Category Archives: Rheumatoid Arthritis

Can brain training reduce dementia risk? Despite new research, the jury is still out

More than 30 million people worldwide live with Alzheimer’s disease, and while researchers are pushing hard to find a cure, their efforts so far have met with failure. With no effective treatment on the horizon, prevention has become the only game in town. But what can be done to reduce the risk of dementia, now the leading cause of death in England and Wales?

In research published on Thursday, US scientists claim that a form of computer-based brain training can reduce the risk of dementia by 29%. The training was designed to speed up people’s visual information processing, for example by having them spot a car on a screen, and a truck on the periphery of their vision, at the same time. Those who are claimed to have benefited trained for an hour, twice a week, for five weeks, and some went on to have booster sessions at the end of the first and third years. To see if the training made any difference, the participants sat tests up to 10 years later.

There are good reasons to be cautious about the results, which appear in the journal Alzheimer’s and Dementia: Translational Research and Clinical Interventions. The study wasn’t designed to examine dementia, and the scientists didn’t rely on a clinical diagnosis when they totted up who had the dementia at the end of the trial. Instead, they opted for a broader definition and allowed people to self-report that they had the disorder. “If you’re going to say you are preventing dementia, you want that defined to the nth degree,” said Peter Passmore, an Alzheimer’s researcher at Queen’s University in Belfast.

The scientists actually tested two other kinds of brain training too. These were designed to strengthen memory and mental reasoning respectively. A decade after training began, the scientists found that 22.7% of people in the speed training group had dementia, compared with 24.2% in both memory and reasoning groups. In a control group of people who had no training, the dementia rate was 28.8%.

But in studies like these, scientists have to take into account whether an intervention might look good or bad simply by chance. The results for the memory and mental reasoning brain training failed this statistical test. More importantly, the effect linked to visual processing was at best at the very edge of statistical significance. Scientific convention has it that if the chance of a result being a fluke is greater than 5%, it is not worth taking seriously. For visual speed training, the figure was 4.9%.

“We’re lacking high quality evidence to show that brain training has any impact on the risk of dementia, and based on current studies we can’t recommend people take it up,” said Clare Walton, research manager at the Alzheimer’s Society. “What we do know is that keeping the body and brain active across life can go someway towards reducing the risk.”

There are some risk factors for dementia that we cannot change, such as age, genetic makeup, gender and ethnicity. And it may be too late to do much about others. Spending more years in education as a child, for example, has a protective effect against dementia, but whether returning to education later in life helps is unclear.

Until effective treatments are found, the most promising way to reduce dementia risk is through lifestyle changes. Smokers are estimated to be 30-70% more likely than nonsmokers to develop dementia, so quitting immediately is a good start. High blood pressure in midlife seems to raise the risk too, and better control of blood pressure may be one reason the rate of new cases of dementia in Britain has dropped in recent years.

Alzheimer’s researchers often say that what’s good for the heart is good for the brain. The basis for the claim comes largely from research on exercise and diet. It shows that regular aerobic exercise can reduce dementia risk by 30-40%, while eating a healthy Mediterranean-style diet rich in fruit, vegetables and oily fish, and low in red meat and sugar, can potentially halve the risk of dementia.

Walton advises people to take up a hobby that hits a number of risk factors all at once. Joining dance classes or a table tennis club is a way to get exercise, to challenge the brain by learning new skills and to socialise, for example. “The best thing is to find activities that do all three,” she said.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Primodos contained synthetic versions of progesterone and estrogen.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Primodos contained synthetic versions of progesterone and estrogen.

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

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

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

‘We are a force to be reckoned with’: voices of newly qualified nurses

‘I finish most shifts feeling guilty and remember things I didn’t have time to do’

Nursing isn’t what I expected it to be, there’s never enough time for patient contact which really saddens me. Nurses are now mainly office-based and have to delegate the patient contact to healthcare workers. I often class a good shift as one where I have managed to sit down and talk to someone who needed me. I finish most shifts feeling guilty and wake up in the middle of the night and remember things I didn’t have time to do. The stress of the job is unbelievable.

