back through once more. My dose kept being jacked up, until I was on 80mg, where it stayed for many years, with only a few short breaks. And still the pain broke back through.
I started to research my book, Lost Connections: Uncovering The Real Causes of Depression and the Unexpected Solutions, because I was puzzled by two mysteries. Why was I still depressed when I was doing everything I had been told to do? I had identified the low serotonin in my brain, and I was boosting my serotonin levels yet I still felt awful. But there was a deeper mystery still. Why were so many other people across the western world feeling like me? Around one in five US adults are taking at least one drug for a psychiatric problem. In Britain, antidepressant prescriptions have doubled in a decade, to the point where now one in 11 of us drug ourselves to deal with these feelings. What has been causing depression and its twin, anxiety, to spiral in this way? I began to ask myself: could it really be that in our separate heads, all of us had brain chemistries that were spontaneously malfunctioning at the same time?
To find the answers, I ended up going on a 40,000-mile journey across the world and back. I talked to the leading social scientists investigating these questions, and to people who have been overcoming depression in unexpected ways from an Amish village in Indiana, to a Brazilian city that banned advertising and a laboratory in Baltimore conducting a startling wave of experiments. From these people, I learned the best scientific evidence about what really causes depression and anxiety. They taught me that it is not what we have been told it is up to now. I found there is evidence that seven specific factors in the way we are living today are causing depression and anxiety to rise alongside two real biological factors (such as your genes) that can combine with these forces to make it worse.
Once I learned this, I was able to see that a very different set of solutions to my depression and to our depression had been waiting for me all along.
To understand this different way of thinking, though, I had to first investigate the old story, the one that had given me so much relief at first. Professor Irving Kirsch at Harvard University is the Sherlock Holmes of chemical antidepressants the man who has scrutinised the evidence about giving drugs to depressed and anxious people most closely in the world. In the 1990s, he prescribed chemical antidepressants to his patients with confidence. He knew the published scientific evidence, and it was clear: it showed that 70% of people who took them got significantly better. He began to investigate this further, and put in a freedom of information request to get the data that the drug companies had been privately gathering into these drugs. He was confident that he would find all sorts of other positive effects but then he bumped into something peculiar.