Category Archives: Alergies

‘We give people their humanity back’: inside Croatia’s pioneering mental health centre

High walls still surround the oldest asylum in the Balkans, an 18th-century building pocked with the artillery scars of last century’s civil war, but the gates are no longer locked. Handles have been replaced on internal doors and bars removed from windows.

“The jail,” said Darko Kovaoic, a 53-year-old poet with schizophrenia who lives here, “has broken open.”

The institution in Osijek, eastern Croatia, is run by Ladislav Lamza, a former social worker who is taking on the government, the health minister, and his own staff to transform the lives of his “beneficiaries” – the patients of what was until recently an old-style asylum.

It was in May 2015 that Lamza ripped down the sign outside – replacing “Home for the Insane” with “Centre for People Like Us” and began moving people out.

“We express many things in that small sentence,” said Lamza. “Because what we have done for the past two centuries is the opposite. We’ve said: ‘You are not like us, you are ugly and mad and I’m not like you.’ This is where we exclude, stigmatise and restrain people for the rest of their lives.

“We have people in need and we provide inappropriate help and the result is catastrophic. I never knew anyone who was rehabilitated. We make equality between criminals and people with disabilities.”

Lamza’s transformation of the centre caused shock and upset: one member of staff pointed out that these were people who should have been “exterminated”.

In four years, 172 out of 200 people have been successfully moved into shared flats dotted around the small city, with carers from the centre visiting them as needed.

As his institution emptied, Lamza ditched the metal bed frames and stained mattresses. Although the paint still peels and the furniture is scratched and sagged, he has turned the bleak, soulless wards into rooms for day classes, a library and a bright cafe where former patients demonstrate how to make pancakes and brew tea for other ex-patients who come by daily to grow cabbages in the gardens or to chat with staff. Staff are no longer janitors, nurses, cooks or cleaners, but all re now “care assistants”. The transformation, says Butkovic Jadranka – formerly a hairdresser here, now running sewing classes and shopping and theatre trips – is amazing.

Slavica Hip left the home three years ago and now lives in Osijek with her boyfriend. ‘In the institution I would take more pills. Now my medication has been reduced. I feel better,’ she says.


Slavica Hip left the home three years ago and now lives in Osijek with her boyfriend. ‘In the institution I would take more pills. Now my medication has been reduced. I feel better,’ she says. Photograph: Photo: Robin Hammond/NOOR

“When we first heard of the director’s plans, I was fearful, everyone was fearful, we thought perhaps he had gone a little crazy. But now everything is completely different. Before it was like they were objects, slightly out of focus objects. Just numbers. Like on a conveyer belt. I never asked anyone’s name. Now they are my friends. People are not dangerous lunatics, they have become citizens, they have become neighbours.”

It is 10 years since Croatia signed the UN’s Convention on the Rights of Persons with Disabilities but Osijek is the only one of Croatia’s 24 mental health institutions, which house a total of 6,700 people, implementing its spirit. “We signed this with our fingers crossed behind our backs. The government still wants people locked up, locked away. People with disabilities, whether mental health or physical, have rights. There are four reasons why inclusion is better than exclusion,” said Lamza. “It’s better for a person, it’s better for the community, it’s legal, it’s cheaper.” He says the cost per person per month in an institution is $ 1,260 (£950). “In the community, even with the maximum 24-hour support, it is $ 1,020.

“The first day I let people go I didn’t sleep: will she hurt someone, will he cope? But there have been no problems. People have thanked us for giving them the best neighbours they have ever had!”

After 12 years in institutions, Branka Reljan, 55, has spent three years living in the community, in a shared flat with her partner Drazenko Tevlli. She speaks fluent German and English but has suffered mental health breakdowns since university and has let go of old ambitions. Now the couple take great delight in visiting cafes and shops. “We met in the institution but love is not allowed so we lived a secret for 11 years. I say I was in prison before. Now I love to make apple pies and buy spices and oils for cooking. It is wonderful for us to have our own keys, to buy fresh juice and to take a bus. We are satisfied with our neighbours. We are happy.”

Zoran Stih and Ruzica Vidakovic met at the institution in Osijek. They moved out in 2015 and are now married and living in an apartment in the town.


Zoran Stih and Ruzica Vidakovic met at the institution in Osijek. They moved out in 2015 and are now married and living in an apartment in the town. Photograph: Photo: Robin Hammond/NOOR

If other asylums in Croatia had any desire to follow Lamza’s care in the community model it would be more difficult. Most were built far from towns.

