Category Archives: Cancer

The US healthcare system is at a dramatic fork in the road | Adam Gaffney

The US healthcare system – and with it the health and welfare of millions – is poised on the edge of a knife. Though the fetid dysfunction and entanglements of the Trump presidency dominate the airwaves, this is an issue that will have life and death consequences for countless Americans.

The Congressional Budget Office’s (CBO) dismal “scoring” of the revised American Health Care Act (AHCA) on Wednesday made clear just how dire America’s healthcare prospects are under Trump’s administration. But while the healthcare debate is often framed as a choice between Obamacare and the new Republican plan, there are actually three healthcare visions in competition today. These can be labelled healthcare past, healthcare present, and healthcare future.

Let us begin with healthcare past, for the dark past is precisely where Republicans are striving to take us with the AHCA. The bill – narrowly passed by the House on 4 May – is less a piece of healthcare “reform” than a dump truck sent barreling at high speed into the foundation of the healthcare safety net.

Wednesday’s CBO score reflects the modifications made to the AHCA to pacify the hard-right Freedom Caucus, changes that allowed states to obtain waivers that would relieve health insurers of the requirement that they cover the full spectrum of “essential healthcare benefits”, or permit them to charge higher premiums to those guilty of the misdemeanor of sickness, all purportedly for the goal of lowering premiums.

In fairness, the CBO report did find that these waivers would bring down premiums for non-group plans. This, however, was not the result of some mysterious market magic, but simply because, as the CBO noted, covered benefits would be skimpier, while sicker and older people would be pushed out of the market.

In some states that obtained waivers, “over time, less healthy individuals … would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all”. Moreover, out-of-pocket costs would rise for many, for instance whenever people needed to use services that were no longer covered – say mental health or maternity care.

Much else, however, stayed the same from the previous reports. Like the last AHCA, this one would cut more than $ 800bn in Medicaid spending over a decade, dollars it would pass into the bank accounts of the rich in the form of tax cuts, booting about 14 million individuals out of the program in the process. And overall, the new AHCA would eventually strip insurance from 23 million people, as compared to the previous estimate of 24 million.

It’s worth noting here that Trump’s budget – released Tuesday – proposed additional Medicaid cuts in addition of those of the AHCA, which amounted to a gargantuan $ 1.3tn over a decade, according to the Center on Budget and Policy Priorities.

The tax plan and budget – best characterized as a battle plan for no-holds-barred top-down class warfare drawn up by apparently innumerate xenophobes – would in effect transform the healthcare and food aid of the poor into bricks for a US-Mexico border wall, guns for an already swollen military, and – more than anything – a big fat payout to Trump’s bloated billionaire and millionaire cronies.

What becomes of this violent agenda now depends on Congress – and on the grassroots pressure that can be brought to bear upon its members.

But assuming the AHCA dies a much-deserved death – quite possible given the headwinds it faces in the Senate – we will still have to contend with healthcare present.

Last week, the Centers for Disease Control released 2016 results from the National Health Interview Survey, giving us a fresh glimpse of where things stand today. And on the one hand, the news seemed good: the number of uninsured people fell from 48.6 to 28.6 million between 2010 and 2016.

On the other hand, it revealed utter stagnation: an identical number were uninsured in 2016 as compared with 2015, with about a quarter of those with low incomes uninsured last year (among non-elderly adults). It also suggested that the value of insurance is declining, with “high-deductible health plans” rapidly becoming the rule and not the exception: for the privately insured under age 65, 39.4% had a high-deductible in 2016, up from 25.3% in 2010.

Healthcare present, therefore, is an unstable status quo: an improvement from healthcare past, no doubt, but millions remain uninsured and out-of-pocket health costs continue to squeeze the insured.

Which takes us to the third vision, that of healthcare future. As it happens, another recent development provided a brief glimmer of hope for that vision. As the Hill reported, the Democratic congressman John Conyers held a press conference yesterday (Physicians for a National Health Program, in which I am active, participated) to announce that his universal healthcare bill – the “Expanded & Improved Medicare For All Act” – had achieved 111 co-sponsors, amounting to a majority of the House Democratic Caucus and the most in the bill’s history.

