Category Archives: Stress Management

Brain tree: why we replenish only some of our cells | Daniel Glaser

We are being treated to a spectacular display of autumn colour this year, but it isn’t only trees that share this pattern for periodic shedding and regrowth. Our own skin cells, for example, are renewed every month or so, but we replenish less than 10% of our bone each year. Certain types of human cells do not seem to regenerate at all and this includes brain cells. With a few exceptions (such as the hippocampus), we are born with all the brain we’ll ever have. Over childhood and into adolescence, extensive pruning of the connections between cells takes place. This neural topiary shapes all the systems of the brain. But once into adulthood, although some new connections are formed, the main structural change is the steady death of our brain cells.

Many aspects of life cause our cells to die off, including trauma, drug use, environmental pollutants, strokes… and that’s before we start on age-related diseases such as Alzheimer’s. Yet the quality of our brain function doesn’t decline for most of adulthood. Maybe as our cells decrease we learn to adapt, picking up tricks to help us to make the best of what we’ve got.

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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


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

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

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

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

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

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

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


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

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

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

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

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

Cross-party MPs request urgent non-partisan debate on future of NHS

Ninety MPs including several senior Tories have urged Theresa May to launch a cross-party convention on the future of the NHS and social care in England.

Sarah Wollaston, chair of the Commons health committee, organised a letter in conjunction with the Liberal Democrat former care minister Norman Lamb and Labour’s former shadow care minister Liz Kendall, that has been sent to the prime minister and the chancellor, Philip Hammond.

The MPs say the health system has been failing patients and they call on Hammond to ensure any moves to lift the public sector pay cap for NHS workers is not funded by raiding existing health budgets.

The signatories, one-third of whom are Conservative MPs, have said only a non-partisan debate can deliver a “sustainable settlement”. They say the failure of normal party politics to secure the future of the system means a non-partisan approach is the only way to ensure action is taken, particularly given that the government does not command a majority.

“The need for action is greater now than ever,” say the MPs, who include about 30 former ministers. “We understand that fixing this is immensely challenging and involves difficult choices.

“We all recognise, though, that patients and those needing care are too often failed by a system under considerable strain. We believe that together we owe a duty of care to the people of this country to confront the serious challenges to the NHS and the social care system.”

The Tory signatories include the former education secretary Nicky Morgan, the former international development secretary Andrew Mitchell, George Freeman, a former policy adviser to May, and the party grandee Sir Nicholas Soames.

The Labour MPs who have signed include Kendall, Chuka Umunna, Hilary Benn, Frank Field and Caroline Flint. Liberal Democrats signatories include the party leader, Sir Vince Cable, as well as Ed Davey and Tim Farron.

In a series of tweets Wollaston said:

Sarah Wollaston (@sarahwollaston)

. Govt also needs to focus on the long term, stop planning for health & social care in separate silos as this approach is setting us up for failure. Finance & workforce need urgent attention for the here & now but also for the long term & MPs from all Parties ready to engage

November 18, 2017

Sarah Wollaston (@sarahwollaston)

Current plans to kick social care into the long grass (again) & to separate planning for young and older adults creates even further fragmentation . Essential to think about whole system of NHS & Care

November 18, 2017

In the letter, MPs argue that only a cross-party NHS and social care convention where there can be a non-partisan debate can ensure a long-term settlement.

This was echoed by Wollaston in further comments in which she said: “The simple reality of a hung parliament means that all our constituents will be failed if long-term plans for NHS and [social] care funding do not command cross-party support.”

She added: “It’s better to take a joint approach to planning from the outset and actually deliver.”

Although MPs recognised that the challenge facing the government involved making difficult choices, they say “patients and those needing care are too often failed by a system under considerable strain”.

Lamb said: “Tribal politics has failed to provide a solution to the existential challenges facing the NHS and social care. We know that the current situation is unsustainable, and these pressures will only get worse as we contend with an ageing population and rising demand for care and treatment.

“This letter shows the strength of cross-party support for a new approach based on cooperation instead of political point-scoring. The fact that so many senior MPs and former cabinet ministers support this initiative is remarkable. Now the government must act on it.”

Kendall said: “Our population is ageing, more people need help and support and our care services desperately need more money to cope, yet any party that comes up with a significant proposal for funding social care risks their political opponents destroying them.

“We could carry on like this for yet another parliament, and yet another election, or we could face up to reality: we will only get lasting change if we secure a cross-party approach.”

According to NHS England chief executive, Simon Stevens, the fall per head in NHS funding means the health service will not be able to meet its routine waiting-time commitments.

Representatives from the Nuffield Trust, Health Foundation and King’s Fund said this year that austerity combined with increasing demand for services had created a “mounting toll on patient care”. They said there was growing evidence that access to some treatments was being rationed and that quality of care in some services was being diluted.