Rada Matos is the director of Ljeskovica home for mentally ill adults, deep in the Pozega forest, an hour’s drive from Osijek. Lamza describes it as “a warehouse for lost souls”. Matos says she does her best for the 284 people here but points out that Croatia is a poor country and mental health is both under-resourced and stigmatised. “We have no psychologists and no psychiatrists, no professional is interested in coming out here to work, yet perversely we are the main employer in the area for unskilled workers. It’s too far for relatives to visit and there is no community for people to live in even if I had the resources to try. There is a tiny village of uneducated people to whom this is the madhouse.”

There is a long waiting list to come here but few leave. “Maybe two a year,” she said. “We try to explain mental health is an illness, we invite in families, school groups. But what I’d really need to do is move this building somewhere else, somewhere where there is a community.”

Around the grounds and in the corridors, people stand or wander in shabby clothes too big or too small. Miryama Nikoli, 38, is new to Ljeskovica but has been institutionalised for 18 years. Eyes glazed by medication that hasn’t been changed in all that time, she talks to everyone about her daughter, taken away as a baby. “I was sick because of my nerves but now I suffer because of my baby,” she says. “I drink the medicine but I want to see her again.” Matos pulls out her file; her background is heart-breaking and abusive. One line mentions the child, who will now be 18. The file contains four A4 pages.

In Osijek the belief is that lives are better on the outside. Care assistant Vlatka Griner said the hardest task in moving people into the community was to make them use chairs: “At the asylum, they squat in the corridors, smoking. Squat, smoke, move a bit and squat again. What else did they have to do? In only slippers, just slippers because they never went out. When they are in the apartments the hard thing is to get people to sit in chairs. It can take a good two months.

“Then they go to the shops, buy their own food, buy their own clothes, run their own lives. Brush their hair. They’re unrecognisable.”


‘Love was not allowed in the institution. Now we are outside we have our own keys and take a bus. We are happy’

It is not a solution for everyone. Back in Osijek, Zdenko Kovac, 64, is a convicted murderer and, although he claims the scars on his head are from an axe wielded by his wife and he is not deemed dangerous enough for a secure hospital, he has failed to cope outside and is back in the institution where he wants to stay “until I die”.

“He is someone I worry about,” admits Lamza, “he wants to stay and ideally he will.” For others, it was never the right place. Luka Bobanovic, 36, caught a fever aged seven that left him brain-damaged. His mother handed him over to state care and he has been bounced around from institution to institution. “When he came to us he was very disturbed,” said Lamza. “Eight times Luka went through a door or window, either him chasing staff or them chasing him. The doctor told staff to tie him to his bed. I found him like that, tied to his bed, crying for his mamma. The staff shrugged and told me ‘we are scared of him’.”

Now he lives in a small bungalow with three other beneficiaries and round-the-clock care.“Our work doesn’t end when people live outside the institution,” said Lamza. “We are supporting them to live like every citizen of this town, to fall in love, dance, eat pancakes. I want to give people back a reason to live. That is what we have been taking from them, their humanity.

“I’m ashamed of how people lived before, but I’m happy,” Lamza said, “because they’re happy.”

‘We give people their humanity back’: inside Croatia’s pioneering mental health centre

High walls still surround the oldest asylum in the Balkans, an 18th-century building pocked with the artillery scars of last century’s civil war, but the gates are no longer locked. Handles have been replaced on internal doors and bars removed from windows.

“The jail,” said Darko Kovaoic, a 53-year-old poet with schizophrenia who lives here, “has broken open.”

The institution in Osijek, eastern Croatia, is run by Ladislav Lamza, a former social worker who is taking on the government, the health minister, and his own staff to transform the lives of his “beneficiaries” – the patients of what was until recently an old-style asylum.

It was in May 2015 that Lamza ripped down the sign outside – replacing “Home for the Insane” with “Centre for People Like Us” and began moving people out.

“We express many things in that small sentence,” said Lamza. “Because what we have done for the past two centuries is the opposite. We’ve said: ‘You are not like us, you are ugly and mad and I’m not like you.’ This is where we exclude, stigmatise and restrain people for the rest of their lives.

“We have people in need and we provide inappropriate help and the result is catastrophic. I never knew anyone who was rehabilitated. We make equality between criminals and people with disabilities.”

Lamza’s transformation of the centre caused shock and upset: one member of staff pointed out that these were people who should have been “exterminated”.

In four years, 172 out of 200 people have been successfully moved into shared flats dotted around the small city, with carers from the centre visiting them as needed.

As his institution emptied, Lamza ditched the metal bed frames and stained mattresses. Although the paint still peels and the furniture is scratched and sagged, he has turned the bleak, soulless wards into rooms for day classes, a library and a bright cafe where former patients demonstrate how to make pancakes and brew tea for other ex-patients who come by daily to grow cabbages in the gardens or to chat with staff. Staff are no longer janitors, nurses, cooks or cleaners, but all re now “care assistants”. The transformation, says Butkovic Jadranka – formerly a hairdresser here, now running sewing classes and shopping and theatre trips – is amazing.