This bill – like other single-payer proposals – is the precise antithesis of Paul Ryan’s AHCA. Rather than extract coverage from millions to provide tax breaks for the rich, it would use progressive taxation to provide first-dollar health coverage to all.

Which of these three visions will win out is uncertain, but the outcome of the contest will have a lasting impact on the country. We can only hope that the thuggish, rapacious vision championed by Trump and his administration does not prevail.

This is what the blood donor service does after an attack – and how you can help | Jane Green

I was overwhelmed by how generously the people of Manchester responded to this horrific attack. Both our blood donor centres in Manchester had queues outside the doors before they even opened. Our national call centre was taking about 1,000 calls an hour by 10am, from people who wanted to help save lives by donating blood.

The response was driven by well-intentioned social media posts from the public. The desire to help was incredible. However we already had enough blood to supply the hospitals treating the victims, and we did not appeal for extra donors. We plan ahead to build in reserves to deal with major incidents. We hope that people who want to help will now become regular donors, because that is how they can best help us save lives when there is a tragedy.

Many people wanted to donate to help that day, but when you donate blood, it is not taken straight to a patient. We need time to test it and process it. The different components such as platelets and red blood cells need to be separated out. Typically, your blood donation will only reach a patient two or three weeks after you donate. The blood used to treat the Manchester victims would have been donated several weeks earlier, and those donors would have been from across the country.

Hospitals order blood from us in advance, without the need for blood to be brought in for each patient. We supply hospitals through our regional stock-holding units (what people refer to as “blood banks”) mainly through routine deliveries. Over Monday night we made 21 deliveries of blood to hospitals in Manchester, including 15 “blue light” emergency deliveries, delivering 346 units of red blood cells. We were able to meet all the hospitals’ requests, and our stocks remained good. We don’t know exactly how this blood was used, and much of the blood from the routine deliveries would have gone to patients not affected by the attack. But this was an exceptionally high level of local emergency demand and many of those precious donations would have been transfused into attack victims.

Trauma patients require more than just red blood cells. They also need platelets to help their blood clot, and other more specialised products: O-negative blood is especially important in emergencies because it can be given to anyone when time is short and you don’t have time to test for blood groups. We always need new O-negative donors because their blood is so valuable.

As Tuesday morning progressed, people began queueing to donate. Some had friends or family members caught up in the incident. We were worried they might be confused or upset about why there was no capacity or urgent need for them to donate that day.


We were inspired to see the diversity of people coming forward, because we need more black and Asian donors

We tried to spread the message about how people could best help across social media and through the press. I was working at Plymouth Grove donor centre, next to Manchester Royal Infirmary, where many victims were being treated, and I spoke to many people face to face. We were inspired to see the diversity of people coming forward, which was moving and very important – because we need more black and Asian donors. Patients benefit from closely matched blood, which will often come from donors of the same ethnicity.

Our message is that blood can best save lives in a tragedy when our stocks are already good through regular donations. Thanks to our loyal army of nearly 900,000 active donors, many of whom give blood three or four times a year, we can do that. But every year many of these donors have to drop out because of age, ill health and many other reasons. We need nearly 200,000 people to register as new donors every year.

If people have been inspired to donate for the first time, please go online, make an appointment, and donate. Blood saves lives, and your donation will help other people in urgent need, and make sure we are again ready for any major incident.

UEA course cut a blow for mental health work | Letters

All the parties in the general election have adopted mental health as a key issue. But this enthusiasm is not reflected on the ground and the electorate should not be fooled. We are students and former students on the internationally renowned counselling programme at the University of East Anglia. We trained to be counsellors, or “shrinks”, to quote Prince Harry in his recent interview. But now the university has closed the course and even made it impossible for some students to complete their professional qualification. As part of this draconian process, in which consultation was at a minimum, responsibility to students, staff and the wider local community has been completely deprioritised. This is exactly the opposite of what the princes, applauded by the government, were calling for.

