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No, there hasn’t been a human ‘head transplant’, and there may never be

In February 2015, Sergio Canavero appeared in this very publication claiming a live human head will be successfully transplanted onto a donor human body within two years. He’s popped up in the media a lot since then, but two years and nine months later, how are things looking?

Well, he’s only gone and done it! As we can see in this Telegraph story from today, the world’s first human head transplant has been successfully carried out. Guess all those more timid neurobods who said it couldn’t be done (myself included) are feeling pretty foolish right now, eh?

Well, not quite. Because if you look past the triumphant and shocking headlines, the truth of the matter becomes very clear, very quickly. In the interest of full disclosure, I do not know Dr Sergio Canavero, he’s done nothing to me directly that I’m aware of. However, I’m now seriously doubting his motivations. I’ve discussed my reasons for this elsewhere before now, but here they are again in one place for ease of reading.

Monster, Monster1931: British actor Boris Karloff lowers his eyes as the Monster in a promotional portrait for director James Whale’s film, ‘Frankenstein’. (Photo by Hulton Archive/Getty Images)

Even the fictional Dr Frankenstein had a better success rate. Photograph: Hulton Archive/Getty Images

These “successful” procedures are anything but

Many of Canavero’s previous appearances in the media have been accompanied by claims of successful head transplant procedures. But, how are we defining “successful” here? Canavero’s definition seems to be extremely “generous” at best.

For instance, he recently claimed to have “successfully” performed a head transplant on a monkey. But did he? While the monkey head did apparently survive the procedure, it never regained consciousness, it was only kept alive for 20 hours for “ethical reasons” and there was no attempt made at connecting the spinal cord, so even if the monkey had survived long-term it would have been paralysed for life. So, it was a successful procedure, if you consider paralysis, lack of consciousness and a lifespan of less than a day as indicators of “success”.

There was also his “successful” rat head transplant, which involved grafting a severed rat head onto a different rat, a living one that still had its head. Exactly how this counts as a “transplant” is anyone’s guess. It’s adding a (functionally useless) appendage onto an otherwise healthy subject.

And this recent successful human head transplant? It was on corpses! Call me a perfectionist if you must, but I genuinely think that any surgical procedure where the patients or subjects die before it even starts is really stretching the definition of “success” to breaking point. Maybe the procedure did make a good show of “attaching” the nerves and blood vessels on the broad scale, but, so what? That’s just the start of what’s required for a working bodily system. There’s still a way to go. You can weld two halves of different cars together and call it a success if you like, but if the moment you turn the key in the ignition the whole thing explodes, most would be hard pressed to back you up on your brilliance.

Perhaps the techniques used to preserve the heads and attach them have some scientific value, but it’s still a far cry from the idea of someone wandering around with a fully functional body that isn’t the one they were born with. Canavero seems to have a habit of claiming barnstorming triumph based on negligible achievements, or even after making things much worse. He seems to be the neurosurgical equivalent of the UK Brexit negotiating team.

Note Pad With White Pages and Pen. Isolated on WhiteAMGFCK Note Pad With White Pages and Pen. Isolated on White

You’d expect copious details when it comes to performing a successful head transplant. Thus far, they’re strangely absent. Photograph: Alamy

The crucial details are strangely overlooked

The human body is not modular. You can’t swap bits around like you would Lego blocks, take a brick from castle and put it onto a pirate ship and have it work fine. There are copious obstacles to contend with when linking a head to body, even when they’re the same person’s. Doctors have, in recent years, “reattached” a severely damaged spinal cord in a young child, but the key-word is “damaged”, not “completely severed”; there’s enough connection still to work with, to repair and reinforce. And this is with a young child, with a still-developing nervous system better able to compensate. Even taking all this into account, and the advanced state of modern medicine, the successful procedure was considered borderline miraculous.

So, to attach a completely severed spinal cord, a fully developed adult one, onto a different one, one that’s maybe been dead for days? That’s, what, at least four further miracles required? And that’s not to take into account immune rejection, the fact that we don’t really know how to “fix” damaged nerves yet (let alone connect two unfamiliar halves) and the issue that everyone’s brain develops in tune with their body. The latter point means the “interface” between the two is relatively unique. You put the head of musician on the body of a builder, it may well prove to be like trying to play an Xbox game on a PlayStation. Except, infinitely more traumatic.

We don’t know for certain of course, because nobody has ever tried it. Canavero seems convinced he can do it, but thus far he’s offered no feasible explanation or science for his claims to be able to overcome these hurdles, beyond some token stuff about preserving tissues and ensuring blood supply during procedures. That’s a bit like someone claiming they can build a working fusion reactor and, when asked how, explains how they’re going to plumb in the toilets for the technicians. Arguably a useful step, but clearly not the main issue here.