The pay conditions really anger me. Working in mental health can be a risky job where staff are assaulted and have to face quite a lot of abuse. I do not think it is fair that I only get paid around £10 an hour, which is a lot less than my friends who do low-level administration work in offices where they get paid to answer the phone. The government is relying on the good nature of nurses to continue doing their job because they care.
Kate Clayton, 15 months post-qualified, mental health nurse, Staffordshire

‘Nurses are a force to be reckoned with – I think that has become more prominent in recent years’

Before I began nursing I didn’t really see nurses as specialists or professors. It was only during my nursing studies and hospital placements that I began to realise the breadth of opportunities within nursing and the new found confidence nurses have. Nowadays we all work as a multidisciplinary team (MDT) and nurses work more closely with doctors and allied healthcare professionals. We, as nurses, are encouraged to speak up, ask questions and play a bigger part in the MDT and in our patients’ care plans. We also now have so many different opportunities for nurses like specialist roles, research and education. I think in the future we will see a lot more nurses going on to do the likes of PhDs and more specialist training. We are a force to be reckoned with and I think that has definitely become more prominent in recent years.
Bebhinn O’Dowd, 12 months post-qualified, critical care research nurse (specialising in major trauma), London

‘We are constantly working more hours than we should because it’s so short-staffed’

There is so much responsibility in modern nursing. You literally have people’s lives in your hands. It’s a big burden for a 22-year-old. Some older nurses have told me that in the past we would have been slowly fed into the system instead of being thrown in and immediately pushed to the limits. We are constantly working more hours than we ever should because it’s so short-staffed.


It seems more of an uphill battle to get what is deserved and to get the kind of respect nurses used to get

Liv Webster

Pay is of course something my friends and I rant about and some people who I studied nursing with have already changed their career path – we’re not even 18 months qualified. A lot are being pushed into private sectors and agency work so the NHS is losing valuable members of the team who can’t deal with the pay when they have families to support. Having said that I absolutely love my job and wouldn’t do anything else.
Ella Clarke-Billings, 14 months post qualified, surgical nurse, London

‘I didn’t realise the monumental amount of paperwork that nursing incorporated’

I went straight into the private sector due to more opportunity. I would have preferred to work for the NHS at the time but in my specialism I found it very hard to get into. I wanted to be a liaison nurse, which is a role to support people with a learning disability while they are in hospital, but people don’t seem to leave those jobs once they’re in them as they are so good to have. There is definitely more room for climbing the ladder in the NHS but that’s not what interests me. For me, getting the right healthcare for my service users and supporting them to have the best quality life they can is what’s most important. It’s why I wanted to become a nurse – to be the voice for those that couldn’t be heard and that’s what I can do in the company I work for.

I didn’t realise the monumental amount of paperwork that nursing incorporated. I definitely thought it would be more hands-on than it is. It seems more of an uphill battle to get what is deserved and to get the kind of respect nurses used to get, especially in my specialty which other health professionals seem to deem as useless. People don’t view learning disability nurses as proper nurses as we deal a lot with the social side and not just the medical side of care. I have even had family members joke that I’m not a proper nurse; when you aren’t given that level of respect it can really deflate you.
Liv Webster, 15 months post-qualified, learning disabilities nurse, Lichfield

‘Coming into nursing is different but it’s important to see it as a vocation rather than a job’

Nursing has certainly changed since I started in the early 1970s. The introduction of technology has had a big impact. I’ve seen the introduction of electronic health records, email and e-learning, and this kind of innovation has helped improve the practice of learning for the benefit of patients and carers. Many nurses had to adapt to the change and for some it was a difficult time as they did not have the computer skills required. For new nurses this will never be a problem as the way they study is academic and they have been brought up with technology.