Slavica Hip left the home three years ago and now lives in Osijek with her boyfriend. ‘In the institution I would take more pills. Now my medication has been reduced. I feel better,’ she says.


Slavica Hip left the home three years ago and now lives in Osijek with her boyfriend. ‘In the institution I would take more pills. Now my medication has been reduced. I feel better,’ she says. Photograph: Photo: Robin Hammond/NOOR

“When we first heard of the director’s plans, I was fearful, everyone was fearful, we thought perhaps he had gone a little crazy. But now everything is completely different. Before it was like they were objects, slightly out of focus objects. Just numbers. Like on a conveyer belt. I never asked anyone’s name. Now they are my friends. People are not dangerous lunatics, they have become citizens, they have become neighbours.”

It is 10 years since Croatia signed the UN’s Convention on the Rights of Persons with Disabilities but Osijek is the only one of Croatia’s 24 mental health institutions, which house a total of 6,700 people, implementing its spirit. “We signed this with our fingers crossed behind our backs. The government still wants people locked up, locked away. People with disabilities, whether mental health or physical, have rights. There are four reasons why inclusion is better than exclusion,” said Lamza. “It’s better for a person, it’s better for the community, it’s legal, it’s cheaper.” He says the cost per person per month in an institution is $ 1,260 (£950). “In the community, even with the maximum 24-hour support, it is $ 1,020.

“The first day I let people go I didn’t sleep: will she hurt someone, will he cope? But there have been no problems. People have thanked us for giving them the best neighbours they have ever had!”

After 12 years in institutions, Branka Reljan, 55, has spent three years living in the community, in a shared flat with her partner Drazenko Tevlli. She speaks fluent German and English but has suffered mental health breakdowns since university and has let go of old ambitions. Now the couple take great delight in visiting cafes and shops. “We met in the institution but love is not allowed so we lived a secret for 11 years. I say I was in prison before. Now I love to make apple pies and buy spices and oils for cooking. It is wonderful for us to have our own keys, to buy fresh juice and to take a bus. We are satisfied with our neighbours. We are happy.”

Zoran Stih and Ruzica Vidakovic met at the institution in Osijek. They moved out in 2015 and are now married and living in an apartment in the town.


Zoran Stih and Ruzica Vidakovic met at the institution in Osijek. They moved out in 2015 and are now married and living in an apartment in the town. Photograph: Photo: Robin Hammond/NOOR

If other asylums in Croatia had any desire to follow Lamza’s care in the community model it would be more difficult. Most were built far from towns.

Rada Matos is the director of Ljeskovica home for mentally ill adults, deep in the Pozega forest, an hour’s drive from Osijek. Lamza describes it as “a warehouse for lost souls”. Matos says she does her best for the 284 people here but points out that Croatia is a poor country and mental health is both under-resourced and stigmatised. “We have no psychologists and no psychiatrists, no professional is interested in coming out here to work, yet perversely we are the main employer in the area for unskilled workers. It’s too far for relatives to visit and there is no community for people to live in even if I had the resources to try. There is a tiny village of uneducated people to whom this is the madhouse.”

There is a long waiting list to come here but few leave. “Maybe two a year,” she said. “We try to explain mental health is an illness, we invite in families, school groups. But what I’d really need to do is move this building somewhere else, somewhere where there is a community.”

Around the grounds and in the corridors, people stand or wander in shabby clothes too big or too small. Miryama Nikoli, 38, is new to Ljeskovica but has been institutionalised for 18 years. Eyes glazed by medication that hasn’t been changed in all that time, she talks to everyone about her daughter, taken away as a baby. “I was sick because of my nerves but now I suffer because of my baby,” she says. “I drink the medicine but I want to see her again.” Matos pulls out her file; her background is heart-breaking and abusive. One line mentions the child, who will now be 18. The file contains four A4 pages.

In Osijek the belief is that lives are better on the outside. Care assistant Vlatka Griner said the hardest task in moving people into the community was to make them use chairs: “At the asylum, they squat in the corridors, smoking. Squat, smoke, move a bit and squat again. What else did they have to do? In only slippers, just slippers because they never went out. When they are in the apartments the hard thing is to get people to sit in chairs. It can take a good two months.

“Then they go to the shops, buy their own food, buy their own clothes, run their own lives. Brush their hair. They’re unrecognisable.”


‘Love was not allowed in the institution. Now we are outside we have our own keys and take a bus. We are happy’

It is not a solution for everyone. Back in Osijek, Zdenko Kovac, 64, is a convicted murderer and, although he claims the scars on his head are from an axe wielded by his wife and he is not deemed dangerous enough for a secure hospital, he has failed to cope outside and is back in the institution where he wants to stay “until I die”.