TED X Brooklyn Event Karl Chu speakingBYR6N4 TED X Brooklyn Event Karl Chu speaking

TED Talks. Slick, inspiring, interesting, not exactly peer-reviewed. Photograph: Alamy Stock Photo

Hype before substance

I’ve said this before, even in a Wired article about Canavero’s previous claims, to the extent where I am considering trademarking it as “Burnett’s law”. Simply put; if someone’s making grand scientific claims but hasn’t provided robust evidence for them, yet they have done a TED talk, alarm bells should be ringing.

I don’t know what Canavero’s confidence is based on. Nobody seems to. He hasn’t published anything that would warrant it thus far. Note his recent “successful” human head transplant claims, which you can read about in the Telegraph before he’s published the actual results, as stated in the article.

Why do that? Why tell the newspapers before you tell your peers? If your procedure is rigorous and reliable enough, the data should reflect that. When scientists, particularly self-styled “mavericks”, court publicity but desperately avoid scrutiny, that’s never an encouraging sign.

Going by the Telegraph article, Canavero claims that the next step will be to attempt a transplant with someone in a vegetative state or similar. He also claims to have plenty of volunteers for this. Exactly how coma patients actively volunteered for this radical procedure is anyone’s guess.

There’s no mention yet of attempting it in a conscious person, despite there being actual volunteers for that. I strongly suspect there never will be. Trying it with a conscious, thinking person means it absolutely has to be 100% effective for them to remain in this state after the transplant is done. This would mean finding workable solutions to all the considerable obstacles presented by the very concept of a head transplant.

If I’m wrong about this then I’ll gladly take back everything and apologise, but nothing Canavero has said or done thus far leads me to think he has any idea about how to do this.

Dean Burnett is fully aware that the procedure should logically be called a “body transplant” but that’s not how it’s usually described, so has used the more common terms. His book The Idiot Brain is available now, in the UK and US and elsewhere.

Anger after report finds birth defects not caused by hormone pregnancy tests

A hormone pregnancy test used in the 1960s and 1970s was not responsible for serious birth defects, according to an official review, which has been severely criticised by campaigners.

An expert working group set up by the Commission on Human Medicines (CHM) concluded there was no “causal association” between a drug called Primodos and severe disabilities in babies.

However, MPs and families who have campaigned against hormone pregnancy tests (HPTs) for more than 40 years, said the report was a whitewash.

Yasmin Qureshi, the MP for Bolton South East, said there should be a judicial review or a separate inquiry to examine allegations of a cover-up by medical regulators at the time.

The Labour MP said: “I am completely disgusted by the report. They clearly have not looked at the evidence that was presented to them. If they had looked at the evidence presented to them they could never have arrived at the conclusion they have now. This report is a complete whitewash. It is not worth the paper it has been printed on.”

Mims Davies, the Conservative MP for Eastleigh, said she was disappointed by the report and would be meeting with the prime minister to raise her concerns.

Davies said: “I was thoroughly dissatisfied by the complete lack of transparency in the creation and preparation of this report, with the only representative of campaigners against these historic injustices on the panel being gagged by a confidentiality agreement and prevented from speaking about the report’s preparation.”

The expert group recommended that families who took an HPT and experienced an “adverse pregnancy outcome” should be offered genetic testing to establish whether there was a different underlying cause.

Campaigners believe that as well as causing disabilities, the drugs could also cause miscarriage or stillbirth.

Marie Lyon, chair of the Association for Children Damaged by Hormone Pregnancy Tests, said: “It’s truly shocking and I am appalled by the report. We all feel betrayed, and I feel like I have no faith in government health agencies now. I am distraught for our members, who still haven’t had the answers they need.”

Charlotte Fensome, whose brother Steven has severe epilepsy, said she was horrified by the report.

“I’m obviously hugely disappointed by this report. My parents are 81 and 76, and they are struggling every day with my brother. Every victim of Primodos is a personal tragedy, and I am shocked at how this investigation has been carried out.

“My mother was given Primodos when she was eight weeks pregnant, and my brother was born with severe brain damage. It affects the whole family every single day. This is just a battle, and there is a long war ahead.”

The expert group assessed a number of studies looking at a possible link between women given an HPT to diagnose pregnancy and congenital anomalies in babies, but concluded there was no connection.

The expert group found that “although there was never any reliable evidence that HPTs were unsafe, concern about this issue, coupled with the development of better pregnancy tests” led to the use of HPTs being restricted in the 1970s.

A 1967 report found there might be a link between HPTs and spina bifida, and – following the thalidomide scandal which had recently led to that drug being withdrawn – concerns about HPTs rose dramatically.

Primodos, which was also used to treat menstruation problems, was then withdrawn completely in 1978. “Whether these precautionary actions were sufficiently timely became a subject of controversy,” noted the report.