The impact is not only on the course itself, but also on those therapy organisations where students have for many years worked as volunteers on placement and beyond, and on the availability of the kind of in-depth listening relationship – described as so crucial by the princes – in the university’s own counselling service. The management-speak reason given by the university for this closure is “a need for greater alignment of courses and a more coherent portfolio of activity centred on the teaching of education theory and practice”. What is the point of accenting mental health if there won’t be any counsellors to deliver it?
Sara Bradly, Dr Rachel Freeth, Bridget Garrard, Nikki Rowntree
Norwich

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

NHS chief tells ministers: face up to the pay crisis

Ministers should address mounting disquiet among NHS staff about pay and recruitment if the health service is to avoid a full-blown staffing crisis, the head of the official body that represents hospital trusts and mental health services says today.

The stark warning from Niall Dickson, chief executive of the NHS Confederation, comes as GP leaders predict that 2,000 European-born doctors could leave the country because of uncertainty about their status caused by Brexit, with disastrous consequences for patient care.

Writing on theguardian.com, Dickson says nurses who complain about pay increases being capped at 1% – meaning they suffer real terms decreases– “have a point” and suggests the government think again about the effects of stagnating pay on morale and rates of staff retention.

“There may now be a case for looking again at pay,” he writes. “Given the financial and demand pressures on the service in recent years, some pay restraint has been necessary and inevitable. But it is also obvious there will be a limit on how far this can be taken before it affects recruitment and morale.”

The intervention by the confederation, whose chairman is former Tory health secretary Stephen Dorrell, is significant on an issue as sensitive as pay rates for NHS workers.

Last weekend, the Royal College of Nursing announced that nearly four out of five of its members (78%) who had taken part in a consultative vote backed a walkout in protest over pay while 91% favoured industrial action short of a strike.

Dickson says the RCN should not resort to any form of action that would harm patients but highlights rising vacancy rates as evidence of a problem that must be addressed. Nearly a quarter of NHS trusts now have a vacancy rate for registered nurses of more than 15%, he says. Specialities such as psychiatry face a constant struggle to fill training places and the number of child and adolescent, and old-age psychiatry posts. has declined.

Parts of the country, Dickson says, are finding it “almost impossible” to entice GPs, while some hospitals are being propped up by doctors in training because they can’t fill consultants’ posts.

The Royal College of GPs, the professional body for family doctors, says today that the manpower problems will be exacerbated as GPs from EU countries return home, because of Brexit. A total of 2,137 GPs in surgeries across Britain are from countries in the European Economic Area: the other 27 EU members plus Switzerland, Norway and Iceland.

Dr Helen Stokes-Lampard, chair of the RCGP, said: “We risk losing well over 2,000 family doctors from the NHS if their position is not secured as part of Brexit negotiations, and that is just not safe or acceptable.

“Our greatest fear is that hardworking, dedicated doctors from EU countries will simply cut their losses and leave, instead of waiting to have their fate determined for them. This would be a disaster for patient care, and it also makes long-term workforce planning for GP practices impossible.”

The RCGP wants the next government to stem the potential outflow of EU national GPs by guaranteeing their future status. Ministers should add family doctors to the migration advisory committee’s shortage occupation list, as happened several years ago with nurses, to make it easier to recruit GPs, it argues.

The British Medical Association claimed last week that general practice “is on the brink of collapse” because it is “several thousand GPs short”, and that family doctors are buckling under an “avalanche of work”.

Research published last week by NHS Improvement warned of “future supply problems” in many parts of England in which large proportions of GPs are over 55 and thus likely to retire in the next few years, including Kent and Medway (24.2%) and Somerset (24%).

Jonathan Ashworth, shadow health secretary for Labour – which has said it will end the pay cap for public sectors workers – said: “The NHS should be an absolute priority in the Brexit negotiations. The Tories’ chaotic approach to workforce management in the NHS has already left us thousands short of the number of GPs we need, and we simply can’t afford to lose the 2000 European GPs working here. Labour are pledging … to guarantee the rights of EU citizens working in our health and care system.”

A Conservative spokesman said only that: “Our manifesto said explicitly that we will make it a priority in negotiations with the EU that the 140,000 health and care staff from EU countries can carry on making their vital contribution.”

Christy Turlington: ‘The closest I’ve come to death? The birth of my daughter’

Born in California, Christy Turlington Burns, 48, was scouted to be a model at 14 and went on to become one of the original supermodels. After suffering a postpartum haemorrhage in 2003, she took a masters in public health and set up non-profit organisation Every Mother Counts, addressing global maternal health. The charity has partnered with Toms shoes. She is married to actor Ed Burns, has two children and lives in New York.