“He is someone I worry about,” admits Lamza, “he wants to stay and ideally he will.” For others, it was never the right place. Luka Bobanovic, 36, caught a fever aged seven that left him brain-damaged. His mother handed him over to state care and he has been bounced around from institution to institution. “When he came to us he was very disturbed,” said Lamza. “Eight times Luka went through a door or window, either him chasing staff or them chasing him. The doctor told staff to tie him to his bed. I found him like that, tied to his bed, crying for his mamma. The staff shrugged and told me ‘we are scared of him’.”

Now he lives in a small bungalow with three other beneficiaries and round-the-clock care.“Our work doesn’t end when people live outside the institution,” said Lamza. “We are supporting them to live like every citizen of this town, to fall in love, dance, eat pancakes. I want to give people back a reason to live. That is what we have been taking from them, their humanity.

“I’m ashamed of how people lived before, but I’m happy,” Lamza said, “because they’re happy.”

Hospitals attack ‘barking mad’ NHS target to manage winter crisis

Health service chiefs have been declared “barking mad” for ordering hospitals to ensure no patient is treated in a corridor or languishes on a trolley for hours when this year’s winter crisis hits.

NHS England’s instructions, intended to avoid a repeat of hospitals’ descent into the sort of meltdown seen last year, also say that patients should not have to wait more than 15 minutes in the back of an ambulance outside an A&E unit as they wait to be handed over to hospital staff.

Critics have described the plans, outlined in a four-page letter sent to hospital chiefs as “la-la land”, “totally unrealistic” and an attempt “to create Narnia”. Hospital bosses say they regularly have to use all the three tactics which the NHS wants to ban in order to help them cope with the influx of patients created by winter weather and seasonal infections.

“We all aspire to avoiding doing any of those things. But trying to flog a dead horse, or to create Narnia, through a new set of executive instructions isn’t going to help us,” said Dr Taj Hassan, president of the Royal College of Emergency Medicine, which represents A&E doctors.

“Our urgent and emergency care system is under extreme stress going into winter. Given that hospitals are underbedded and underfunded, and emergency departments are understaffed, trying to deliver performance in that climate is nigh-on impossible. We have to define reality rather than delude ourselves about the scale of this problem of caring safely for patients during winter.”

One NHS trust chief executive, who spoke on condition of anonymity, said: “They are barking mad. Patients are waiting on corridors already. This will only get worse as we progress through winter. Twelve-hour trolley breaches in some hospitals are no longer unusual, and for some no longer cause distress or outrage as they are viewed as inevitable. The demands are not realistic.”

Disclosure of NHS England’s attempt to impose a detailed series of duties on hospitals comes amid claims by senior insiders that its leadership is in a state of panic over winter.

Theresa May has told Simon Stevens, the organisation’s chief executive, that he is “personally responsible” for how the NHS performs during what most expect to be a very tough winter, with a flu outbreak feared. Some NHS bosses believe that the prime minister’s move is intended to protect Jeremy Hunt, the health secretary, who they blame for underfunding it and presiding over huge staffing problems.

The regulator NHS Improvement warned last week that the service was already under such pressure, with hospital wards too full after the failure of a £1bn exercise to free up 2,000-3,000 beds, that it was in an “extremely challenging” position.

NHS England’s plans are laid out in a letter sent to all 233 NHS trusts and 209 clinical commissioning groups on 7 June by Pauline Philip, its national director of urgent and emergency care, headed “Winter briefing one: operational management of winter – expectations and communication”. Philip sets out actions “to consistently ensure that safety is maintained during times of significant pressure”. They include an edict that “clinical escalation will need to ensure that patients are not cared for on hospital corridors; 12-hour trolley waits in the emergency department never happen; [and] patients do not wait more than 15 minutes in ambulances before being handed over to the hospital”.

But hospital bosses claim their struggle to keep up with the sheer demand for care over winter, while maintaining patient safety, forces them to deploy the three practices Philip wants to end. Another chief executive said: “This is totally la-la land thinking. The pressure is mounting now. I don’t think any of the areas ‘to be avoided’ will be. Many chairs and non-executive directors of trusts are in complete disbelief about NHS England’s tone and approach.” Serious doubts have been raised about the ability of hospitals to do what Philip has asked. For instance, 1,597 patients had to wait at least 12 hours in an A&E unit to be admitted into the hospital itself in January to March this year, when cold weather caused a spike in illness that led to the NHS experiencing its most pressurised winter ever. So many hospitals struggled so much last January that the British Red Cross called the situation “a humanitarian crisis”.