Modern pregnancy tests measure hormone levels in a woman’s urine. The older HPTs contained synthetic versions of two hormones found naturally in the body. Two pills were taken on consecutive days, with a withdrawal bleed a few days later in those who were not pregnant.

Primodos contained synthetic versions of progesterone and estrogen.

Prof Stuart Ralston, the chair of the CHM, said: “This was a comprehensive and wide-ranging scientific review of all the available evidence on the possible association between HPTs and birth defects by internationally leading experts across a broad range of specialisms.”

Dr Ailsa Gebbie, the chair of the expert working group, said: “Our recommendations will strengthen further the systems in place for detecting, evaluating and communicating risk with use of medicines in pregnancy and help safeguard future generations.”

A spokeswoman for Bayer AG, which acquired Primodos manufacturer Schering in 2006, said: “Bayer notes that a review by an independent expert working group on hormone pregnancy tests of the Commission on Human Medicines has found, consistent with Bayer’s view, based on all available data, that the scientific evidence does not support a causal association between the use of hormone pregnancy tests, such as Primodos, and birth defects or miscarriage.”

UK supreme court rules minimum alcohol pricing is legal

The UK supreme court has backed the Scottish government’s plans to introduce a minimum price for all alcoholic drinks, in a decisive victory for Nicola Sturgeon.

After a five-year legal battle against the plans led by the Scotch Whisky Association (SWA), the court ruled on Wednesday that minimum pricing was legal on health grounds under EU law.

The seven judges unanimously agreed it was “a proportionate means of achieving a legitimate aim”.

The ruling clears the way for the Scottish and Welsh governments to introduce a minimum unit price for alcoholic drinks, likely to be set at 50p, and will increase pressure on UK ministers to follow suit in England.

Nicola Sturgeon (@NicolaSturgeon)

Absolutely delighted that minimum pricing has been upheld by the Supreme Court. This has been a long road – and no doubt the policy will continue to have its critics – but it is a bold and necessary move to improve public health.

November 15, 2017

Shona Robison, the Scottish health secretary, said the devolved government in Edinburgh would introduce minimum pricing as soon as possible and would set out a timetable to parliament within days. The pricing may come into force in spring 2018.

English health campaigners said the ruling meant the UK government had to revisit the issue, which was studied but shelved when David Cameron was prime minister.

Richard Piper, the chief executive of Alcohol Concern, said: “Now is the time for Westminster to step up and save lives. As alcohol has become more affordable, the rates of alcohol-related ill-health have risen. The fact is, something has to be done.”

The group, which recently merged with Alcohol Research UK, said strong cider was being sold at 18p per unit of alcohol, fortified wine at 27p per unit and the cheapest vodka and gin at 38p, increasing the risks for problem drinkers.

Alcohol Focus Scotland has calculated that adults buying one brand of strong cider can drink their maximum recommended weekly limit of alcohol – 14 units – for £2.52.

Robison said the ruling had “global significance. This is a historic and far-reaching judgment, and a landmark moment in our ambition to turn around Scotland’s troubled relationship with alcohol.”

Alcohol-related deaths in Scotland had increased in the five years since the legislation was passed, she said: “With alcohol available for sale at just 18p a unit, that death toll remains unacceptably high.

“Given the clear and proven link between consumption and harm, minimum pricing is the most effective and efficient way to tackle the cheap, high-strength alcohol that causes so much damage to so many families.”

Vaughan Gething, the Welsh health secretary, said there were 504 alcohol-related deaths in Wales last year, all of which were avoidable. He would look at whether the court ruling had implications for the Welsh minimum pricing bill introduced last month.

“We have long recognised that action to combat the availability of cheap and high-strength alcohol has been missing in our strategy,” Gething said. “We welcome this clear, unanimous judgment that minimum pricing is an appropriate and proportionate means of tackling hazardous and harmful drinking.”

The policy, championed by Sturgeon since she was Scotland’s health secretary, had been backed by Scottish judges in several hearings before it reached the supreme court.

Prof Petra Meier, director of the alcohol research group at the University of Sheffield, which published the data and evidence that Sturgeon’s proposals were based on, said a 50p minimum price would in time result in 120 fewer deaths and 2,000 fewer hospital admissions from alcohol abuse each year.

“Our research has consistently shown that minimum unit pricing would reduce alcohol-related health problems in Scotland by targeting the cheap, high-strength alcohol consumed by the heaviest and highest-risk drinkers,” Meier said. “Moderate drinkers would be affected to a much smaller degree.”

The SWA, with support from the European drinks industry, had argued that minimum pricing breached EU and global trade law as it interfered with free trade and open borders regulations. It lodged a series of appeals against the earlier rulings.

The industry’s case was supported by an interim opinion from the European court of justice in an appeal hearing at which European judges asked the Scottish and UK courts to re-examine the case.