When were you happiest?
Before kids, when I was 13 or so, on the back of my horse, running at full speed in an open pasture. Post kids, happiness happens often, but in more subtle ways. I now prefer the word “content”.

What is your greatest fear?
I don’t fear anything but fear itself. Fear makes humans behave inhumanely.

What is your earliest memory?
I have a collage of memories beginning around age four: my first walk alone to a store or to school, and early trips to Central America with my mom to visit her family.

Which living person do you most admire, and why?
A midwife named Jennie Joseph. She is a tireless activist for women, family health and equal access to quality maternity care.

What is the trait you most deplore in yourself?
I sometimes set unreasonably high expectations of myself and those around me.

What was your most embarrassing moment?
There are too many to name, but none of them keeps me up at night.

What makes you unhappy?
Government policy decisions that negatively impact the health and wellbeing of women and families.

What do you most dislike about your appearance?
Having to talk about it.

Who would play you in the film of your life?
The world does not need a film about my life.

What is the worst thing anyone’s said to you?
A boyfriend once told me there was always going to be someone smarter, funnier and prettier than me, which at the time felt pretty mean, but it was true.

To whom would you most like to say sorry, and why?
To strangers. Living in New York, I see individuals every day who are invisible to so many. I want to say sorry that so many of us think their pain and suffering is not our own.

What was the best kiss of your life?
The first kiss from my husband and every one since.

What has been your biggest disappointment?
My father’s death before my marriage, and motherhood.

If you could edit your past, what would you change?
I might speed up a few details, but wouldn’t change anything, other than my dad still being here.

How do you relax?
Yoga, running, recreational reading.

What is the closest you’ve come to death?
The birth of my daughter.

What keeps you awake at night?
The fact that at least 300,000 women die every year from pregnancy and childbirth-related issues that are largely preventable.

What is the most important lesson life has taught you?
That I am more than I thought I was.

How would you like to be remembered?
As someone who didn’t waste a minute.

Coca-Cola’s ‘health by stealth’ wheeze is sneaky. But if it works so be it | Gaby Hinsliff

It had been a long day. I was knackered, and frankly not concentrating. Which is how I managed recently to bake a plum cake and forget to put the sugar in. The damn thing was already cooked and cooling by the time the penny dropped, so there was little option but to keep quiet and dish it up. But surprisingly, plates were licked clean. It tasted fine, if a little drier than usual. And yes, there is a point to this tedious domestic mishap, which is that Coca-Cola just did something similar to millions of its customers, in a move that has interesting implications for the debate over public health and the nanny state.

The soft drinks giant started by silently reducing the calories in Sprite. People didn’t seem to mind, so two weeks ago it secretly cut the sugar in Fanta by a third, and again sales held perfectly steady. So much for all the outraged spluttering over government plans to introduce a levy on sugary drinks next year – the reason Coca-Cola changed its recipes, since both drinks will now escape the tax – and how it would ruin much-loved brands. People literally didn’t notice.

There is admittedly something mildly disconcerting about the concept of “health by stealth” – although health is, in this case, a relative term. The acid in fizzy drinks is still no friend to teeth, and swapping sugar for other sweeteners does nothing to discourage the craving for sweetness. Who knows? In a few years we may all be panicking instead about some unforeseen side-effect of stevia, the natural plant-based sweetener substituted in Sprite. But it remains a rare example of a company fooling its customers into better choices, not worse ones – for once. They’re treating us like children. This is, after all, the equivalent of smuggling hated vegetables into pasta sauce and brazenly liquidising the evidence. But then, there’s nothing like a public health intervention for provoking a national tantrum.

Andy Burnham was accused of waging war on parents only four years ago for promising that a future Labour government would act to reduce sugar in cereals such as Frosties. Last year, when George Osborne finally unveiled plans for a tax on sweetened drinks, libertarian Tories were outraged.

Yet in a few years’ time we’ll surely look back and wonder what the fuss was about, for such is the way of health and safety interventions, from the ban on smoking in public places to the introduction of compulsory seatbelts. Outrage turns to grudging acceptance, before mellowing into surprise that things were ever any different.


