Category Archives: Diet & Fitness

No such thing as an ideal heating setting | Letters

As a thermal comfort researcher, men often complain to me that their wives turn up the thermostat because they prefer warmer conditions (Why women secretly turn up the heating, G2, 12 October). There is no such thing as a single comfort temperature. A thin lady is likely to feel colder than a plump one. A recent sample in English homes recorded living room temperatures from 10C to 25C. Thermostat settings are driven by many factors including environmental beliefs, customs, daily routines, incomes or different approaches to heating. The heating and energy industries would love us to heat whole buildings, but all we often need to do is heat the people inside them. Average winter living-room temperatures in New Zealand are around 14C where people sit by a small heater when relaxing. In Japanese homes temperatures can fall to 5C indoors because people keep warm with a “Kotatsu”, a small heater by their chair covered by a shared rug, as in parts of Spain. We all adapt to those temperatures we normally occupy. If uncomfortable, and we can afford to, we change our environments.
Emeritus Professor Sue Roaf
Oxford

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No such thing as an ideal heating setting | Letters

As a thermal comfort researcher, men often complain to me that their wives turn up the thermostat because they prefer warmer conditions (Why women secretly turn up the heating, G2, 12 October). There is no such thing as a single comfort temperature. A thin lady is likely to feel colder than a plump one. A recent sample in English homes recorded living room temperatures from 10C to 25C. Thermostat settings are driven by many factors including environmental beliefs, customs, daily routines, incomes or different approaches to heating. The heating and energy industries would love us to heat whole buildings, but all we often need to do is heat the people inside them. Average winter living-room temperatures in New Zealand are around 14C where people sit by a small heater when relaxing. In Japanese homes temperatures can fall to 5C indoors because people keep warm with a “Kotatsu”, a small heater by their chair covered by a shared rug, as in parts of Spain. We all adapt to those temperatures we normally occupy. If uncomfortable, and we can afford to, we change our environments.
Emeritus Professor Sue Roaf
Oxford

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

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

ITV’s Victoria illustrates how 19th-century sexism helped syphilis to spread

Historically, syphilis was extremely difficult to cure. Often patients would think that their disease had disappeared or been cured, only to be have their bodies betray them with a resurgence of symptoms. This was the story outlined in Sunday night’s episode of Victoria – but aside from the obvious scientific questions about drugs and treatment regimes, it also raises points about the treatment of women.

In Victoria, things were finally looking up for Prince Ernest (David Oakes). He was responding well to treatment and, consequently, had been given the all-clear by his doctor to marry. Moreover, the Duke of Sutherland had considerately fallen off his horse, making Harriet (Margaret Clunie) a merry widow and prospective bride. But that was before a coppery rash appeared across Ernest’s splendid shoulders.

To a historian of medicine, this didn’t come as a great surprise. I’ve read hundreds of Victorian case notes on venereal-disease (VD) patients, and they often follow a dishearteningly familiar pattern. Having responded well to treatment, many relapsed several months or years later. Stigmatising infections, lengthy treatments and uncertain outcomes took an emotional toll on patients. Nineteenth-century doctors took seriously the notion that a diagnosis of syphilis could trigger acute despair and melancholia. Indeed, this was the subject of Arthur Conan Doyle’s short story Third Generation, which follows an aristocratic young man diagnosed with syphilis. Consumed by paranoia that his fiancee’s family will discover his secret, and fearing disgrace, he throws himself under a horse-drawn carriage.


It’s tempting to condemn doctors for what we now consider to be the mistreatment of female patients

Happily, such a fate has not befallen Ernest. But he’s nonetheless been dealt a terrible blow, all the more because he had believed himself cured. He also faces a moral dilemma familiar to many young Victorian men. Does he postpone his marriage to Harriet, thereby ruining their happiness? Or does he marry Harriet, thereby ruining their happiness? The first option, as Conan Doyle would have us believe, risks social ruin. The second has even more serious consequences. Ernest risks infecting her and any children they might have together.

As well as causing infertility, syphilis can induce miscarriages and stillbirths. Some children born to syphilitic mothers will never show any signs of infection. Others die in infancy or develop serious health complications. Today, routine antenatal screening in Britain catches most cases of syphilis among pregnant women. But in the 19th century, infection among wives and children was common across all social classes.

