Boots has been criticised for refusing to lower the cost of the morning-after pill for fear it would “incentivising inappropriate use”.
It comes after a campaign from the British Pregnancy Advisory Service (BPAS), a leading provider of abortion care, prompted Tesco and Superdrug to halve the price of the emergency contraceptive. The chemist Boots, however, did not follow in this move for fears of encouraging over-use.
British women pay up to five times more than their European peers for the contraceptive. In France, the tablet costs £5.50. This contrasts to Boots price of £28.25 for the leading brand Levonelle and £26.75 for its own generic version. Tesco now charges £13.50 for Levonelle and Superdrug £13.49 for a generic version.
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Do you think more should be done to reduce the cost of the morning after pill in the UK? Are you going to boycott Boots as a result? Do you think high prices put people off making purchases? Are some people embarrassed to buy the pill? What are your experiences? Share your views and stories.
The problem we have with talking about mental health is that we still don’t think of it as an equal priority with physical health. This is wrong not simply because it leads to less money being spent on mental health service provision by governments, but also because it fails to see that the whole idea of mental health shouldn’t be an isolated one.
As a species, we love to divide things up. We draw a straight line in a map between the Atlantic and Indian Oceans while the water remains oblivious. We also draw a line between the mental and physical and base our entire system of healthcare on that false division.
Once upon a time, the medical world detailed the makings of the human body by saying there were four distinct humours. Every single health complaint could be explained as an excess or deficiency of one of four distinct bodily fluids – black bile, yellow bile, phlegm and blood. And these in turn were related to the four elements, as well as the four seasons and the four ages of man.
If in those golden olden days you were feeling depressed, or melancholic, that was down to an overload of black bile. In fact, the very word melancholia, as with melancholy, stems via Latin from the ancient Greek words melaskholē, which literally meant “black bile”. It seems funny, now, this idea. But in one way at least it was more advanced than much of our present approach. Namely, it did not see a rigid divide between physical and mental health. Mental illness was seen to have physical roots, and was associated with the four elements.
Now, of course, if you visit your doctor about persisting feelings of worthlessness and despair and the futility of existence they will be unlikely to talk of bile of any kind. But then, before we think we are at the end of progress, and have all the answers, we should remember that our doctors might not talk about your body at all.
And yet everything I have come to learn about my own experience of mental health and illness has taught me that this is also a mistake. Even if you have the idea that mental illness is solely an illness of the brain, the brain is a physical thing. The brain is the body. Mental health is physical health. Bodies and minds interact.
You can’t draw a line between a body and a mind any more than you can draw a line between oceans
I would go even further. I don’t want to get too cross-legged on a Himalayan mountain top, but mental health isn’t just brain health. Mental health is intricately related to the whole body. And the whole body is intricately related to mental health. You can’t draw a line between a body and a mind any more than you can draw a line between oceans.
It’s comforting to realise that many cognitive scientists these days acknowledge this. Thoughts aren’t just the products of brains, and vice versa. As Guy Claxton – himself a cognitive scientist – writes in Intelligence in the Flesh, “the body, the gut, the senses, the immune system, the lymphatic system, are so instantaneously and so complicatedly interacting with the brain that you can’t draw a line across the neck and say ‘above the line it’s smart and below the line it’s menial’.” In short: “we don’t just have bodies. We are bodies.”
The word “holistic” is so often associated with scientifically dubious kinds of therapies, but the science is slowly leading us towards a more holistic view of minds and bodies, so our healthcare needs to acknowledge that. We need to realise the physical nature of mental illness and the mental nature of physical illness. Mental hospitals and physical hospitals should all be mental-physical hospitals (but maybe they should be called something catchier).
A happy side product of erasing the line between mind and body, a line that has been boldly drawn since Descartes, would be to destigmatise mental health by placing it on an equal footing with stigma-free physical issues such as asthma and arthritis. It would also lead to a better health service. If mental health was understood in physical terms, it would stop being the poor relation of health when it comes to government funding.
Ultimately, it wouldn’t just help doctors and nurses to understand us better. It would also change the way we view ourselves. The idea that our minds are in our control, and that free will is all, still pervades, and makes people feel a kind of guilt or shame for being ill. A guilt that in itself exacerbates symptoms. We need to truly understand the way minds and bodies interact with each other, and how both are affected by the world.
So a new, more integrated, healthcare system would not only be good because it would help patients, it would also help anyone feeling distress to understand that there is no more shame to be felt than if they had tonsillitis. Illness is illness, and health is health. There can be no “mind over matter” when we understand that mind is matter.