But ultimately a good new nurse will have the same core skills and qualities, such as empathy and compassion, as when I trained. Coming into nursing now is different but it is even more important now that those entering see it as a vocation rather than a job. It is a hard career albeit rewarding.
Helen Smith, 41 years post qualified, mental health matron and ward manager, West Midlands

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs.

Mental health? It’s in the mind and the body, too | Rachel Kelly

Something is stirring in the world of mental health and for once the news is positive. This month, British scientists began testing a radically new approach to treating schizophrenia based on emerging evidence that it could be a disease of the immune system. Meanwhile, scientists are investigating the possibility that low levels of chronic inflammation may be linked to depression.

Oliver Howes, a professor of molecular psychiatry at the MRC London Institute of Medical Sciences and a consultant psychiatrist at the Maudsley hospital in south London, is leading the schizophrenia research. “In the past, we’ve always thought of the mind and the body being separate, but it’s just not like that,” he says. “The mind and body interact constantly and the immune system is no different. It’s about changing the way we think about mental illnesses.”

Hear, hear to that. For a while, I’ve believed that we need to stop splitting mental and physical health. The mind doesn’t exist outside the body. A body without a mind is a corpse. In a way, this is a return to an old way of thinking: a “healthy mind in a healthy body” was the main component of the ancient Greek Hippocratic philosophy. But since Descartes split mind and body, arguing that the two were distinct, we’ve been living with the consequences.

The NHS distinguishes between mind and body – and can use the division as an excuse not to fund mental health services. And I used to embrace the split, too, until I was afflicted by two severe depressive episodes. I was astonished by how physically unwell I became. I couldn’t sleep. My heart sped up. I felt nauseous. Every bit of me hurt. I was suicidal, because I felt so rotten.

Try this for a moment. Take a deep breath. Let your shoulders drop. Close your eyes. Breathe. Enjoy that moment of physical relaxation. And notice something interesting. When we become physically relaxed, we become mentally relaxed. It’s impossible to be physically relaxed and mentally tense. Equally, if you feel stressed and tense, your body follows.

In repressive cultures where expressions of the thought are not allowed, the mind can manifest itself in symptoms of pain. Those who have suffered intolerable trauma, such as childhood sexual abuse, often have a wide range of physical symptoms. Equally, any doctor will tell you that the physical body breaks down when the mind can’t take any more trauma. Thyroid disorders, psoriasis and arthritis are all autoimmune illnesses that can develop at times of emotional stress.

Once we accept the union of mental and physical health, a few things become clear. First, we should ditch the term “mental health”. From now on, we should talk about someone’s health – all in. We would lose much of the stigma that still surrounds saying we are “mentally” unwell. We’re not. We’re just unwell.

And it follows we should embrace a new way of treating those with mental illnesses once we accept that mental illness can be embodied in this way. The split between mind and body has poorly served us, both in terms of diagnosis and in treatment. First diagnosis. We need to look more to underlying causes for why we often feel so glum, many of them physical.

We don’t exercise enough. We eat junk food. Many of us suffer from chronic high levels of inflammation, with inflammed guts leading to stressed bodies – and low mood. We lead hectic lives. We live in cities. We are divorced from nature, and each other. We are glued to our phones. We are not compassionate to ourselves, or to others.Second, treatment. What promotes good cardiovascular, endocrine and musculoskeletal health also promotes good mental health and vice versa. When I look back at my own battle with the black dog, I wonder if I might have recovered more quickly, or been less ill in the first place, if I had understood more about the connection between my mental and physical health. It seems I’m not alone – and hooray for that.

NHS at centre of storm: Brexit Means … podcast

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In this episode of Brexit Means, we look at a sector of the economy that ought not to be too affected by leaving the EU but that has found itself in the eye of the storm. If anything, healthcare was meant to be a major beneficiary of leaving, at least if you believed the £350m-a-week claim on the side of a bus. But our hospitals and care homes are kept afloat by an army of EU workers, many of whom feel increasingly gloomy about their long-term future in the UK.