Skeleton of an 11-year-old child born with syphilis, on display at London’s Wellcome Collection.


Skeleton of an 11-year-old child born with syphilis, on display at London’s Wellcome Collection. Photograph: Linda Nylind for the Guardian

These domestic tragedies were often dealt with quietly. But occasionally they exploded into scandal, as in the very public breakdown in 1886 of the marriage of Gertrude Blood and Lord Colin Campbell. Unbeknown to Gertrude or her parents, Lord Colin was being treated for syphilis and knowingly infected her. The case became a cause célèbre as curious readers pored over salacious newspaper reports of the Campbell’s dysfunctional marriage. With the establishment of the divorce courts in 1858 women like Gertrude could theoretically extricate themselves from abusive marriages. But, whereas husbands needed only to prove adultery, wives needed additionally to prove either cruelty, desertion or bestiality. Able to demonstrate only cruelty through the wilful communication of syphilis, Gertrude had to settle for a judicial separation.

Women in Gertrude’s predicament contended with husbands who were protected by the medical and legal establishment. If a husband infected his wife with syphilis or gonorrhoea, a doctor went to great lengths, usually at the behest of the husband, to conceal the cause of her illness. She would know that she was ill, but she wouldn’t necessarily know that she had VD. Doctors who withheld information from women claimed that they were bound by patient confidentiality – a doctor couldn’t tell a wife that she was suffering from syphilis because doing so would reveal that her husband also had syphilis. A degree of pragmatic paternalism informed these decisions: doctors believed that they knew best and prioritised expediency. After all, a woman who discovered that she was infected with VD might cause a fuss and make her husband’s life difficult. And since the husband was usually the one paying the doctor’s fee, his interests took priority.

Moreover, in the minds of Victorian moralists, possessing knowledge of VD debased a woman. Ignorance was equated with innocence and purity. And the cost, all too often, was her health. Once the more obvious symptoms disappeared, a doctor might find himself compelled by the husband to terminate treatment lest the wife become suspicious. Certainly, not all women were victims of such negligence. The growing numbers of women doctors were especially willing to discuss diagnoses and treatments with their patients. Yet concealment was so common as to become the subject of fraught medical and social debate.

It’s tempting to condemn doctors for what we now consider to be the mistreatment of female patients. In our modern ethical framework, we prioritise the patient’s right to make decisions about their care and to be given the information needed to make those decisions. But other important factors informed 19th-century medical encounters. Victorian doctors were in a legal and professional bind. Disclosing information to their patients might at best result in dismissal from the case. At worst, they might be pursued through the courts for breaching confidentiality. Such inequalities are difficult to sustain in a nationalised health service, where doctors are not subject to market pressures. Indeed, the establishment of a state VD service during the interwar years helped to consolidate new types of healthcare protocols that resemble those of today. With a mandate to provide free, universal care, the VD clinics of the 1920s and 1930s helped to break down the economic power imbalances that had shaped Victorian doctor–patient relationships.

These changes were also the product of new debates over culpability and infection control. British medical authorities were preoccupied at mid-century with the idea that prostitutes were the primary carriers of infection. By the 1890s, however, public censure was shifting to the intemperate, affluent men who exploited working-class women and infected their own families. The threat posed to women like Harriet and Gertrude became the focus of a campaign spearheaded by the “New Woman” movement. Young, affluent and unchaperoned, the New Woman railed against sexual hypocrisy and demanded that women have knowledge of, and control over, their own bodies.

Syphilis was a capricious mistress and the Victorians were intolerant of those who crossed her path. Ernest may yet be cured, but if Harriet marries him before that happens, she could find herself in the same mess as Gertrude.

  • Anne Hanley is a historian of medicine at Birkbeck, University of London and acted as a historical consultant on Victoria. For more about Victorian medicine, follow her on Twitter at @annerhanley.

Private insurance reforms a mental health ‘work-around’

The national mental health commissioner, Prof Ian Hickie, has described private health insurance reforms affecting mental health as a “work-around” that will lead to more mental health hospital beds without providing the community-based services people need.

On Thursday the health minister, Greg Hunt, announced a private health insurance overhaul, including changes to mental healthcare. From April people will be able to upgrade their coverage to cover mental health treatment when they need it without facing waiting periods, and basic private policies will include mental health cover as standard.