If you announce you’re lowering fat, sugar or salt, then consumers glumly assume the result will be thin and joyless

It seems genuinely astonishing now that until 31 people died in the King’s Cross station fire in 1987, which was started by a dropped cigarette, nobody seemed to think smoking on the tube was a problem. My son boggles at the idea that back in the 1970s, kids would travel piled on top of each other in the backseat of a car or rolling around in the boot. But it still requires political courage to get past the initial wall of resistance, which is constructed of corporate inertia plus kneejerk irritation among consumers at being told what to do. Legislation can obviously overcome the former, but what’s less often noted is that it can also prompt imaginative responses to the latter.

Once, food manufacturers who made their products healthier would shout it from the rooftops, but increasingly they’re learning to do it on the sly. If you announce that you’re lowering fat, sugar or salt then consumers glumly assume the result will be thin and joyless; since so much of eating is about anticipation, that may be exactly how it tastes to them. But do it quietly and – as any slapdash home cook will know – you can get away with murder. Even in baking, which does depend on measuring ingredients accurately, it’s the ratio of fat to flour and liquids that seems crucial to the chemistry, rather than the sugar. A diabetic friend was advised by nurses that most recipes will still work even if you halve the sugar – which is roughly what I did by accident, since the plum cake recipe I screwed up still contained honey, fruit and golden syrup – at least so long as you don’t tell. Sneaky?

Growing up transgender: ‘I wish I could have come out younger’

Growing up is tough enough for any young person approaching puberty. But for Aimee Challenor the challenges she faced as a 10-year-old were much harder: “It struck me when I was about 10 or 11 that I was a girl. I couldn’t put my finger on it but something wasn’t right. I was in year 6 and I left my parents a letter on their bed before I went to school one morning. When we talked about it later they were very supportive, but no one knew what trans was. So I went back into the closet.”

During the next six years Challenor, now 19, felt anxious, isolated, lonely and depressed. “I spent my time at secondary school feeling pressured by society to be somebody that I was not. I wasn’t able to be myself; there was always that nagging feeling at the back of my head, so I didn’t take opportunities and grab them. I didn’t reach my potential and my education suffered as a result.”

It wasn’t until her school graduation prom that she decided to come out as trans: “It was then that articles about trans started to appear and I discovered that there was a word for it. I found the trans guide published by the Tavistock and Portman NHS foundation trust and decided to come out at my prom – it was the day before I was due to leave school.”

Her mum helped her with her dress and one of her school’s teachers did her makeup on the night: “Some of the staff were very supportive, but they were not in the school leadership team. Generally, I didn’t get any support from my school – it wasn’t up to speed on the Equality Act and they wouldn’t let me wear a dress to the prom because they thought it was unnecessary attention seeking; they said it made the school look stupid. But I dug my heels in. I was incredibly nervous on the night, but it felt so positive – for me it reinforced what was right.”

Challenor is in the process of transitioning from male to female but feels “in limbo” as she waits to continue adult gender identity services: “I’ve been out now for three years and publicly present as female, but I wish I could have come out younger and not have had to wait until I completed puberty.”

Today Challenor speaks on LGBTIQ (lesbian, gay, bisexual, transgender, intersex and questioning) issues for the Green Party in England and Wales and also contributed to charity Stonewall’s Vision for Change report, published in April, which spells out what still needs to be done to deliver equality for the UK’s trans community. Challenor says: “I speak to schools about trans issues and I am the first openly trans person to work for a political party. I think trans [people] need to show that you can be trans and reach your potential.”

Designed by patients: the mental health centre saving the NHS £300,000 a year

Soft, neatly folded blankets hang invitingly over the backs of the modern but comfy armchairs in the Gellinudd Recovery Centre’s communal living room. In the en suite bedrooms, there are white waffle slippers and dressing gowns embroidered with the centre’s tree symbol.

Staff and guests – those who stay are not termed patients – join forces to cook, clean and tend the fruit and veg they then sit down to eat together at Gellinudd, which is the UK’s first inpatient mental health centre to be designed by service users and their carers. “If you’re a psychiatrist you’ll still be expected to be in the kitchen chopping vegetables alongside everyone else,” says the centre’s director, Alison Guyatt.