Dr Eric Carlin, the director of Scottish Health Action on Alcohol Problems, a campaigning body backed by the medical profession, lambasted drinks companies for their “ferocious, cynical” opposition to the measure.

“The opponents to MUP [minimum unit pricing] have shamed the reputation of their industry by prioritising profits over people’s lives. As MUP has been delayed, we have seen the tragic, premature deaths of 24 people every week in Scotland as a result of alcohol misuse, many of them in our poorest communities, and affecting families across our nation,” he said.

Karen Betts, the SWA chief executive, said the industry would work with ministers on implementing the policy, as well as promoting responsible drinking and tackling alcohol-related harm.

“We will now look to the Scottish and UK governments to support the industry against the negative effects of trade barriers being raised in overseas markets that discriminate against Scotch whisky as a consequence of minimum pricing, and to argue for fair competition on our behalf,” she said.

“This is vital in order that the jobs and investment the industry provides in Scotland are not damaged.”

She said the association wanted to see an objective assessment of the impact of minimum pricing.

The Alcohol (Minimum Pricing) (Scotland) Act, passed at Holyrood with all-party support in 2012, requires ministers to review its impact after five years. It includes a “sunset clause” under which minimum pricing is withdrawn unless Holyrood passes a renewal bill supporting it, six years after the act comes into force.

The court ruling was applauded by Scottish brewers and pub owners, who believe it will help protect the pub trade and undermine cut-price competitors.

Paul Bartlett, the group corporate relations director for C&C, which makes Tennent’s lager and Magners cider, said the company had always backed responsible drinking, and urged the Irish and Northern Irish governments to consider minimum pricing.

“Now that the supreme court have made their ruling, we urge the industry to get behind the decision,” he said. “We also hope similar legislation can be realised across other territories we operate in, including Ireland and Northern Ireland.”

One in five European NHS doctors plans to quit UK, survey reveals

Almost one in five of the NHS’s European doctors have made plans to quit Britain, according to research that has raised fresh fears of a Brexit-induced medical brain drain.

And almost half of the health service’s 12,000 medics from the European Economic Area (EEA) are considering moving abroad, the British Medical Association survey of 1,720 of them found.

The findings come amid growing evidence that Brexit may exacerbate problems of understaffing in the NHS by making both retention and recruitment of EU staff more difficult. In September NHS figures showed that more than 10,000 staff from EU countries had quit since the Brexit vote. And the number of EU nurses coming to Britain has dropped by 89% in the last year, Nursing and Midwifery Council figures released this month showed.

In total, 45% of respondents to the BMA survey said they were thinking about leaving Britain following the result of the EU referendum in June 2016 – three percentage points more than when the BMA ran a similar poll in February – while a further 29% were unsure whether they would go.

Among those who were considering going elsewhere 39% – or 18% of the whole sample – have already made plans to leave. The 12,000 doctors from the EEA (the EU plus Iceland, Liechtenstein and Norway) represent 7.7% of the NHS’s medical workforce.

Some of those leaving have been offered jobs abroad, while others are applying for posts overseas. Some have begun the process of seeking citizenship elsewhere, while others are having their qualifications validated so they can work in another country, the BMA said.


What was wrong with the claim that the UK sends the EU £350m a week?

The claim that Britain “sends the EU £350m a week” is wrong because:

  • The rebate negotiated by Margaret Thatcher is removed before anything is paid ​​to Brussels. In 2014, this meant Britain actually “sent” £276m a week to Brussels; in 2016, the figure was £252m.
  • Slightly less than half that sum – the money that Britain does send to the EU – either comes back to the UK to be spent mainly on agriculture, regional aid, research and community projects, or gets counted towards ​the country’s international aid target.

Regardless of how much the UK “saves” by leaving the EU, the claim that a future government would be able to spend it on the NHS is highly misleading because:

  • It assumes the government would choose to spend on the NHS the money it currently gets back from the EU (£115m a week in 2014), thus cutting f​unding for​ agriculture, regional development and research by that amount.
  • It assumes​ the UK economy will not be adversely affected by Brexit, which many economists doubt.

“That so many EU doctors are actively planning to leave the UK is a cause for real concern. Many have dedicated years of service to the NHS and medical research in the UK, and without them our health service would not be able to cope,” said Dr Andrew Dearden, the BMA’s treasurer.

The Labour MP Darren Jones, a supporter of the pro-EU Open Britain campaign, said: “The British people were told last year that Brexit would boost the NHS by £350m a week. Now the evidence is piling up that it will break it instead.

“We all depend on the brilliant work done by doctors, nurses and other staff who come from the EU. There is no chance that we could replace their expertise if they continue to leave the UK.”