Under the reforms it will be harder for insurers to place limits on mental health treatments and therapy sessions, such as group counselling sessions, electroconvulsive therapy or transcranial magnetic stimulation.

But Hickie told Guardian Australia he wanted to know what Hunt had planned to increase mental health services available under Medicare so that community-based mental health services would be more readily available.

“Private health insurance encourages growth in the wrong kind of service, which is hospital-based mental health services through more private hospital beds,” Hickie said. “But we also need to be building alternative services outside of hospitals to prevent people from going into hospitals in the first place.

“Of course, it’s unacceptable that private health insurers have been excluding mental health from policies … The bottom line is, though, the minister has developed a work-around to address junk policies that exclude mental health, but where the minister could make an enormous difference is by introducing regulatory changes that would permit private health insurers to cover specialised care outside of hospitals.”

He said state, territory and federal governments had been unwilling to address the gap in mental health services covered by Medicare, and that it could not be up to private health insurers alone to improve access to mental health support.

Inpatient mental heath programs in private hospitals varied widely in quality, he said.

“The danger is we end up with wrong sets of services,” he said. “These reforms are the first step but they are not the solution. They are the work-around while people are dealing with the holes. My worry is that sometimes the first step is so hard to take that it becomes the only step.”

The Greens leader Richard Di Natale, who is a medical doctor, said the ability of people to upgrade their coverage to cover mental health treatment without facing waiting periods was welcome.

“But let’s remember that half the population doesn’t have private health insurance, and this group are far more likely to have mental health issues,” he said. “This is mental health care only for those who can afford it.”

The chief executive of the Consumers Health Forum, Leanne Wells, said the changes would lead to “significant improvement in access to cover for mental healthcare, a much-needed provision given the demand for these services and their greater availability in the private sector”.

“A further positive development is the plan to boost the powers and resourcing of the health insurance ombudsman to assist people to make more informed choices about their policies, and to investigate claims of wrongdoing by health funds,” she said.

Private insurance reforms a mental health ‘work-around’

The national mental health commissioner, Prof Ian Hickie, has described private health insurance reforms affecting mental health as a “work-around” that will lead to more mental health hospital beds without providing the community-based services people need.

On Thursday the health minister, Greg Hunt, announced a private health insurance overhaul, including changes to mental healthcare. From April people will be able to upgrade their coverage to cover mental health treatment when they need it without facing waiting periods, and basic private policies will include mental health cover as standard.

Under the reforms it will be harder for insurers to place limits on mental health treatments and therapy sessions, such as group counselling sessions, electroconvulsive therapy or transcranial magnetic stimulation.

But Hickie told Guardian Australia he wanted to know what Hunt had planned to increase mental health services available under Medicare so that community-based mental health services would be more readily available.

“Private health insurance encourages growth in the wrong kind of service, which is hospital-based mental health services through more private hospital beds,” Hickie said. “But we also need to be building alternative services outside of hospitals to prevent people from going into hospitals in the first place.

“Of course, it’s unacceptable that private health insurers have been excluding mental health from policies … The bottom line is, though, the minister has developed a work-around to address junk policies that exclude mental health, but where the minister could make an enormous difference is by introducing regulatory changes that would permit private health insurers to cover specialised care outside of hospitals.”

He said state, territory and federal governments had been unwilling to address the gap in mental health services covered by Medicare, and that it could not be up to private health insurers alone to improve access to mental health support.

Inpatient mental heath programs in private hospitals varied widely in quality, he said.

“The danger is we end up with wrong sets of services,” he said. “These reforms are the first step but they are not the solution. They are the work-around while people are dealing with the holes. My worry is that sometimes the first step is so hard to take that it becomes the only step.”

The Greens leader Richard Di Natale, who is a medical doctor, said the ability of people to upgrade their coverage to cover mental health treatment without facing waiting periods was welcome.

“But let’s remember that half the population doesn’t have private health insurance, and this group are far more likely to have mental health issues,” he said. “This is mental health care only for those who can afford it.”

The chief executive of the Consumers Health Forum, Leanne Wells, said the changes would lead to “significant improvement in access to cover for mental healthcare, a much-needed provision given the demand for these services and their greater availability in the private sector”.