Over three years, via consultation meetings attended by up to 50 people and annual general meetings attracting as many as 300, service users and carers who are also members of the Welsh charity Hafal, which runs the centre, have influenced everything from the policies and procedures to the decor, facilities and recovery-focused activities on offer.

“They’re the experts,” says Guyatt. “They can say how it feels to be on the receiving end of care, how anxious you would be, what your concerns would be. They have such powerful stories to tell.” The lack of privacy and dignity in hospital settings, together with old and decrepit buildings that provide little access to fresh air, were common themes among those who gave input. “A lot of them feel very clinical, rather than homely and welcoming,” Guyatt says.

Ensuring a different atmosphere at Gellinudd, which opened in April 2017, was therefore critical. Members met the architects in the earliest stages, and Guyatt arranged for furniture makers to bring chairs, tables and beds to consultation events to be tested.

Hafal believes co-produced, recovery-focused services improve outcomes for patients and reduce costs. It has estimated that Gellinudd, which was developed with Big Lottery funding of £1m and £500,000 from the Welsh government’s Invest to Save scheme, will generate year-on-year NHS savings of £300,000 in Wales.

Could the model be copied elsewhere in the UK? Commissioners are increasingly interested in co-production, according to Grazina Berry, director of performance, quality and innovation at the Richmond Fellowship, a voluntary sector mental health support provider that involves its users in shaping services. But the resources to make it happen are not necessarily available.

“We’re seeing many more opportunities coming up which directly ask for co-produced innovations,” Berry says. “But the money to match that isn’t always there because funding is reducing. We as a provider can say we’ll implement a whole range of innovative services. But to prove they work we want to evaluate them, and evaluation costs money.” Berry has no doubt that services designed with users bring better outcomes: “They give power to the people who understand recovery the most.”

At the National Survivor User Network (NSUN), a charity which helps mental health service users shape policy and services, managing director Sarah Yiannoullou believes the extent to which service users are listened to remains patchy. “There are some really good examples where the rhetoric is starting to become the reality, but it’s not consistent,” she says.

“I think we’re still in a system where the medical model is dominant and there’s this culture that the professional still knows best. The problem for the voluntary sector is that quite often what you say works and helps is regarded as anecdotal or dismissed as not credible.”

But it is crucial service users are listened to: “Meaningful, effective involvement can transform people’s lives, improve the quality and efficiency of services and develop the resilience of communities,” says Yiannoullou. “If commissioners and clinicians really listen to us, respect us and treat us as equals then our experience of services will improve.”

E-cigarette companies fined over false claims about toxic chemicals

Australia’s competition regulator has become the first in the world to successfully take legal action against e-cigarette companies for making false and misleading claims about the carcinogens in their products.

Federal court Justice John Gilmour ordered three online e-cigarette retailers – The Joystick Company Pty Ltd, Social-Lites Pty Ltd and Elusion Australia Ltd – and their individual CEOs and directors to pay penalties for breaching consumer law.

In separate proceedings the court found each of the companies had claimed their products did not contain harmful carcinogens and toxins, when this was not the case. It also found that the directors of Joystick and Elusion, and the CEO of Social-Lites, were knowingly involved in this deception.

Joystick and Social-Lites have been ordered to pay a penalty of $ 50,000, while the company heads have been ordered to pay $ 10,000. Elusion has been ordered to pay $ 40,000 and its director $ 15,000.

All three retailers admitted the conduct alleged by the ACCC and consented to the amounts of the penalties.

According to the case brought by the Australian Competition and Consumer Commission (ACCC), statements on the company websites led consumers to believe they would not be exposed to the harmful chemicals found in ordinary cigarettes.

However independent testing commissioned by the ACCC identified the presence of carcinogens and toxic chemicals, such as formaldehyde, acetaldehyde and acrolein in the products of Joystick, Social-Lites and Elusion, as well as acetone in Social-Lites’ products.

Formaldehyde is classified by the World Health Organisation International Agency for Research on Cancer as a Group 1A carcinogen, meaning it causes cancer, while acetaldehyde is classified as possibly carcinogenic. Acrolein is classified as a toxic chemical.