NHS England, working alongside NHS Improvement and Public Health England, have made unprecedented joint efforts to ensure the health service can withstand this winter’s rigours. For example, NHSE has put £237m into a campaign to offer free flu jabs to a record 21m people including expanded numbers of primary schoolchildren and, for the first time, care home staff.

Chris Hopson, chief executive of NHS Providers, which represents trusts, said hospitals would do everything they could to avoid trolley waits or patients being treated on corridors, and minimise patient handover times between ambulance and A&E staff. But he added: “The indications are that flu may cause more problems than we have seen in recent years. And a prolonged cold spell – often linked to falls and respiratory problems – could make matters worse. So we need to be realistic and honest.

“Trusts cannot guarantee that these problems will not happen. What they can do – and are doing – is to have strong and well developed plans in place to identify when they are struggling to cope, so they can call on support to ensure patients get the best care possible.”

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.

What can Britain learn from the US on links between economic distress and poor health?

Theresa May, in her first speech as prime minister, stood on the steps of Downing Street and referred to the glaring injustice of gaps in life expectancy and declared her intention to solve it by governing for everyone. I had a moment of hope for concerted action to increase health equity. That’s not looking bright at the moment; the government’s attention is elsewhere.

For many young people in Britain today – what with student debts, rental costs, the decline in home ownership, the gig economy and the economic uncertainties of Brexit – times are challenging.

A 15-year-old boy expects to be immortal, but evidence shows that expectation is less justified in the UK than in more than a score of other countries. The probability that a 15-year-old boy will die before his 60th birthday is 85 out of 1,000 in the UK. Is that a lot? It is higher than the best, Switzerland, at 61 per 1,000.

The UK ranks 22nd among all 185 countries for which the World Health Organisation reports this measure. Not terrible, but worse than Spain, Italy, Malta, Singapore, the United Arab Emirates, the Maldives, the Nordic countries, the Netherlands and Japan.


The US has a disastrous level of health for young and middle-aged adults

My colleagues and I at University College London’s Institute of Health Equity recently drew attention to the fact that the rise of life expectancy in the UK has stalled – a much more marked slowdown than in other European countries. Most of that levelling off is because of deaths at older ages.

I want here to focus on younger adults. You may ask why I worry about 61 in Switzerland compared with 85 in the UK. It seems like a small difference. But these figures represent something deeper: the quality of social conditions, how we are doing as a society. In the UK, we are not doing so well.

The US is doing worse. It ranks 44th on the probability that a 15-year-old boy will die before his 60th birthday. Mostly, this is not due to healthcare issues. The US spends more on healthcare, per person, than any other country, but has a disastrous level of health for young and middle-aged adults.

It is worth focusing on the US because it may have lessons for the UK. Anne Case and Angus Deaton of Princeton University recently updated their 2015 report showing that there has been a big rise in mortality rates among non-Hispanic whites; a rise that that was not seen in Hispanics or African Americans. The causes: poisonings from drugs and alcohol – in part, caused by medical care, because of over-prescription of opioids; suicides; and chronic liver disease, which is commonly alcohol-related. This adds to the toll of violent deaths. Medical care will not address the underlying social angst that gives rise to these causes of death.

Two important features of this US mortality in non-Hispanic whites have lessons for the UK. First, the fewer the years of education, the steeper the mortality increase, thus contributing to increase in health inequalities.

Second, Shannon Monnat of Penn State University looked at the geographic distribution of deaths from drugs, alcohol and suicide (pdf), and found that the greater the economic distress of an area, the higher the mortality rate. Monnat found, in the industrial midwest particularly, the higher the rate of these deaths the greater the 2016 vote for Trump, compared with Romney four years earlier. Trump didn’t cause these deaths, but these deaths may have caused Trump. More precisely, economic distress led both to death by drugs, alcohol and suicide and a greater likelihood of voting Trump.

In the UK we do not have the same appalling toll of drug and alcohol deaths, but we do see higher mortality in areas of economic distress. People in those areas were more likely to vote Brexit – perhaps prompted by the same dissatisfactions that led to the Trump vote in the US.

There is, though, much that can and is being done at local level. In London, for example, there has been a sharp reduction in inequalities (pdf) between children from poor families and the average in early child development and educational performance.

Coventry has become a “Marmot city”. It has taken the recommendations from my 2010 health inequalities review, Fair Society, Healthy Lives, and is implementing the recommendations.

Elsewhere, in addition to dedicated doctors and nurses, occupational therapists are supporting older people to remain independent at home. In the West Midlands and Merseyside, fire services are, as they put it, improving lives to save lives; they use their time and community commitment to get young people active, look after their homes, support older people and engage with improving people’s social lives.