“A further positive development is the plan to boost the powers and resourcing of the health insurance ombudsman to assist people to make more informed choices about their policies, and to investigate claims of wrongdoing by health funds,” she said.

Private insurance reforms a mental health ‘work-around’

The national mental health commissioner, Prof Ian Hickie, has described private health insurance reforms affecting mental health as a “work-around” that will lead to more mental health hospital beds without providing the community-based services people need.

On Thursday the health minister, Greg Hunt, announced a private health insurance overhaul, including changes to mental healthcare. From April people will be able to upgrade their coverage to cover mental health treatment when they need it without facing waiting periods, and basic private policies will include mental health cover as standard.

Under the reforms it will be harder for insurers to place limits on mental health treatments and therapy sessions, such as group counselling sessions, electroconvulsive therapy or transcranial magnetic stimulation.

But Hickie told Guardian Australia he wanted to know what Hunt had planned to increase mental health services available under Medicare so that community-based mental health services would be more readily available.

“Private health insurance encourages growth in the wrong kind of service, which is hospital-based mental health services through more private hospital beds,” Hickie said. “But we also need to be building alternative services outside of hospitals to prevent people from going into hospitals in the first place.

“Of course, it’s unacceptable that private health insurers have been excluding mental health from policies … The bottom line is, though, the minister has developed a work-around to address junk policies that exclude mental health, but where the minister could make an enormous difference is by introducing regulatory changes that would permit private health insurers to cover specialised care outside of hospitals.”

He said state, territory and federal governments had been unwilling to address the gap in mental health services covered by Medicare, and that it could not be up to private health insurers alone to improve access to mental health support.

Inpatient mental heath programs in private hospitals varied widely in quality, he said.

“The danger is we end up with wrong sets of services,” he said. “These reforms are the first step but they are not the solution. They are the work-around while people are dealing with the holes. My worry is that sometimes the first step is so hard to take that it becomes the only step.”

The Greens leader Richard Di Natale, who is a medical doctor, said the ability of people to upgrade their coverage to cover mental health treatment without facing waiting periods was welcome.

“But let’s remember that half the population doesn’t have private health insurance, and this group are far more likely to have mental health issues,” he said. “This is mental health care only for those who can afford it.”

The chief executive of the Consumers Health Forum, Leanne Wells, said the changes would lead to “significant improvement in access to cover for mental healthcare, a much-needed provision given the demand for these services and their greater availability in the private sector”.

“A further positive development is the plan to boost the powers and resourcing of the health insurance ombudsman to assist people to make more informed choices about their policies, and to investigate claims of wrongdoing by health funds,” she said.

Children’s tsar savages NHS over ‘unacceptable’ mental health care

The children’s commissioner has launched a savage attack on the head of the NHS, accusing him of denigrating research that shows an “unacceptable” lack of children’s mental health provision.

In a highly unusual move, Anne Longfield has published an open letter to Simon Stevens, chief executive of NHS England, accusing him of ignoring young people’s experiences of the service and the frustrations of their parents. Laying out a list of grievances against him and his team, she also threatens to use the law to compel him to hand over data on waiting times for children’s mental health services.

Longfield made the decision to go public with her complaints – published on the commissioner’s website – after Stevens rubbished many of the claims in her recent report into children’s mental health, an issue she identified as her top priority after consulting with children.

“Many told me about their desperate attempts, sometimes lasting years, to access support, and even primary school children raised concerns about anxiety,” Longfield told Stevens in the letter. The report, published to coincide with World Mental Health Day last week, estimated that only between a quarter and a fifth of children with mental health conditions received help last year. It stated: “Progress in improving children’s mental health services has been unacceptably slow.”

Stevens is standing his ground. In a response to Longfield, obtained by the Observer, he suggests NHSE was “bounced” into giving a response to the report only after aspects of it were shared with journalists. He said that a key finding of the report, that “the government’s much-vaunted prioritisation of mental health has yet to translate into change at a local level”, was “demonstrably factually inaccurate”. Stevens writes: “I’m afraid we stand by our view that your report did indeed in places give a misleading view of NHS care.”

Longfield had warned that provision for young people was a postcode lottery and said that “children’s inability to access mental health support” was leading to a range of extra problems, “from school exclusions to care placements breaking down to children ending up in the youth justice system”.