But the Department of Health said that figures released last week by the General Medical Council, showing a slight year-on-year rise in 2016-17 in the number of EEA doctors joining its medical register, showed the BMA’s findings were inaccurate.

“This survey does not stand up to scrutiny. In fact, there are actually more EU doctors working in the NHS since the EU referendum, more EU graduates joining the UK medical register and 3,193 more EU nationals working in the NHS overall,” a spokesperson said.

It’s true: Conservative governments really do kill people | Zoe Williams

There was a splenetic exchange on BBC Question Time last week, between an audience member and my colleague, Aditya Chakrabortty, who had pointed out that disabled people had died as a result of cuts to social security. You’re like “Donald Trump”, said a guy in the audience: the parallel was, Aditya had made a statement that was stirring, powerful, emotive and trenchant – so I guess, if we leave aside the fact that it was also true, it was pretty Trumpian.

Just as it’s verboten to call someone a liar in parliament, so there is a curious and ancient disapproval around pointing out that a state has been the direct cause of any deaths, whether of its own citizens or abroad. It is taken as hysterical overstatement (something that should only be levelled at an authoritarian regime, which takes its people out and shoots them) and pitiful naivety (a wilful misunderstanding of the business of government, to trace its policies crudely back to the lives of those who are affected by them).

Since “hysterical” and “naive” are two of the deadliest charges in political discourse, one always checks oneself before going full-pelt: we know that 90 people a month die after being declared fit for work, but can we really lay those deaths at the government’s feet? Plainly, they might have died anyway. All we can say about the Conservatives is that they instituted a disability assessment system that makes bad decisions, repeatedly, and causes untold trauma and desperation to people who are on the brink of death.

So let’s refine it: we know of the existence of 49 Department for Work and Pension reports – called peer reviews – that are triggered when someone dies following a cut to their benefits, 40 of which were suicides. They are heavily redacted, and what we can read of them does not amount to a straight causal link between a cut or sanction and a suicide.

The government – which will casually spend hundreds of thousands of pounds fighting a freedom of information request to release these peer reviews, and yet cannot afford to support a terminally ill cancer patient – has upended priorities when it comes to discussing the deaths of its citizens. It ploughs all its energy into denying a link between destitution and desperation, and apparently no energy at all into asking why these suicides occurred.

A much more striking example of that came in 2015, when there were 30,000 “excess deaths” in England and Wales, the greatest rise in mortality for 50 years, according to a study published this year. The researchers – from Oxford University, the London School of Hygiene and Tropical Medicine, and two borough councils – examined possible explanations and, having rejected environmental collapse, natural disaster and war, concluded that “the evidence points to a major failure of the health system, possibly exacerbated by failings in social care”, adding for clarity: “The impact of cuts resulting from the imposition of austerity on the NHS has been profound.”

People die having had their support system ripped from them and the response is a shrugging ‘whatever’

An unnamed Department of Health spokesman rejected the claim, citing “personal bias” of the authors (the truth has a liberal bias, as the saying goes), but strikingly, took no further interest in the matter. You would think that, even if someone vigorously denied responsibility for 30,000 excess deaths, they would at least ask where, then, responsibility lay.

Last year, meanwhile, the suicide rate within prisons in England and Wales reached an all-time high: 119 deaths, or one every three days. The background is a 40% drop in the number of prison officers, which had an obvious practical impact, pinpointed by Prof Pamela Taylor of the Royal College of Psychiatrists: there simply weren’t enough staff to accompany mentally ill patients to clinics and appointments.

But understaffing in prisons has much more profound atmospheric affects: it erodes officers’ capability to observe prisoners closely; to support those suffering a decline; to control bullies and legal highs; and to perform the subtle, invaluable, life-changing business of jail craft. Only a government with no insight at all into the prison estate would think you could shred its staff by nearly half and suffer no catastrophic effects.

Going right back to 2010, this is the enduring picture of Conservative government, which the Liberal Democrats still claim to have cushioned us from the worst of: not the parsimony, the defensiveness, the lack of curiosity when disasters occur, not the callousness or myopia, but the sheer indolence.

Decisions are made as if the consequences belonged to someone else. Judicial process is treated like long-grass. Ernest Ryder, senior president of tribunals, said last week that the DWP habitually provided evidence whose quality was so poor it would be “wholly inadmissible” in any other court. People die having had their support system ripped from them and the response is a shrugging “whatever”, plus maybe a blast of noise about bias and the last Labour government, like ducks flapping pointlessly on a pond. Every tactic is diversionary; the overarching strategy is, break it and see what happens.

Consensus now is that the Tories were governing, sometimes controversially but broadly effectively, when Brexit came along and capsized everything. This is mistaken: the referendum could only have been called, and the leave campaign only fought, by politicians with a fundamental lack of seriousness, a puerile indifference to the outcome of their decisions.