Dr Becky Freeman, a tobacco control researcher with the University of Sydney’s school of public health, said some consumers thought e-cigarette companies were “small artisan companies interested in improving health” when in fact most were owned by big tobacco.

Many advertisements for e-cigarettes and related products claimed they were less toxic and therefore less harmful than tobacco, she said. “But I’d challenge you to find something that isn’t less toxic than tobacco,” Freeman said. “We have no long-term data on e-cigarettes to show that they’ve help people quit for good or that they’re safe.”

The federal court ruling was “enormously significant”, said Simon Chapman, an emeritus professor of public health. He was aware that other complaints about e-cigarette advertising have been made to the ACCC. “These are by no means isolated examples,” Chapman said.

“Tobacco companies want to walk on both sides of the street. They try to argue that e-cigarettes are simply an ordinary consumer product and not a therapeutic device and therefore shouldn’t be subject to the same regulations, yet they often make statements that these things are excellent ways of quitting.”

He said it was “insulting to science” to claim the products were harmless or safe given the lack of evidence about long-term effects.

“Of course they don’t have all the products of combustion that tobacco products have, as they are vaporised and not burned. So while they’re likely to be less harmful, we do not yet know the magnitude of their harm, we just have no accurate way of estimating that yet,” said Chapman.

The ACCC’s acting chair, Delia Rickard, said businesses, including those online, must ensure they provide accurate information to customers and have a reasonable basis for making any claims. “This is particularly important for products that may cause harm to the health of consumers,” she said.

Ice baths and snow meditation can cold therapy make you stronger?

Before Scott Carney set about climbing a Polish mountain in his underwear in temperatures 10 degrees below zero, he believed his days of adventure were just about over. He was in his mid-30s. An anthropologist by training and a journalist by vocation he had written two books about the dangerous extremes to which humans go to find salvation – the first about the black market in organ donation, the second about the fatal consequences of a particular meditation practice.

His journey to the Polish mountain – called Sněžka, 5,300ft, the pinnacle of the Silesian mountain range – had begun one afternoon at his computer in Long Beach, California, with palm trees swaying gently outside his window. He had been idly Googling when he came across a picture of a man in his 50s sitting cross-legged on a glacier in the Arctic Circle, unclothed.

The man was Wim Hof, a Dutch evangelist for an extreme physical method that he claimed allowed him to raise and lower his body temperature at will and to control his immune system with the power of his mind. Carney was intrigued, but also highly sceptical. He decided to investigate Hof’s claims, and persuaded Playboy magazine to sign him up for a week-long initiation into the Dutchman’s methods that took place in a shack in Silesia in January.

He assumed that the story would be about another guru with an eye to the main chance, another investigation into the ways in which the gullible can be parted from their money in the name of enlightenment (the week cost Carney and his fellow disciples $ 2,000 each).

His scepticism did not last long. By the end of the week, after a short course in the breathing techniques that Hof demonstrated, and controlled exposure to the winter elements and icy water, Carney felt transformed. Not only could he climb Sněžka in 2ft of snow, but he discovered a kind of elation – and an enormous sense of internal warmth. He was converted.

Carney with Wim Hof and a fellow disciple, all bare-chested, linking arm and with fists of defiance, near the summit of Kilimanjaro.


Frozen assets: (from left) Carney with Wim Hof and a fellow disciple near the summit of Kilimanjaro.

His latest book, What Doesn’t Kill Us, explores the science and the philosophy of Wim Hof’s methods, which promise to unleash dormant “inner fire” by creating the mitochondria-rich tissue – “brown fat” – that is produced when the body is exposed to extreme cold.

By the time Carney met him, Hof had achieved notoriety by running a barefoot marathon in the Arctic and climbing 25,000ft up Everest in his shorts. Carney went on not only to relish the Dutchman’s regime of ice swimming, but also to accompany him in a shirtless climb up Kilimanjaro. The “guru-buster” had been won over by a man who claimed that a few simple physical techniques can promote world peace and “win the war on bacteria”.