Solving the problem would mean a “steadily increasing share of national income would need to be spent on providing these services,” they said.

The UK spends 9.9% of GDP on the health budget – a considerably lower percentage than many other European nations.

Niall Dickson, chief executive of the NHS Confederation, which represents various organisations in the healthcare system, said promises to reform funding were being “kicked down the road”.

He said: “The government promised reform before the election, then said there would be a green paper before Christmas. Now it has been put off until summer next year – and even then we are not being promised firm commitments.”

A government spokesperson said: “We have announced a cross-government green paper on care and support for older people with input from a group of independent experts. We recognise that there is broad agreement across parliament that reform for social care is a priority and look forward to hearing a range of views.”

They said MPs would be consulted on social care before the green paper policy statement next year. The government had already provided an additional £2bn to social care over the next three years, the spokesperson said, adding that the government was committed to making the sector sustainable.

Use carrot and stick to tackle obesity crisis | Letters

The UK is the “most obese nation in western Europe” (Report, 11 November), and there is widespread agreement that a range of measures is required to address this problem. One such measure, the government’s proposed sugar tax on soft drinks, should therefore be commended, especially since it introduces the concept of using price policies to promote healthier eating. However, the policy is likely to be more effective if the stick of the sugar tax is balanced by a carrot of subsidies on fruit and vegetables, increased consumption of which protects against numerous disorders – notably heart disease, stroke and bowel cancer – and is likely to limit the rise in obesity. As the WHO pointed out in its 2015 report Using Price Policies to Promote Healthier Diets, “Taxes on sugar-sweetened beverages and targeted subsidies on fruit and vegetables emerge as the policy options with the greatest potential to induce positive changes in [food] consumption”. However, as the WHO says, extra government intervention will likely be required to bring the price of fruit and veg down to a level everyone can afford and provide the maximum benefit to all. This will require more research on price policy strategies of how to spend the tax on sugar-containing drinks – something which was not the remit of the government’s adviser, Public Health England.
Henry Leese
Windermere, Cumbria

Your report says correctly that the government’s childhood obesity strategy was heavily criticised “for its reliance on voluntary action by the food and drink industry and lack of restrictions on the marketing and advertising of junk food”. It was also criticised for making no reference to breastfeeding, or to the current inadequate restrictions on marketing and advertising of breastmilk substitutes that contravene the WHO code. Obesity begins in infancy, and it is no accident that the breastfeeding rate in Britain is among the lowest in Europe.
J Peter Greaves
London

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NHS cash squeeze forces hospitals to postpone non-urgent operations

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Lincolnshire NHS enforces three-month wait for surgery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.”

Commuters urged to make small talk to help prevent railway suicides

Commuters and travellers have been urged to strike up conversations with vulnerable people near railway tracks as part of a campaign to prevent suicide.

Small Talk Saves Lives aims to give the public the confidence to trust their instincts and take action if they see someone who may be at risk.

The campaign, which has been launched by Samaritans, the British Transport Police, Network Rail and train operators, promotes the message that suicidal thoughts can be temporary and interrupted by a simple question.

The initiative commissioned a survey of 5,000 passengers, which found that the majority are willing to play a role in stopping suicides.

More than four out of five (83%) passengers said they would approach someone who may be suicidal if they knew the signs to look for, what to say and that they would not make the situation worse. Nearly nine out of 10 (89%) thought someone in need of support would find it hard to ask for help.

Warning signs could include a person standing alone and isolated, looking distant or withdrawn, staying on a platform a long time without boarding a train, or displaying something out of the ordinary in their behaviour or appearance.

Small Talk Saves Lives stresses there is no single sign or combination of behaviours that mean a person is suicidal, but if passengers spot something that “doesn’t feel right” they should take action by starting a conversation or alerting rail staff or the police.

About 273 people died in suicides on Britain’s railways in 2016/17, according to Office of Rail and Road figures.

Ian Stevens, who manages Network Rail’s suicide prevention programme, said: “If it were your loved one, a daughter or son, husband or wife who was going through an emotional crisis, wouldn’t you hope that somebody took the time to stop and ask if they were OK?”

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Ruth Sutherland, the chief executive of Samaritans, said suicide was everybody’s business and claimed “any one of us could have an opportunity to save a life”.

She added that the skills to save lives on the railways could be applied to many other situations and she hopes the campaign starts “a much wider conversation about how suicide is preventable”.

Samaritans told the story of Sarah Wilson, who was 28 when she decided to take her life. “Someone talking to me and showing they cared about me helped to interrupt my suicidal thoughts and that gave them time to subside. The more that people understand that suicide is preventable, the better,” she said.

In the UK, Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

UK supreme court rules minimum alcohol pricing is legal

The UK supreme court has backed the Scottish government’s plans to introduce a minimum price for all alcoholic drinks in a decisive victory for Nicola Sturgeon.