Long before it gambled with our future prosperity and place in the world, the Conservative party was shooting craps with the lives of its own people.

Zoe Williams is a Guardian columnist

The Guardian view on the trade bill: bad law; bad plan | Editorial

The practical implications of Brexit escaped much scrutiny when Britain voted to leave the EU. But the capacity of British ministers to strike trade deals with foreign states has long been central to Conservative Eurosceptic ideology. Reclamation of that particular portion of “sovereignty” was more important to many Tory leavers even than immigration control, although that worked more powerfully on public opinion. Liam Fox, international trade secretary, is meant to be lining up a banquet of deals for British exporters to feast on post-Brexit. In practice, not much can be achieved on that front before the UK’s end-state arrangements with the EU are settled. But a legal framework is needed in advance. That is the function of the trade bill that was published last week. It attracted little attention when Westminster was distracted by other scandals, but it is a document of paramount importance.

Like the withdrawal bill that continues its passage through the Commons this week, Dr Fox’s trade blueprint relies heavily on “Henry VIII powers” – effectively granting ministers the power to write law behind parliament’s back. It envisages an “appropriate authority” implementing legal changes and future agreements “by regulations”. That is a coded way of saying that Dr Fox reserves the right to do whatever he likes without pesky MPs getting in the way.

The bill was published just 24 hours after the deadline for submissions to a formal consultation, suggesting that Dr Fox was not interested in what businesses, trade unions and other affected parties have to say on the subject. That is consistent with the government’s wider approach to the terms of Brexit. It begins with ideology and proceeds with disregard for dissent. So if a wide-ranging market-access agreement with the US requires a bonfire of safety regulations and social protections – as the Trump administration has signalled it would – Dr Fox does not want to give parliament any means of obstruction.

The government has obvious reason to fear scrutiny of the deals it will strike outside the EU. The UK is a major economy by European standards but not the equal of superpowers such as the US or China. Negotiations will be tough and Britain, as the junior party, will be forced into some ugly compromises. Argument in Westminster about the desirability of importing chlorine-washed American chicken is an early sign of things to come. Ministers will find themselves caught between voters, who expect certain standards to be upheld, certain limits to apply, and business lobbies that want unlimited rights of market exploitation. US health providers and pharmaceutical companies would gladly see the NHS dismantled, for example. Some Tory MPs would be relaxed about that, but they would not have public opinion on their side.

Theresa May is in no hurry to confront the real-world consequences of her grandiose pledge that Brexit heralds the rebirth of “Global Britain” – a beacon of enterprise that can only be lit on departure from the EU’s customs union and single market. Not even everyone in cabinet believes she can redeem it. The Treasury, in line with the vast majority of international economic modelling, is unpersuaded. In reality, the UK will surrender practical influence over trade policy via its seats at top tables in Brussels for the “freedom” to have trading terms dictated by Americans, Chinese, Indians and indeed the EU.

But No 10 dare not confront the possibility that the single market – the biggest and most comprehensive free-trading arrangement in the world – is more valuable than the alternatives. That admission would eviscerate its Brexit policy. It would sabotage the whole case for leaving.

The UK’s entire approach in negotiations with Brussels has been skewed by blind faith in economic wonders available through bilateral trade deals that are, at best, remote. The gains in terms of sovereignty – enhanced control of the nation’s destiny in a globalised economy – might well prove illusory. And the bill for expediting that risk-laden choice is designed explicitly to deny MPs a voice in the process. A battle is already under way to defend parliament’s capacity to hold the government to account for its Brexit decisions with regard to the withdrawal bill. But that is not the only device by which ministers are trying to smuggle their half-baked plans and unchecked powers on to the statute book. It is clear that the battle for a proper democratic debate about Britain’s future outside the EU will have to be waged on many fronts.

Taxpayers pay twice for crucial drugs like Avastin | Letters

It is shocking, but not surprising, that big drugs companies are threatening to sue the NHS for using cheaper versions of drugs that could save people from going blind (Drug firms trying to stop cheap eye treatment on NHS, 1 November). Another part of this story is that the two medicines in question – Lucentis (known generically as ranibizumab) and Avastin (bevacizumab) are based on the groundbreaking discovery of monoclonal antibodies, which were developed with UK public funding.

The NHS itself funded the trials to show that off-licence use of Avastin is as good as Lucentis, a finding that benefits patients not just in the UK but also globally. So the taxpayer is paying twice, first for public investment in the original research and clinical trials and then for the high prices being charged by the pharmaceutical companies. It is high time for conditions to be attached to publicly funded research and development to prevent these excessive profits and ensure crucial drugs are accessible and affordable for all.
Heidi Chow Global Justice Now

I read with interest your article on the amount that could be saved for the NHS by using the non-licensed drug Avastin in eye conditions such as macular degeneration. You state £84m. We found that it was more like £539m per year, deduced from a freedom of information act request from all hospitals in the UK.
Alastair Lockwood
Queen Alexandra hospital, Portsmouth

Blood plasma infusions from young may arrest Alzheimer’s

Regular infusions of blood plasma from young donors could be used to treat patients with Alzheimer’s disease, a medical conference in Boston was told on Saturday.