But Carney is enthusiastic rather than being easily won over when it comes to Hof’s more grandiose claims. The book is pretty exhaustive in its investigation and he provides anecdotal evidence for Hof’s belief that his regime can improve the lives of those with auto-immune conditions – such as Parkinson’s, Crohn’s disease and rheumatoid arthritis – and this comes with caveats. The biology of the method focuses on the potential of vasoconstriction – the narrowing of blood vessels in response to extreme cold. The philosophy behind it suggests that our bodies – and brains – require exposure to physical extremes to realise what they are capable of.

Speaking to me about his conversion, Carney explains his belief that we have “forgotten” how to access the powers Hof describes. “Our technology has advanced to such a degree that we no longer see ourselves as part of nature,” he says. “But we are just big smart monkeys, right? One of the driving forces in our technological progress has been to try to maximise comfort and convenience – and that has had consequences.”

Whether that progress is thermostatically controlled room temperature, a decent sofa, or easy navigation, the aim, Carney suggests, is to protect ourselves from things that are hard physically and mentally. Without those everyday challenges, he argues, we have undermined our natural biological armoury. The Hof method – which begins with hyperventilation and culminates in lots of ice – is designed to switch on and wake up inbuilt energies, and to trigger immune responses – those same responses that allowed our ancestors to trek across tundra and thrive in unheated caves.


It’s designed to trigger the immune responses that allowed our ancestors to thrive in unheated caves

The idea is seductive, but isn’t Carney wary about evangelising what are potentially dangerous practices? He claims there is some evidence to support Hof’s theory, although it’s not conclusive or wholly supported by science. “There is always the risk that people take these things to extremes,” he says. “Certainly one of my worries about writing this book is that someone might read it and think: ‘Oh my God, I can be immune to the elements!’ and then die on a mountaintop. That is not the message I am pushing…”

He is cautious, too, as he describes the health claims Hof has made, but is clearly personally persuaded. He has moved with his wife to Boulder, Colorado, in the foothills of the Rockies, where he can experience temperature extremes more easily than on the coast. Still, he stops short of describing himself as a “brown fat” disciple. Though he was seduced by Hof’s philosophy, he attempts to balance that with a clear-eyed examination of the Dutchman’s frailties.

Hof comes across as a kind of freaky Spartan, but not a charlatan. “The good thing is that you would never want to be him,” Carney says. “He has a very disorganised life. Kids with different women, alcoholism in his past. He is flawed and human. I feel that if you hang out with him that makes you trust his really good qualities.”

It’s four years since the pair of them first met in Poland and they remain close friends. Carney has kept up his regime. “I had a cold shower this morning, did my 70 push-ups and 15 minutes of breathing exercise with my wife” (who is also a convert). But it is the understanding of the connection between his health and his environment that has changed his life. “I am much more comfortable with being uncomfortable now,” he says. The understanding of extremes provides, he believes, a sense of “physical perspective”. He feels not only healthier, but part of the natural scheme of things. While our fight or flight responses are as likely to be triggered these days by worrying about the mortgage or getting outraged by the internet, he says, contact with the elements reminds us both of our frailty and our strength.

The regime becomes addictive. A cold shower might release a few endorphins, but it is only a gateway drug. Carney craves the sensation of plunging through ice. “Jumping into very cold water and knowing you will feel warm is pretty cool,” he says. He does it as often as he can.

His book links the psychological appeal of the practice to the attractions of punishing obstacle course challenges, such as Tough Mudder. Carney sees not only a health benefit in those challenges, but also the kind of rite of passage that society rarely affords: “The idea used to be ‘a war will make a man of you,’” he says. “An idea that obviously doesn’t do us any favours. With these kinds of disciplines, you are putting yourself in a challenge and proving you can overcome it. There are many benefits of that.”

As an anthropologist, with an interest in eastern religions, I wonder how much he sees it in an ascetic, monastic tradition. Isn’t it just masochism?

“They are related, but they are not the same,” he says. “Ascetics deny the flesh to get closer to God. That is not the heart of this. It is celebrating what our bodies can do. You don’t have to do it all day every day. You can wear a coat sometimes if you want. I am not suggesting you become a cavemen and ditch the internet and forget modern medicine. It is about balance,” he pauses. “But I guess it certainly shows there can be a joy in pain.”

What Doesn’t Kill Us by Scott Carney is published on 11 May by Scribe Publications at £14.99. To order a copy for £12.74, go to bookshop.theguardian.com