None of this should let central government off the hook. We need an end to austerity, a reversal of plans to make the tax and benefit system less progressive, and real attention to regional inequalities. But the action of dedicated professionals at local level is an inspiring example of what can be done.

  • Michael Marmot is professor of epidemiology at University College London. He will be speaking at the King’s Fund annual conference on 29 and 30 November 2017

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Owning a dog cuts risk of heart attacks and other fatal diseases, study shows

Never mind the chewed slippers, the hair on the sofa, and the inexplicable barking at 3am. Having a dog in the home substantially reduces the risk of heart attacks and other fatal conditions, a major study has shown.

Researchers found that dog ownership had a dramatic effect on people who live alone, cutting the risk of death from cardiovascular disease by 36%. In households with more people under the same roof, dogs had less of a positive impact, but still lowered deaths from heart disease by 15%, the work reveals.

The findings emerge from a study of more than 3.4 million people in Sweden whose medical and pet ownership records were analysed to investigate the potential health benefits of dog ownership. Those who took part in the study were aged 40 to 80 years old and were followed for up to 12 years. Just over 13% had pet dogs.

Tove Fall, professor of epidemiology at Uppsala University, and owner of a five-month-old Kooikerhondje puppy, said the health benefits of dog ownership appeared to be starkest for people who otherwise lived alone. “We see effects in the single households that are much stronger than in multiple-person households,” she said. “If you have a dog you neutralise the effects of living alone.”

Last month, the leader of Britain’s GPs, Helen Stokes-Lampard, warned that loneliness was as bad for human health as a long-term illness. The estimated 1.1 million lonely Britons are 50% more likely to die prematurely than those with good social networks, making loneliness as harmful to the nation’s health as diabetes. While people who live alone are not necessarily lonely, many in the Swedish study seemed to benefit disproportionately from having a dog around.

Working with her colleague, Mwenya Mubanga, on records from Sweden’s national registries, Fall also looked at deaths from any cause and found that people who lived alone with their dogs were a third less likely to die over the study period than those without dogs. For those in larger households, the risk of death was 11% lower among dog owners, the researchers write in Scientific Reports.

The study cannot explain how dogs have a health-boosting impact, but the company alone may reduce stress and motivate people to live healthier lifestyles. In the study, Fall analysed the effects of different breeds and found that owners of dogs originally bred for hunting, such as terriers, retrievers, and scent hounds, had the lowest risk of cardiovascular disease.

People who buy hunting dogs may be more physically active in the first place, because the dogs require so much exercise. The relationship may work both ways though, with livelier dogs effectively demanding that their owners do not slip into an overly-sedentary lifestyle.

But Fall does not believe that getting more exercise explains all, or even most, of the health effects that come with dog ownership. “My impression is that this has to do with social support,” she said.

Other explanations have been put forward, too. Having a dog around the house might influence what varieties of microbes take up residence on and in human bodies, and these may influence our health for the better, Fall said. In previous research, she showed that having a pet dog reduced a child’s risk of asthma by 15%, lending support to the “hygiene hypothesis” which suggests that living in too clean an environment can increase susceptibility to allergies.

Fall hopes to have more answers soon. One key question is whether dogs protect humans against heart disease by reducing blood pressure or through some other effect. “It may be that dog owners like to be outdoors more, or are more organised, or more empathic,” she said.

NHS cash squeeze forces hospitals to postpone non-urgent operations

The NHS is under fire for forcing patients who need surgery to wait at least three months before they can have an operation in order to save money.

NHS clinical commissioning groups (CCGs) in Lincolnshire have provoked sustained criticism after deciding to introduce minimum waiting times for non-urgent surgery including cataract operations and joint replacements.

They have adopted the policy as a result of the NHS-wide cash squeeze and also because they insist that some patients’ condition clears up while they wait.

A Liberal Democrat MP, Norman Lamb, a former health minister, said the move was “a shameful indictment of the under-funding of the NHS” that would prove unfair and divisive. “It undermines the core principles of the NHS: that everyone should get compassionate treatment, as early as possible, when they need it. Those who can afford it will go private to skip the wait, while others will be left waiting in pain and discomfort. This is simply impossible to justify.”

Trafford CCG in greater Manchester has confirmed that it is also considering bringing in a similar policy, according to the Health Service Journal (HSJ), which first reported on the plans.

NHS England oversees all 209 CCGs which between them spend over £60bn of the NHS’s £125bn annual budget. It appeared to back minimum waits, despite the controversy they have aroused.

A spokesman for NHS England said that with health budgets so squeezed that NHS bodies face “difficult choices” about what they spend their money on. However, there are doubts about whether it is legal for any CCG to bring in minimum waits for care, given that patients are supposed to be guaranteed in the NHS constitution that they will be treated as soon as possible.