Researchers said that their study showed transfusions were safe, had no serious side effects and hinted that infusions could lead to benefits in patients’ memory and thinking.

Infusions of blood plasma – the liquid, cell-free part of blood – are used in surgery and to treat conditions such as liver disease. In addition, research on mice has shown that regular plasma infusions from young mice improves memory in older mice.

The new trial, sponsored by Stanford University, was set up to build on these findings and to test the safety and feasibility of administering blood plasma from younger people to those living with Alzheimer’s disease.

The team, who were speaking at the Clinical Trials on Alzheimer’s Disease conference in Boston, revealed that they worked with 18 volunteers with mild to moderate Alzheimer’s disease who received four weekly infusions of either a placebo saline solution or blood plasma from donors aged between 18 and 30. Then there was a six week “wash-out” period during which participants did not receive either infusion. The researchers then switched the infusions that participants received so that those who previously had plasma received the placebo and vice versa. The participants also took part in memory and thinking tests and assessments of their ability to carry out everyday tasks.

“The research points to potential signs of improvement but we need to see much larger studies before we can tell if this approach could help improve the lives of people living with Alzheimer’s,” said Dr Carol Routledge, director of research at Alzheimer’s Research UK. “Alzheimer’s is the most common cause of dementia, affecting half a million people in the UK, and we urgently need treatments capable of stopping the disease in its tracks.”

Full statutory inquiry to be held into tainted blood scandal

An inquiry into how contaminated blood transfusions infected thousands of people with hepatitis C and HIV has been moved from the Department of Health to the Cabinet Office after pressure from families, Downing Street has announced.

The inquiry, ordered in July after years of pressure from MPs and campaign groups, will be held as a statutory public inquiry under the 2005 Inquiries Act, Theresa May’s spokesman said.

An earlier parliamentary report found about 7,500 patients were infected by imported blood products from commercial organisations in the US, whose paid donors included injecting drug users and prison inmates. More than 2,400 haemophiliacs who received the tainted blood are dead.

While those affected and their families had welcomed the announcement of the inquiry, they had expressed concern that if it was held under the control of the Department of Health, it would in effect be investigating itself.

This was of particular concern following fears expressed by some MPs that officials had sought to cover up the scale of the scandal.

May’s spokesman said the first secretary of state, Damian Green, would post a written ministerial statement on Friday giving details about the inquiry.

“This follows a consultation with those who were affected on how the would like the inquiry to proceed,” he said, saying the consultation had received more than 800 written responses.

“We have been absolutely clear of our determination to establish what happened in relation to the contaminated blood scandal of the 70s and 80s, and to work with the victims and families of those affected, and we are now moving forward with that process,” the spokesman said.

Responsibility for the inquiry will move to the Cabinet Office, which is headed by Green.

“There was a strong view that it should be done away from the Department of Health. We’ve listened to those views, and that’s why it’ll be conducted under the auspices of the Cabinet Office,” the spokesman said.

It was not yet known who would head the inquiry or the terms of reference, he said, adding that a further announcement would be made before the end of the year.

A spokesman for the Haemophilia Society said it hoped the shift to the Cabinet Office “will be a turning point in helping the victims of this scandal finally get the justice they have long deserved”.

“We now hope a new and fresh discussion will be launched to establish the chair and terms of reference, which can now include the many groups who, like us, had felt unable to work with the Department of Health when it was so clearly conflicted,” he added.

Pressure for an inquiry had grown amid campaigning by the Labour MP Diana Johnson and Andy Burnham, the former Labour MP who is now mayor of Greater Manchester.

Johnson, who co-chairs an all-party group on the issue, said she welcomed the move but stressed that the Department of Health should have no say on the chair, panel or terms of reference.

“Secondly, this statutory inquiry must use its full powers to compel witnesses and hear evidence under oath. It must not be inhibited in its functions by the possibility of criminal liability being inferred,” she added. “Thirdly, the inquiry terms of reference must cover the aftermath of the tragedy as well as the run-up to infection. This includes the allegations of a criminal cover-up on an industrial scale.”

Diana Johnson (@DianaJohnsonMP)

Government have now done the right thing moving contaminated blood inquiry away from DOH and giving it full legal powers.

November 3, 2017

Labour’s shadow public health minister, Sharon Hodgson, said: “Having been implicated in this public health scandal, it would be highly inappropriate for the department to be the sponsoring body.