After a five-year legal battle against the plans led by the Scotch Whisky Association (SWA), the court ruled on Wednesday that minimum pricing was legal on health grounds under EU law.

The seven judges unanimously agreed it was “a proportionate means of achieving a legitimate aim”.

The ruling clears the way for the Scottish and Welsh governments to introduce a minimum unit price for alcoholic drinks, likely to be set at 50p, and will increase pressure on English ministers to follow suit.

Nicola Sturgeon (@NicolaSturgeon)

Absolutely delighted that minimum pricing has been upheld by the Supreme Court. This has been a long road – and no doubt the policy will continue to have its critics – but it is a bold and necessary move to improve public health.

November 15, 2017

Shona Robison, the Scottish health secretary, said the devolved government in Edinburgh would introduce minimum pricing “as soon as possible”, setting out a timetable to parliament within days.

The pricing may come into force in spring 2018 and English health campaigners said the ruling meant the UK government had to revisit the issue, which had been studied but shelved when David Cameron was prime minister.

Richard Piper, the chief executive of Alcohol Concern, said: “Now is the time for Westminster to step up and save lives. As alcohol has become more affordable, the rates of alcohol-related ill-health have risen. The fact is, something has to be done.”

The group, which recently merged with Alcohol Research UK, said strong cider was being sold at 18p per unit of alcohol, fortified wine at 27p per unit and the cheapest vodka and gin at 38p, increasing the risks for problem drinkers.

Alcohol Focus Scotland has calculated that adults buying one brand of strong cider can drink their maximum recommended weekly limit of alcohol – 14 units – for £2.52.

Robison said the ruling had “global significance. This is a historic and far-reaching judgment, and a landmark moment in our ambition to turn around Scotland’s troubled relationship with alcohol.”

Alcohol-related deaths in Scotland had increased in the five years since the legislation was passed, she said: “With alcohol available for sale at just 18p a unit, that death toll remains unacceptably high.

“Given the clear and proven link between consumption and harm, minimum pricing is the most effective and efficient way to tackle the cheap, high-strength alcohol that causes so much damage to so many families.”

The policy, championed by Sturgeon since she was Scotland’s health secretary, had been backed by Scottish judges in several hearings before it reached the supreme court.

Prof Petra Meier, the director of the alcohol research group at the University of Sheffield, which published the data and evidence that Sturgeon’s proposals were based on, said a 50p minimum price would in time result in 120 fewer deaths and 2,000 fewer hospital admissions from alcohol abuse each year.

“Our research has consistently shown that minimum unit pricing would reduce alcohol-related health problems in Scotland by targeting the cheap, high-strength alcohol consumed by the heaviest and highest-risk drinkers,” Meier said. “Moderate drinkers would be affected to a much smaller degree.”

The SWA, with support from the European drinks industry, had argued that minimum pricing breached EU and global trade law as it interfered with free trade and open borders regulations. It lodged a series of appeals against the earlier rulings.

The industry’s case was supported by an interim opinion from the European court of justice in an appeal hearing at which European judges asked the Scottish and UK courts to re-examine the case.

Dr Eric Carlin, the director of Scottish Health Action on Alcohol Problems, a campaigning body backed by the medical profession, lambasted drinks companies for their “ferocious, cynical” opposition to the measure.

“The opponents to MUP [minimum unit pricing] have shamed the reputation of their industry by prioritising profits over people’s lives. As MUP has been delayed, we have seen the tragic, premature deaths of 24 people every week in Scotland as a result of alcohol misuse, many of them in our poorest communities, and affecting families across our nation,” he said.

Karen Betts, the SWA chief executive, said the industry would work with ministers on implementing the policy, as well as promoting responsible drinking and tackling alcohol-related harm.

“We will now look to the Scottish and UK governments to support the industry against the negative effects of trade barriers being raised in overseas markets that discriminate against Scotch whisky as a consequence of minimum pricing, and to argue for fair competition on our behalf,” she said.

“This is vital in order that the jobs and investment the industry provides in Scotland are not damaged.”

She said the association wanted to see an objective assessment of the impact of minimum pricing.

The Alcohol (Minimum Pricing) (Scotland) Act, passed at Holyrood with all-party support in 2012, requires ministers to review its impact after five years. It includes a “sunset clause” under which minimum pricing is withdrawn unless Holyrood passes a renewal bill supporting it, six years after the act comes into force.

The court ruling was applauded by Scottish brewers and pub owners, who believe it will help protect the pub trade and undermine cut-price competitors.

Paul Bartlett, the group corporate relations director for C&C, which makes Tennent’s lager and Magners cider, said the company had always backed responsible drinking, and urged the Irish and Northern Irish governments to consider minimum pricing.

“Now that the supreme court have made their ruling, we urge the industry to get behind the decision,” he said. “We also hope similar legislation can be realised across other territories we operate in, including Ireland and Northern Ireland.”