Lincolnshire West CCG told HSJ that it had “a responsibility to ensure public money is spent effectively and efficiently”. It added that “there is evidence that some conditions do get better over time and that, in some cases, surgery may be unnecessary” though did not specify to which conditions it was referring.

The commonest non-urgent operations hospitals perform include removal of cataracts, replacement of a worn-out hip or knee and the repair of a hernia.

The Royal College of Surgeons (RCS) said making patients wait at least 13 weeks for treatment was “arbitrary” and “ethically wrong” because patients would suffer.

Sue Hill, the college’s vice-president, said: “We strongly urge all these CCGs to reconsider this decision. Patients in Trafford currently wait an average of 7.2 weeks for any type of treatment. If this policy were to go ahead average waiting times in Trafford would double and it is difficult to see how these targets coud be achieved.”

While the RCS appreciates the severe financial pressures facing CCGs, “introducing an arbitrary minimum waiting time for surgery is unlikely to save money in the long-term and is ethically wrong. Delaying surgery can mean a patient’s condition worsens, and can make surgery more difficult and less successful,” added Hill.

Cambridgeshire and Peterborough CCG was the first to bring in minimum waits for non-urgent surgery, also for 12 weeks. But it recently abandoned the policy two months after it was brought in.

Minimum long waits for treatment were banned when the coalition was in office through a ruling in 2011 by the now defunct Cooperation and Competition Panel. However, it appears that that applied only to primary care trusts, which CCGs replaced, and not to CCGs, which hold the NHS budget across England.

Jon Ashworth, the shadow health secretary, urged the government to prevent NHS bodies from using the tactic. “I’m demanding Jeremy Hunt intervenes, enforces the NHS constitution and bans these minimum waiting times. Secondly, in the budget Theresa May must provide the NHS with the money it needs to end this postcode lottery of care that has developed under the Tories.”

An NHS England spokesperson said: “CCGs face difficult choices about what can be afforded within the funds parliament has made available, recognising the priority being accorded to emergency care, mental health, cancer and GP services. Last month 1.3 million patients started consultant-led elective treatment and the vast majority of patients wait less than 18 weeks.”

Lincolnshire NHS enforces three-month wait for surgery

The NHS is under fire for forcing patients who need surgery to wait at least three months before they can have an operation in order to save money.

NHS clinical commissioning groups (CCGs) in Lincolnshire have provoked sustained criticism after deciding to introduce minimum waiting times for non-urgent surgery including cataract operations and joint replacements.

They have adopted the policy as a result of the NHS-wide cash squeeze and also because they insist that some patients’ condition clears up while they wait.

A Liberal Democrat MP, Norman Lamb, who was a health minister in the coalition government, said the move was “a shameful indictment of the under-funding of the NHS” that would prove unfair and divisive. “It undermines the core principles of the NHS: that everyone should get compassionate treatment, as early as possible, when they need it. Those who can afford it will go private to skip the wait, while others will be left waiting in pain and discomfort. This is simply impossible to justify.”

Trafford CCG in greater Manchester has confirmed that it is also considering bringing in a similar policy, according to the Health Service Journal (HSJ), which first reported on the plans.

NHS England oversees all 209 CCGs which between them spend over £60bn of the NHS’s £125bn annual budget. It appeared to back minimum waits, despite the controversy they have aroused.

A spokesman for NHS England said that with health budgets so squeezed that NHS bodies face “difficult choices” about what they spend their money on. However, there are doubts about whether it is legal for any CCG to bring in minimum waits for care, given that patients are supposed to be guaranteed in the NHS constitution that they will be treated as soon as possible.

Lincolnshire West CCG told HSJ that it had “a responsibility to ensure public money is spent effectively and efficiently”. It added that “there is evidence that some conditions do get better over time and that, in some cases, surgery may be unnecessary” though did not specify to which conditions it was referring.

The commonest non-urgent operations hospitals perform include removal of cataracts, replacement of a worn-out hip or knee and the repair of a hernia.

The Royal College of Surgeons (RCS) said making patients wait at least 13 weeks for treatment was “arbitrary” and “ethically wrong” because patients would suffer.

Sue Hill, the college’s vice-president, said: “We strongly urge all these CCGs to reconsider this decision. Patients in Trafford currently wait an average of 7.2 weeks for any type of treatment. If this policy were to go ahead average waiting times in Trafford would double and it is difficult to see how these targets coud be achieved.”

While the RCS appreciates the severe financial pressures facing CCGs, “introducing an arbitrary minimum waiting time for surgery is unlikely to save money in the long-term and is ethically wrong. Delaying surgery can mean a patient’s condition worsens, and can make surgery more difficult and less successful,” added Hill.