It is highly unusual for the holders of two important public offices to be involved in such a public argument, particularly over an issue as sensitive as children’s mental health. Longfield, whose role is to promote and defend the rights of children, was appointed to the post by then education secretary Nicky Morgan in 2014. Stevens took his job at the head of NHS England (NHSE) in the same year.

Longfield’s report made difficult reading for the government at a time when concerns over the health service have reached a critical level. Theresa May identified improving mental health as a key issue but, before the busy winter period, there are concerns the NHS will struggle to cope with demand even for what are considered priority services, such as accident and emergency.

Stevens’s robust criticisms that the report contained “basic errors” were a powerful retort to Longfield’s claims. However, in a move that will ensure mental health provision for young people once again becomes a major political issue, Longfield has hit back, saying the report was published only after consultation with NHS England.

“The briefing was prepared using the NHS’s own data,” Longfield writes. “My conclusion on reading, checking and rechecking was that the service that exists at the moment is worryingly poor, a conclusion I stand by.”

In a highly personalised attack, Longfield tells Stevens: “I was very disappointed that NHS England’s response to our report, and your own personal response in front of the Commons health select committee, was to attempt to denigrate the research. Not once did you address the central issues raised. Instead, you and your team sought to undermine the important evidence that we are putting forward and strangely ignore the reality of children’s experiences of the service and the frustrations of their parents.”

Longfield suggested that Stevens’s claims that she and her team had not bothered to check the report were “untrue”. Similarly, claims that NHSE had not been given adequate time to review the report before commenting were also without foundation, according to Longfield. “I am under no duty or obligation to share my work in advance, yet we did so, out of courtesy.”

Stevens had indicated that NHSE was in possession of data that could be used to refute many of Longfield’s claims. However, the commissioner said: “If the NHS has data not in the public domain that disputes the picture we painted, then in the interests of transparency and accountability NHSE should publish it.”

She adds: “I hope you will feel able to share this data. As you will know, I am also able to demand such data under section 2f of the Children’s Act 2014.”

She concludes: “I hope in future we could all concentrate our efforts on tackling [health issues] rather than trying to undermine the work of those who make valid and constructive criticisms.”

Sarah Wollaston, chair of the health select committee, said the row would be discussed when the committee met on Tuesday.

“It’s very important that there is a constructive relationship between the Office of the Children’s Commissioner and NHS England,” she said.

MPs urge action on lengthy wait for autism diagnosis

Parents of children with suspected autism are having to wait at least 44 months for diagnoses, prompting a cross-party group of more than 140 MPs to write to the health secretary, Jeremy Hunt, demanding urgent action.

The startling new figures, revealed in response to a freedom of information request, relate to children under the age of five who need a specialist autism assessment after being referred by a GP or other health professional.

The request, submitted by a concerned member of the public, relates to an area of Teesside covered by the Tees, Esk and Wear Valleys NHS foundation trust. But Mark Lever, chief executive of the National Autistic Society, said that such “unacceptable” delays were a problem in many parts the country but varied hugely from one region to the next.

“An autism diagnosis can be life-changing,” he said. “It can explain years of feeling different and help unlock crucial advice and support. The longer someone lives without the right support, the higher – and more expensive – their needs can become.”

The official response to the request showed that if a child aged under five and living in Stockton was referred to a specialist assessment team today, the family would have to wait roughly 44 months before receiving any answer. In neighbouring Middlesbrough the waiting time was six months.

Experts in the NHS cite several reasons for the long waiting times, including a lack of coordination between professionals throughout the assessment, as well as a lack of resources.

The matter was taken up by the Labour MP for Stockton South, Paul Williams, who is also a GP. Williams has rallied the support of 142 MPs to write to Hunt demanding that he introduce a maximum interval of three months from point of referral to beginning of specialist assessment. This would bring waiting in line with National Institute for Health and Care Excellence (Nice) guidelines.

The letter, sent on Friday, welcomed the Department of Health’s recent commitment to record waiting times as “progress”, but warned: “Recording data alone does not tackle delays.”

Williams said: “This is an issue of profound unfairness. While children are waiting and their parents are struggling, they often don’t get much-needed access to support in school, and they fall behind their peers.”