• How to Stop Time by Matt Haig is published by Canongate. To order a copy for £7.99 (RRP £12.99) go to bookshop.theguardian.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99.
Ministers are working on a plan to rescue the troubled inquiry into contaminated blood after none of the victims of the scandal turned up to its first consultation meeting.
All the key campaign groups boycotted the meeting because of the involvement of the Department of Health. Survivors lack trust in the department and its officials after fighting for 30 years for an investigation into how contaminated blood transfusions infected thousands of people with hepatitis C and HIV.
No 10 said the Department of Health would work on setting up the inquiry jointly with the Cabinet Office, but officials are rethinking the plan after failing to get any engagement from survivors.
Jeremy Hunt, the health secretary, spoke to Diana Johnson, a Labour MP and key campaigner for contaminated blood victims, to see if they could work out a way forward on Thursday.
However, the stalemate remains just a week after campaigners welcomed Theresa May’s pledge to hold an inquiry after such a long fight for an official investigation.
Johnson was granted an urgent question on the issue in the House of Commons on Thursday, telling MPs that the government had run roughshod over the wishes of victims by allowing the Department of Health to be involved in a UK-wide inquiry.
She compared the decision to allow the department to be involved in the inquiry to “asking South Yorkshire police to lead an inquiry into the Hillsborough disaster”, as she called for it to be fully independent.
Sharon Hodgson, the shadow public health minister, also called on ministers to “keep their promises, place the affected community genuinely at the centre of this inquiry, and ensure their views are taken seriously”.
In response, Jackie Doyle-Price, a health minister, said the government was “very much in listening mode” and no decisions had been made on who would lead the inquiry.
A Department of Health spokesperson said the government was “absolutely committed to a thorough and transparent inquiry”.
“To establish the best format and remit, we want to hear as many opinions as possible. Our door is open for anyone who wants to discuss the inquiry or raise any concerns,” the spokesman said.
The controversy follows previous criticism of the government for failing to gain the trust of survivors of child abuse and the Grenfell Tower fire while inquiries were being set up.
Survivors initially welcomed the announcement, while expressing frustration that the decades-long wait for answers had been so long. The contamination took place in the 1970s and 80s, and the government started paying those affected more than 25 years ago.
There have been calls for a boycott of Boots after the chemist refused to lower the cost of the morning-after pill for fear it would encourage over-use.
Rivals Tesco and Superdrug halved the price of the emergency contraceptive following a campaign from the British Pregnancy Advisory Service (BPAS), a leading provider of abortion care.
The charity had written to retailers asking them to consider offering a more affordable product, after it was revealed that British women are forced to pay up to five times more than their European peers for the contraceptive.
Boots, however, said it would not lower the price as it did not want to be accused of “incentivising inappropriate use”. Campaigners said its statement was insulting and sexist.
Around 4% of British women of reproductive age use emergency contraception in any given year. Boots charges £28.25 for Levonelle emergency contraceptive (the leading brand) and £26.75 for its own generic version. Tesco now charges £13.50 for Levonelle and Superdrug £13.49 for a generic version. In France, the tablet costs £5.50.
A letter seen by the Guardian to BPAS from Marc Donovan, chief pharmacist of Boots UK, said it had considered the issue very carefully, but pointed out that it is already available for free in community pharmacies and NHS services.
However, towards the end of the letter, Donovan wrote: “In our experience the subject of emergency hormonal contraception polarises public opinion and we receive frequent contact from individuals who voice their disapproval of the fact that the company chooses to provide this service.
“We would not want to be accused of incentivising inappropriate use, and provoking complaints, by significantly reducing the price of this product.”
BPAS said deliberately setting the price high to prevent women from using it regularly was both “patronising and insulting”.
Clare Murphy, director of external affairs at BPAS, said: “There is no doubt about it: the high price of [emergency contraception] is an absolute barrier to women’s access to this product and puts women needlessly at risk of unwanted pregnancy.”
Murphy wrote back to Donovan after Tesco and Superdrug reduced the price, asking him to reconsider Boots’ position. “He wrote back and said they weren’t changing their minds and the letter still stood,” she said.
Sophie Walker, leader of the Women’s Equality Party, which has joined forces with BPAS to call for a boycott using the hashtag #justsaynon, said that the morning-after pill can be difficult to access for free on the NHS, with appointments at GP surgeries or family planning clinics hard to obtain at short notice.
She said: “Many women will need to buy these pills over the counter, and it is irresponsible and exploitative for retailers to charge over the odds for them … Boots’ approach to this concern is indicative of a society that prioritises profit over women’s health and wellbeing.”