Cambridgeshire and Peterborough CCG was the first to bring in minimum waits for non-urgent surgery, also for 12 weeks. But it recently abandoned the policy two months after it was brought in.

Minimum long waits for treatment were banned when the coalition was in office through a ruling in 2011 by the now defunct Cooperation and Competition Panel. However, it appears that that applied only to primary care trusts, which CCGs replaced, and not to CCGs, which hold the NHS budget across England.

Labour seized on the controversy. Jon Ashworth, the shadow health secretary, urged the government to step in and ban NHS bodies from using the tactic. “I’m demanding Jeremy Hunt intervenes, enforces the NHS constitution and bans these minimum waiting times. Secondly, in the budget Theresa May must provide the NHS with the money it needs to end this postcode lottery of care that has developed under the Tories.

“Let us be under no illusions: these minimum waiting times are the direct result of Theresa May’s sustained underfunding and neglect of our health service, which has placed unprecedented cost pressures on trusts nationwide.”

An NHS England spokesperson said: “CCGs face difficult choices about what can be afforded within the funds parliament has made available, recognising the priority being accorded to emergency care, mental health, cancer and GP services. Last month 1.3 million patients started consultant-led elective treatment and the vast majority of patients wait less than 18 weeks.”

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.”

Long NHS delays can be ‘devastating’ for patients with eating disorders

People with an eating disorder are waiting as long as five years to start treatment on the NHS, putting their recovery in peril, according to a report.

Beat, a charity which helps people suffering from anorexia and bulimia, warns that delays to access vital care can have a “devastating” impact on those with eating disorders.

It stresses that while the five-year wait was a one-off, too many patients are waiting too long to see a specialist, despite recent efforts by the NHS to provide more services and cut waiting times.

Patients wait on average six months after first visiting their GP about their condition before they start treatment, it said. Some have been made to wait as long as that – 26 weeks – just to have the appointment at which they are assessed, after being referred for help by their GP.

And it can then take as much as 13 weeks after the assessment appointment before they see a psychiatrist who specialises in treating eating disorders, Beat said.

Its findings are based on the experiences of 1,478 patients who responded to a survey the charity undertook.

“The impact of having to wait a long time before receiving treatment can be devastating for eating disorders sufferers and their families,” said Andrew Radford, Beat’s chief executive.

“Eating disorders are serious, complex mental illnesses and early intervention is key to recovery. All evidence tells us the sooner someone with an eating disorder gets the treatment they need, the more likely they are to make a full and sustained recovery,” he added.

Around 725,000 people in the UK are estimated to have an eating disorder, and the conditions cost the NHS about £4.6bn a year to treat. Almost 90% of sufferers are young girls or women.

It takes on average three and a half years between symptoms emerging and the sufferer starting treatment, with the gap among adults seeking help double that found in children. People typically take over 18 months to realise they have a problem and then more than a year before they seek help, Beat found.

Under NHS England waiting times targets for eating disorders, under-18s who are classed as an emeregncy should receive treatment within 24 hours, urgent cases should be seen inside a week and non-urgent cases within four weeks.

Barbara Keeley, Labour’s shadow cabinet minister for mental health, said that official waiting times performance figures showed that many young patients were still not receiving timely care.

Between July and September, 29% of urgent cases did not start treatment within a week and 17.6% of patients did not begin routine treatment within four weeks.

“This [Beat] report suggests that Tory ministers need to snap out of their complacent attitude to the treatment of eating disorders. It is yet more proof that warm words from the Tories haven’t been met with firm action to improve services in the community,” Keeley said.

Research by Labour found that a few NHS mental health trusts have reported worryingly long waits for children and young people with eating disorders.

Tees, Esk and Wear Trust reported eight urgent cases who had waited over four weeks, five of whom waited over 12 weeks, and 44 routine cases who had waited longer than 12 weeks.

Avon and Wiltshire Trust had five urgent cases waiting four to 12 weeks and 13 routine cases in which those involved had waited over 12 weeks.

Dr Marc Bush, YoungMinds chief policy adviser, said: “Sadly, these figures chime with what we hear on our helpline, from worried parents who are desperately trying to get support from child and adolescent mental health services.”

Bush added: “Parents of children with eating disorders say that their children have been turned away because their weight isn’t low enough, or that they’re put on long waiting lists, during which time the situation can get worse.

“While services are improving in some areas, these figures suggest that too often NHS targets for the treatment are not being met. It’s also clear that there is still a huge amount of work to do to help young people recognise when they may be developing an eating disorder and seek help earlier on.”

An NHS England spokesperson said: “There are now 70 NHS community eating disorder services for children and young people covering the whole of England, backed £150m of investment. As a result, eight in ten young people now get care within four weeks, and three-quarters receive urgent treatment in a week, so progress is clearly being made.”