The Observer spoke to several parents in the area covered by the freedom of information request, many of whom had been on the waiting list for far longer than the three months recommended by Nice. Nichola Binks said she was struggling to navigate the system with her three-year-old son, Thomas.


It’s so important for Thomas to get the help now. He’s never going to catch up if not

Nichola Binks, mother

In a letter to Binks in January, her local NHS trust said that the proposed date for her son’s assessment was August 2019. “It’s so stressful and upsetting. It’s a postcode lottery,” she said, explaining that those living five miles down the road were waiting a fraction of the time.

“I have to chase everything up all the time,” she said. As long as Thomas did not have a formal diagnosis, they were unable to access respite care, send him to a special school, or get help with his sensory issues. She said she worried that he would not finish the assessment process before he entered primary school: “It’s so important for him to get the help now. He’s never going to catch up if not.”

Dr James Cusack, director of science at UK research charity Autistica, said that it was possible to improve a child’s communication skills by making early interventions, but the average age of diagnosis was “avoidably high” and had not changed in a decade: “Late diagnosis represents a missed opportunity for autistic children.”

Children’s tsar savages NHS over paucity of mental healthcare

The children’s commissioner has launched a savage attack on the head of the NHS, accusing him of denigrating research that shows an “unacceptable” lack of children’s mental health provision.

In a highly unusual move, Anne Longfield has published an open letter to Simon Stevens, chief executive of NHS England, accusing him of ignoring young people’s experiences of the service and the frustrations of their parents. Laying out a list of grievances against him and his team, she also threatens to use the law to compel him to hand over data on waiting times for children’s mental health services.

Longfield made the decision to go public with her complaints – published on the commissioner’s website – after Stevens rubbished many of the claims in her recent report into children’s mental health, an issue she identified as her top priority after consulting with children.

“Many told me about their desperate attempts, sometimes lasting years, to access support, and even primary school children raised concerns about anxiety,” Longfield told Stevens in the letter. The report, published to coincide with World Mental Health Day last week, estimated that only between a quarter and a fifth of children with mental health conditions received help last year. It stated: “Progress in improving children’s mental health services has been unacceptably slow.”

Stevens is standing his ground. In a response to Longfield, obtained by the Observer, he suggests NHSE was “bounced” into giving a response to the report only after aspects of it were shared with journalists. He said that a key finding of the report, that “the government’s much-vaunted prioritisation of mental health has yet to translate into change at a local level”, was “demonstrably factually inaccurate”. Stevens writes: “I’m afraid we stand by our view that your report did indeed in places give a misleading view of NHS care.”

Longfield had warned that provision for young people was a postcode lottery and said that “children’s inability to access mental health support” was leading to a range of extra problems, “from school exclusions to care placements breaking down to children ending up in the youth justice system”.

It is highly unusual for the holders of two important public offices to be involved in such a public argument, particularly over an issue as sensitive as children’s mental health. Longfield, whose role is to promote and defend the rights of children, was appointed to the post by then education secretary Nicky Morgan in 2014. Stevens took his job at the head of NHS England (NHSE) in the same year.

Longfield’s report made difficult reading for the government at a time when concerns over the health service have reached a critical level. Theresa May identified improving mental health as a key issue but, before the busy winter period, there are concerns the NHS will struggle to cope with demand even for what are considered priority services, such as accident and emergency.

Stevens’s robust criticisms that the report contained “basic errors” were a powerful retort to Longfield’s claims. However, in a move that will ensure mental health provision for young people once again becomes a major political issue, Longfield has hit back, saying the report was published only after consultation with NHS England.

“The briefing was prepared using the NHS’s own data,” Longfield writes. “My conclusion on reading, checking and rechecking was that the service that exists at the moment is worryingly poor, a conclusion I stand by.”

In a highly personalised attack, Longfield tells Stevens: “I was very disappointed that NHS England’s response to our report, and your own personal response in front of the Commons health select committee, was to attempt to denigrate the research. Not once did you address the central issues raised. Instead, you and your team sought to undermine the important evidence that we are putting forward and strangely ignore the reality of children’s experiences of the service and the frustrations of their parents.”

Longfield suggested that Stevens’s claims that she and her team had not bothered to check the report were “untrue”. Similarly, claims that NHSE had not been given adequate time to review the report before commenting were also without foundation, according to Longfield. “I am under no duty or obligation to share my work in advance, yet we did so, out of courtesy.”