When asked for a comment, Boots released a statement that did not discuss the price, nor its reasons for justifying it being kept high, but instead said the sale of the pill was a “professional healthcare service which, we believe, requires a professional healthcare consultation”.
When asked if the reason for the higher price was due to the provision of consultations, Boots did not respond with a comment.
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I recently saw a girl in clinic with terrible complications following a caesarean section. The operation had been botched and she had an infection around her uterus. She was in terrible pain and critically unwell. This was in the children’s clinic; the girl was 14 years old.
This scenario is all too common. She is just one of the thousands of adolescent girls estimated to have become pregnant this year in Sierra Leone. In 2013 the country had the 7th highest teenage pregnancy rate in the world, 38% of women aged 20-24 had their first baby before the age of 18. Sierra Leone is by no means an exception. Worldwide teenage pregnancy is a huge issue, 11% of births globally are to women aged 15-19, with the majority of these taking place in low- and middle-income countries.
From a medical point of view, teenage pregnancy is terribly risky. Teenage mothers are estimated to be 40-60% more likely to die in childbirth. Their babies are 50% more likely to be stillborn or die shortly after birth than babies born to mothers in their 20s.
Terrifying medical complications aside, it can be devastating socially and economically for adolescent mums. In 2015, when schools in Sierra Leone reopened after the Ebola crisis, the minister for education banned visibly pregnant girls from school and sitting exams. This discriminatory ban persists and has been strongly condemned by, among others, Amnesty International.
A “bridging system” was started where girls can seek alternative education elsewhere, but the disruption remains huge. Often girls will be prevented from sitting exams and need to repeat a whole year of school, meaning many will not go back at all. This discriminates against the girls, but not the men who get them pregnant. After giving birth they face continued problems reintegrating into their schools of choice.
During the recent Ebola crisis teen pregnancy rates rose in Sierra Leone by an estimated 50%. This rise could give insights into why the country’s teen pregnancy rate is so high. A factor highlighted as being behind the spike in pregnancy during the Ebola outbreak was extreme poverty, with girls reportedly having sex in exchange for water, food or other forms of financial protection.
What can be done to help these girls? This problem is complex with many driving factors.
The UK is one of Europe’s great success stories with reducing its high teenage pregnancy rate. Improved sex education and access to contraception and changes in social norms are credited with this drop. Can any of the lessons learned be applied in this context?
Improving knowledge of and access to contraception is certainly important. Access to contraception in Sierra Leone is limited; an estimated 16% of women in Sierra Leone use contraception and this figure falls to 7.8% for teenagers. Safe access to abortion for girls who do not want to continue their pregnancy is essential. In Sierra Leone, the country with the world’s worst maternal mortality, abortion is illegal in nearly all circumstances and unsafe abortion is estimated to account for 10% of maternal deaths. This will only be compounded by Trump’s enactment of the “global gag rule” which has a disastrous effect on funding for organisations working for women’s reproductive rights.
The girls themselves will never be the key to reducing the teenage pregnancy rate. There has to be buy in from the men
However, assuming that knowledge about and access to contraception would end this problem is deeply misguided. It puts all of the onus on to the girls not to get pregnant, it assumes they have the option of making a choice. Even when contraception is available many of the girls are not empowered to insist on its use. This approach ignores the wider societal contexts that drive the high teenage pregnancy rate. A recent report by the Secure Livelihoods Research Consortium highlighted some of the inadequacies in current programming.
The girls themselves will never be the key to reducing the teenage pregnancy rate. There has to be buy-in from the men, and a change in attitudes that currently accept the concept of teenage pregnancy. Currently, a lot of work being done on this issue focuses only on the girls. Addressing the attitudes that perpetuate teenage pregnancy is difficult and there are few programmes that do this at the moment. It is easy to pick out and identify the teenage women, but harder to involve the men who could potentially impregnate them.
The high adolescent pregnancy rate, in Sierra Leone and around the world, jeopardises the achievement of the sustainable development goals (SDGs). The SDGs focus specifically on reducing maternal mortality, improving health for all ages and promoting women’s rights. Teenage pregnancy is a threat to the realisation of all those goals and so meaningful efforts to reduce the appalling rate are essential to making any progress.
In the hospital where I work, a teenage pregnancy support group is going on. Girls receive education sessions. Efforts are being made to find them jobs and reintegrate them into the school system. The excitement of the girls is palpable. Many of them have come from situations where they are not shown any respect, but now they are being empowered to take control of this important part of their lives.