Both Theresa May and her Brexit secretary, David Davis, have said they want to keep existing EU nationals working here and then have a system for allowing skilled workers to arrive from Europe. But the first desire depends on the divorce agreement with the rest of the EU and the second is in direct contradiction with continued promises to slash immigration rates.

Then there are the numbers. According to Health and Social Care Information Centre, 55,000 of the NHS’s 1.3 million workers and 80,000 of adult social care’s 1.3 million workers come from the rest of Europe.

Joining Dan Roberts to discuss what Brexit means for the NHS, and for healthcare more generally, are Janet Davies, the chief executive and general secretary of the Royal College of Nursing, and Sarah Johnson, a Guardian journalist who writes and commissions for our Healthcare Professionals Network.

Brexiters must honour extra cash pledge for NHS, says health chief

The Brexit campaign’s pledge that leaving the European Union would mean more money for the health service must be honoured or voters will lose trust in politics, the head of NHS England will warn.

Simon Stevens will cite the leave campaign’s controversial claim that Brexit will bring £350m back under British control to spend on the NHS to argue for more funding for the health service.

He will not call specifically for the figure emblazoned on the side of the Vote Leave bus, which carried Brexiters such as Boris Johnson around the country during the referendum.

But he will insist trust in democracy “will not be strengthened” if the chancellor, Philip Hammond, argues in his budget this month that economic turbulence caused by Brexit means he cannot promise extra cash for the NHS.

Speaking at the NHS Providers conference in Birmingham, Stevens is expected to say: “The NHS wasn’t on the ballot paper, but it was on the battlebus. Vote Leave for a better funded health service – £350m a week.”

He will quote the Vote Leave campaign director, Dominic Cummings’s, analysis that Britain would have voted to remain in the EU without the pledge, going on: “Rather than our criticising these clear Brexit funding commitments to NHS patients – promises entered into by cabinet ministers and by MPs – the public want to see them honoured.

“By the end of the NHS’s next financial year – March 2019 – the United Kingdom will have left the European Union.

“Trust in democratic politics will not be strengthened if anyone now tries to argue: ‘You voted Brexit, partly for a better funded health service. But precisely because of Brexit, you now can’t have one.’

“A modern NHS is itself part of the practical answer to the deep social concerns that gave rise to Brexit.

“At a time of national division, an NHS that brings us together. An institution that tops the list of what people say makes them proudest to be British. Ahead of the army, the monarchy or the BBC. Unifying young and old, town and country, the struggling and the better off.”

His speech will immediately follow a keynote address from health secretary, Jeremy Hunt, and comes as leading health thinktanks warn that NHS funding will be at one of the lowest rates in its history next year.

The Health Foundation, The King’s Fund and the Nuffield Trust calculated that the NHS needs £4bn more next year to prevent patient care from deteriorating following a joint analysis of NHS finances in England.

Why Nancy Friday’s 1970s collection of women’s sexual fantasies still matters

For me, it is the dogs and the lesbians. These were the sections in Nancy Friday’s 1973 cult sexuality tome, My Secret Garden: Women’s Sexual Fantasies, that I can still recall. As a 10-year-old, I sneaked endless peaks of it (alongside Jacqueline Susann and The Joy of Sex) from my mother’s bookshelf. The clumsiness in expression of many of Friday’s interviewees is a poignant testament to the raw honesty behind the confessions. The housewife “Jo” who fantasised about her neighbour’s dog during her afternoon baking session is compulsive reading.

My Secret Garden exploded on to bestseller lists around the globe in 1973. The work was shocking, deeply sexy in parts and proved that women had erotic imaginations just as men did, and that they, too, masturbated just as men did. It heralded the innocent dawning of what later became known as the sex-positive feminist movement. My Secret Garden came at the beginning of a wave of overtly sexual content written by women. Also in 1973, Betty Dodson penned what was to become the world’s bestseller on masturbation, Sex for One. My Secret Garden didn’t have the gravitas and respectability of say, Shulamith Firestone, but as author Susie Bright, the original “Sexpert” in the 1980s and 90s, says, “it sold millions and millions of copies and was a big wake-up for America’s puritanical, sheltered girls and young women”.