“The thousands of innocent families affected by this appalling tragedy deserve justice and today’s decision is an important step in that direction.”

Norman Lamb, the Liberal Democrat health spokesman, said: “This is crucial to ensure that the inquiry is completely independent from the Department of Health, whose role in this scandal needs to be fully scrutinised.”

The prime minister announced the contaminated blood inquiry hours before she faced possible defeat in a House of Commons vote on an emergency motion about the need for an investigation into the failings and the deaths.

Survivors welcomed the announcement, but said the decades-long wait for answers had been far too long. The contamination took place in the 1970s and 80s, and the government started paying those affected more than 25 years ago.

In his final speech to the Commons in April, Burnham said he had been contacted by victims and families who believed medical records had been falsified to obscure the scandal, saying there was evidence of “a criminal cover-up on an industrial scale”.

The scandal has its origins in the 1970s when people with haemophilia began to be given “factor concentrates” to treat their symptoms.

Drug companies found they could take the clotting factors out of blood plasma and freeze-dry them into a powder. There was high demand for the concentrate, taken from blood plasma, and in the US prisoners and people who were addicted to drugs were among those paid to give their blood. Donations were mixed together, which increased the chances of contamination.

Patients waiting at least an hour in ambulances double in two years

The number of patients waiting an hour or more to be transferred from an ambulance into an NHS A&E ward has doubled in England over the past two years.

There were 111,524 people who waited at least 60 minutes in an ambulance in 2016-17, up from 51,115 in 2014-15, prompting fears about patient safety. The increase was even more pronounced in some parts of the country, with figures from South East Coast ambulance service (Secamb) showing the number more than quadrupled over the same period, while in London it almost trebled.

Earlier this year, NHS Improvement (NHSI) said: “Tolerating ambulance handover delays is tolerating significant risk of harm to patients.”

Labour, which obtained the figures through freedom of information requests, said they were a sign the NHS has been “pushed to the brink”.

The shadow health secretary, Jon Ashworth, said: “These figures show an ambulance service pushed to the brink by years of Tory underinvestment. It’s clear that NHS services last year were operating at the absolute limit of what they could cope with.

“There is no excuse for the government to allow another crisis on this scale to develop this year. They’ve been well warned and they should take action to sort it out.”

The sight of ambulances queuing outside hospitals has become increasingly familiar in recent years and the figures explain why. South Western ambulance service was the only one of the 10 English ambulance trusts to record a decline (by almost a third) in waits of an hour or more between 2014-15 and 2016-17.

There was also an increase – by three-quarters, to 509,062 – in patients waiting 30 minutes or longer for admission to an emergency ward. Every trust recorded a rise from 2014-15, except West Midlands ambulance service, which did not provide the relevant statistics on half-hour waits.

As with patients waiting an hour or more, Secamb showed the biggest increase. The next biggest rises were recorded by Yorkshire ambulance service and then North West ambulance service. In these three trusts the number of waits of 30 minutes or more last year was more than double the corresponding figure in 2014-15.

NHSI has said that when ambulances are forced to queue, it increases the risk to patients because of delays in diagnosis in treatment, and means the vehicles are not available to respond to other emergencies. No targets for NHS ambulance response times have been met since May 2015.

In advice to hospitals and ambulance services, published in March, NHSI wrote: “It is crucial that patients are assessed on arrival in the ED [emergency department] and ambulance crews are freed up to attend the next emergency call.”

Ashworth said: “Theresa May has a choice in the budget: give the NHS the money it needs to deliver a decent standard of care, or leave NHS patients stranded in pain in the back of ambulances because the hospitals are just too full to cope.”

A Department of Health (DH) spokeswoman said: “In the face of huge increases in demand, our paramedics and call-handlers are working exceptionally hard and answering 4,500 more 999 calls every day compared to five years ago.

“Nevertheless, we expect patient handovers from ambulance to A&E to happen within 30 minutes and where delays occur hospital and ambulance trusts have a responsibility to make improvements.”

The figures on ambulance handover delays were published on the same day as the King’s Fund’s latest quarterly monitoring report also illustrated the pressures facing the NHS.

Half (51%) of the 85 (out of a total of 233) NHS trust directors who responded to the thinktank said patient care in their area had got worse over the last year. Less than half of trusts (45%) expect to meet their financial targets this year, its survey found.

Siva Anandaciva, chief analyst at the King’s Fund, described the results as “sobering” and said they showed “NHS funding pressures are now having a real impact on the people using its services”. Like Ashworth he urged the government to make additional funding available in the budget.

An NHS England spokesman said: “As the Care Quality Commission recently reported, the NHS’s high standards of care have been maintained and in many cases improved.”

The DH spokeswoman said the NHS was “better prepared for winter than ever before, supported by an additional £100m funding for A&Es and £2bn for social care”.