This month the UK government hosted Family Planning Summit 2017 to recommit to this global issue, announcing that the UK would increase international development spending on family planning from £180m per year until 2020 to £225m per year until 2022. Governments from countries around the world came together to make commitments to improving women’s access to family planning. In the face of Trump’s regressive change to US policy, putting women’s reproductive rights at the centre of the international community’s agenda is of great importance.
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Theresa May has been urged to tighten checks on private hospitals used by the NHS after a Labour MP raised the case of a young patient with an open wound who contracted MRSA on a private mental health ward.
Louise Haigh, a Labour frontbencher, called for the NHS to thoroughly investigate the quality of care before it commissions beds and treatment from private providers.
She cited the case in her of a “young women with MRSA with open wounds” on a child and adolescent mental health ward at Cygnet hospital Sheffield, which a report by a healthcare watchdog rated as inadequate in terms of safety.
“NHS England commissions child and adolescent mental health beds at a private hospital in my constituency, which recently received a damning Care Quality Commission report,” she said.
“Does the prime minister share my concern that a shortage of mental health beds risks the NHS placing vulnerable young people in unsafe environments, and will she consider giving NHS England the responsibility for, and the resources to investigate, the quality of care before it commissions?”
In response, May promised to ask Jeremy Hunt, the health secretary, to investigate, while highlighting a “a number of steps to improve mental health” provision in the NHS, including an increase in funding.
But Haigh said she wanted to see more action to make sure private beds paid for by the NHS are safe.
“Clearly the NHS should not be commissioning beds for children and young people unless they are confident they are safe places for them to be treated,” she said.
“This horrifying example suggests that a shortage of beds in the NHS and by private providers is forcing the NHS to place vulnerable young people in situations that are dangerous.
“I want to see NHS England have the responsibility and the resources to ensure that all places are safe and provide decent quality care before they are commissioned.”
Cygnet Health Care, which runs the hospital in Sheffield, said it had proactively notified the Care Quality Commission about cases of MRSA.
A spokesperson for the hospital said: “Our absolute priority is the health and wellbeing of the young people we support. Prior to the CQC’s inspection, we had notified the regulator about two instances of infection relating to patients.
“During the inspection, we further advised inspectors that a member of staff had also tested positive, and had been temporarily removed from the hospital as part of our infection control measures.
“Following the inspection we thoroughly reviewed our infection control protocol, and carried out additional staff training to ensure all measures are followed appropriately.”
A decision not to vaccinate boys against a cancer-causing sexually transmitted infection has been condemned by health bodies and campaigners.
The Joint Committee on Vaccination and Immunisation (JCVI), which has been reviewing the human papilloma virus (HPV) vaccination programme, concluded that it was “highly unlikely to be cost-effective” to extend the scheme to include adolescent boys as well as girls.
Since 2008, all girls aged 12 to 13 are offered the HPV vaccination as part of the NHS childhood vaccination programme, and the JCVI has been considering whether to include boys on the scheme since 2014.
Up to eight out of 10 people will be infected with the virus at some point in their lives and it has been linked to one in 20 cases of cancer in the UK, according to health professionals. Campaigners have been calling for a gender-neutral approach to the vaccination, which would ensure that 400,000 school-age boys are not left at risk.
The committee, which has yet to publish its final recommendation, said in an interim statement that studies “consistently show” boys are afforded “considerable herd protection” when there is high uptake of the vaccine in girls.
Critics called the decision “indefensible”. The Faculty of Sexual and Reproductive Healthcare (FSRH), a membership body for healthcare professionals who work in sexual and reproductive health, said the decision should be reversed when the JCVI meets again in October.
Asha Kasliwal, the FSRH president, said the interim decision to deny boys the HPV vaccination was a huge missed opportunity for improving long-term sexual and reproductive health outcomes and tackling gender inequality.
Kasliwal said: “FSRH aims to improve women’s sexual and reproductive health, especially access to contraception. However, HPV affects not only women, but also men, and FSRH firmly believes that men and boys are vital in contributing to secure women’s reproductive health and rights.
“We support boys’ and men’s right to access high-quality [sexual and reproductive healthcare] services and live a life free of sexually transmitted infections such as HPV.”
Peter Baker, director of the campaign group HPV Action, said the decision was about saving money and not improving health: “It is astonishing that the government’s vaccination advisory committee has ignored advice from patient organisations, doctors treating men with HPV-related cancers, public health experts and those whose lives have been devastated by HPV.”
Baker said HPV Action would urge ministers to make the right decision and said there might also be grounds for a legal challenge on the grounds that a decision to leave boys and men at risk breaches equality law.