Of course, Friday was attacked by many. Like Dodson, her work was dismissed for being not scientific enough or for being too personal, or too much like soft porn. But an even bigger issue was that she wasn’t, Bright recalls with glee, “the tiniest bit politically correct”.

There is something quite secret about My Secret Garden. All Friday’s interviewees, who talk about fantasies ranging from being sex workers to being urinated on, talk anonymously.One interviewee explains how, when she has sex with her husband, her fantasy is imagining “the bed practically torn apart and us ending up on the floor wet and sticky and happy”. The reality though is that, “All he’s really doing is lying on top of me and thrusting away.

In 1996, Friday told Salon: “I would no more go to a consciousness-raising group and talk about my intimate life with my husband than fly to the moon.” In that same year, while discussing sexual harassment in the office on Bill Maher’s Comedy Central talk show Politically Incorrect, she claimed that men suffered from harassment as much as women.

Nancy Friday’s legacy is that My Secret Garden still inspires a younger generation of women.


Nancy Friday’s legacy is that My Secret Garden still inspires a younger generation of women. Photograph: rec

And so she found herself in the firing line of the feminist sex wars before that concept had even properly taken shape. Ms magazine wrote of her: “This woman is not a feminist.” But her background was not in feminism and she had no community of “sisters”. Bright adds that Friday was “hurt” when she was denounced by feminists. “She wasn’t a political mind,” says Bright. “But she was a superb interviewer, and a good journalist.” Born in Pittsburgh and later attending the prestigious Wellesley College in Massachusetts, Friday started life as a magazine reporter before having the idea, which she reiterates in the introduction to My Secret Garden, that, “In trying to understand what it is to be a woman, neither nationality nor class helps to define us so much as the honesty of our feelings about ourselves and our desires.”

Today, we take a lot of sex-positive talk about women for granted. And, with a 21st-century eye, we might have hoped for Friday to have gone a little further in her delvings into female sexuality.

But if some women didn’t know what a fantasy was, then many more had no idea what an orgasm was or how to get one. Dodson made it her life’s work to show women how to do that – to go beyond the fantasy and get to the nuts and bolts of how your sexual body actually works. But Friday had another path. Her third book, My Mother/My Self: The Daughter’s Search for Identity (1977) is a fascinating, reflective and critically acclaimed look at why so many of her previous interviewees had such deep feelings of guilt about sex.

Friday died on Sunday 5 November, aged 84. Her legacy is that My Secret Garden still inspires a younger generation with its bold, embarrassing honesty, and Bright gives her own advice for a rereading: “Don’t read the analysis, read the stories, then think of your own.”

Stephanie Theobald is the author of Sex Drive

Taxpayers pay twice for crucial drugs like Avastin | Letters

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

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

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

Brain game: how we see colour – in fireworks and on screens | Daniel Glaser

Fireworks may have been invented in 7th century China but we are still trying to improve the chemical technology behind them. Unlike colour representation in digital technology, fireworks work on the eye and hence brain in an entirely different way.

Pyrotechnicians use chemicals to make the colours: strontium carbonate (red), barium chloride (green) and sodium nitrate (yellow). Yet our visual processing system means that we can’t distinguish between these colours and ones that appear on the screen.

If you, like Newton, were to pass the light through a prism to see the spectrum of colours, you’d be amazed at the purity of the light created by fireworks compared to the synthesised digital version.

Screens use combinations of red, green and blue light (RGB) to make a particular colour. It’s a trick of the brain’s colour processing systems that we can’t tell the difference between this and the pure chemical colour.

But maybe knowing that you’re seeing real colour when you watch fireworks live this year, as opposed to watching the TV, will enhance the experience after all.

Dr Daniel Glaser is director of Science Gallery at King’s College London