Stevens had indicated that NHSE was in possession of data that could be used to refute many of Longfield’s claims. However, the commissioner said: “If the NHS has data not in the public domain that disputes the picture we painted, then in the interests of transparency and accountability NHSE should publish it.”

She adds: “I hope you will feel able to share this data. As you will know, I am also able to demand such data under section 2f of the Children’s Act 2014.”

She concludes: “I hope in future we could all concentrate our efforts on tackling [health issues] rather than trying to undermine the work of those who make valid and constructive criticisms.”

Sarah Wollaston, chair of the health select committee, said the row would be discussed when the committee met on Tuesday.

“It’s very important that there is a constructive relationship between the Office of the Children’s Commissioner and NHS England,” she said.

‘Dr Huge’: the champion of dangerous weight-loss drug DNP

The two men behind Sacramento-based Enhanced Athlete – the company believed to be behind UK sales of the deadly weight-loss drug DNP – are a former lawyer and champion bodybuilder, known as Dr Tony Huge, and a convicted fraudster, Scott Cavell, who served time in Ireland and the US.

Dr Huge – whose real name is Charles Anthony Hughes – is the very visible face (and muscle) of Enhanced Athlete, promoting the fat-burning and bodybuilding supplements it allegedly sells in the US, Europe and Australia through numerous YouTube videos.

Among them is a video diary series entitled “DNP: World’s Most Dangerous Fat Loss Drug”, featuring Hughes swallowing the pills he sells and working out. “Will I die or will I arise shredded?” asks the caption. In another he shows off his Ferrari 430 Scuderia, at one point lifting a scantily clad woman above his head in front of the bonnet.

Hughes is not a medical doctor. His videos all feature warnings that he is experimenting with his own body and that DNP is a dangerous drug that is not for human consumption – before he consumes it or discusses its use with other people.

On another bodybuilding site, Hughes is filmed in England discussing the enthusiasm that people have for DNP. “It seems like everybody in England takes DNP. I’ve never been to a country or a place where so many people take DNP,” he says. “It’s incredibly more popular here in England than it is in the United States.”

The British bodybuilder he is talking to says says people are not afraid of it. “Only a couple of years ago, a teenage girl died of DNP overheating and her mum found her dead in a cold bath. DNP obviously isn’t for human consumption but having said that I think the only people that die from it are the people that abuse it.”

Cavell was involved in a $ 7.4m (£5.6m) mortgage fraud in the US. He and his accomplice, Christopher Warren, who managed a finance company in Sacramento, converted the loot into “travel friendly” gold and coins, according to the FBI and went on the run in 2009.

Both headed for Ireland, but Warren then paid $ 156,000 for a private charter plane to Lebanon. He was caught trying to re-enter the US with a fake passport and $ 70,000 hidden in his cowboy boots.

Cavell lay low in Ireland with a false Irish passport in the name of Marcus Dwyer. He opened two Irish bank accounts and lived in a comfortable apartment in Dublin on the $ 1.7m he had hidden in his luggage until the gold ran out. Then he took to drug dealing, growing cannabis in his apartment. In February 2011, the Irish drug squad turned up. Cavell was said to be out at the time but arrived during the raid and was arrested.

Nobody knew that Marcus Dwyer was not his real name until one of the detectives, curious about his American accent, sent his fingerprints to Interpol, who identified him as Cavell, a wanted man. However, at his trial, the judge allowed bail and he went on the run again, continuing to fund himself through drug peddling.

He was arrested in possession of 28 ecstasy tablets at the Electric Picnic festival in Ireland in September 2011, but released without charge. Eventually the gardai tracked him down in a modest rented house in Dublin, where they found equipment to make ecstasy tablets worth €20,000. He spent about eight months in Mountjoy prison before being deported.

Cavell was sentenced to five years for the mortgage fraud – considerably less than the 14 months that his accomplice Warren got, partly because it was claimed in court that he had suffered in the Irish prison.

“The conditions were deplorable, with buckets used as a latrine, rodent infestation, no running water, severe overcrowding, and no heat or air conditioning,” his attorney John Manning wrote in a memo to the court. “It is a place where Ireland houses the worst of the worst.”