A recent poll conducted by HPV Action showed that 94% of GPs backed the expansion of the programme, with the same proportion saying if they had a son, they would want them to receive the vaccination. Both positions were also supported by 97% of dentists.
Mick Armstrong, the chair of the British Dental Association, said: “HPV has emerged as the leading cause of oropharyngeal cancers, so JCVI’s unwillingness to expand the vaccination programme to boys is frankly indefensible. The state has a responsibility to offer all our children the best possible defence.
“Dentists are on the frontline in the battle against oral cancer, a condition with heart-breaking and life-changing results. Ministers can choose to sit this one out, or show they really believe in prevention.”
The JCVI said: “The JCVI is consulting on its interim findings to ensure that the most appropriate and up-to-date evidence has been used, and that reasonable assumptions have been made where evidence is limited or unavailable. Once the consultation is completed, the JCVI will develop and publish its final advice.”
After almost 11 hours of surgery involving four teams of doctors, Zion Harvey had earned his place in medical history. The eight-year-old had become the first child in the world to receive two new hands in a procedure that seemed to herald a revolution in transplant medicine.
Two years on, the sports-mad boy from Baltimore, Maryland, is enjoying the freedom and independence his new hands have given him. In the first medical journal report of Zion’s pioneering treatment, published on Wednesday, the experts involved declare the operation a success and say other children could benefit from the knowledge gained.
Zion had to rely on others after he had his hands and feet amputated aged two when he contracted sepsis. For six years he used a combination of his residual limbs and specialist equipment to dress, wash himself and eat – until the double transplant changed his life.
“At 18 months [after the transplant], the child had exceeded his previous adaptive abilities. As of 18 months after transplantation surgery he is able to write and feed, toilet and dress himself more independently and efficiently than he could do before transplantation,” writes the team from the Children’s hospital of Philadelphia in the Lancet Child and Adolescent Health.
Organ transplantation is risky in that a recipient’s body may reject the new body part, while the drug regime involved carries a series of health risks. Two years on from the surgery he had in July 2015, Zion, now 10, is coping well with both.
“Cases like this demonstrate how new developments and innovation in science and transplantation have the potential to make enormous differences to the quality of life of patients,” said Lorna Marson, the president of the British Transplantation Society, which represents specialists working in the field across the NHS.
“Transplantation is a constantly evolving sector and it is heartening to hear the positive outcomes of groundbreaking transplants such as this one.”
More than 100 people worldwide have had a hand or arm transplant since the first adult received a new hand in 1998, closely followed by the first replacement of both hands in 2000. Many countries now conduct such transplants on small numbers of carefully selected patients.
In May 2000, a baby girl in Malaysia who was born with a severe congenital deformity became the first child to receive a new hand and arm, transplanted from her identical twin sister who died at birth.
In an update last year on his progress in the year since his surgery, Zion said: “The only thing that’s different is instead of no hands, I have two hands. I’m still the same kid everybody knew without hands.”
Referring to his new hands, he added: “Here’s the piece of my life that was missing. Now it’s here, my life is complete.”
Within eight months of the operation Zion was using scissors and crayons and after a year he was able to swing a baseball bat with both hands – once throwing the opening pitch at a Baltimore Orioles game.
Dr Scott Levin, team leader for Zion’s 10-hour surgery, has praised his young patient’s bravery. “I’ve never seen Zion cry. I’ve never seen him not want to do his therapy. He’s just such a remarkable human being, let alone child or adult. He has such courage and determination and gives us all inspiration,” he said.
But the last two years have been mentally and physically hard for Zion. He has had huge amounts of physiotherapy and occupational therapy to help him adjust, as well as counselling to aid his psychological recovery.
The doctors write: “Since his surgery he has undergone eight rejections of the hands, including serious episodes during the fourth and seventh months of his transplant. All of these were reversed with immunosuppression drugs without impacting the function of the child’s hands.”
He is still taking four different immunosuppressant drugs to maximise the chances of his body continuing to tolerate the pair of new hands, though doctors hope to reduce the dose.
“While functional outcomes are positive and the boy is benefitting from his transplant, this surgery has been very demanding for this child and his family,” said Dr Sandra Amaral, a member of the team at the Philadelphia hospital.
However, in an accompanying comment article, Dr Marco Lanzetta, an Italian expert in hand transplant surgery, doubts that many children could tolerate a similar procedure and highlights the risks from lifelong use of immunosuppressants. Zion’s case was exceptional as he was already on the drugs, after receiving a kidney from his mother, Pattie Ray.
Prosthetic hands and limbs, adds Lanzetta, have now developed so much that they, rather than transplant surgery, are more likely to prove the future for patients like Zion.