A diet which reduces or even excludes meat and animal produce in favour of vegetables, fruit and grains could halve people’s chances of becoming obese, according to new research.
A study carried out in Spain describes the benefits of what researchers call a “pro-vegetarian” diet which does not exclude meat and dairy products but reduces them. It has also been called a “flexitarian” diet – basically vegetarian, with meat and fish consumed occasionally.
Some 16,000 university graduates were tracked from 1999 for 10 years, by which time 584 were obese, according to findings presented at the European Congress on Obesity in Porto, Portugal.
At the beginning of the study, participants completed detailed food questionnaires which were scored to establish how pro-vegetarian their diet was. They got more points for eating from seven plant food groups – vegetables, fruits, grains, nuts, olive oil, legumes (such as peas, beans, and lentils) and potatoes.
Points were then deducted for foods from five animal groups – animal fats, dairy, eggs, fish and other seafood, and meat.
The researchers compared the 20% whose diet included the most animal products with the 20% who ate the least. They found that those whose diet was the most vegetarian were 43% less likely to become obese.
Although fish was included in the animal foods group, the results showed that there was very little difference in the amount of fish that any of the participants ate, so had little impact on obesity rates.
But there was a significant difference in the amount of meat eaten – those who ate most consumed about 200g a day (roughly the weight of a small chicken breast or a seven ounce steak), while those who ate least consumed 142g. There was an even larger difference in the consumption of vegetables – 348g in the meat-eating group and 731g for those whose diet was the most vegetarian. The same applied to fruit consumption – 191g versus 531g.
“Our recommendation is to eat less meat,” said Prof Maira Bes-Rastrollo, one of the authors. “Don’t increase the consumption of animal foods. Prefer plant-based foods to animal foods.”
The study’s weakness is that it is observational – it did not recruit people eating a mainly vegetarian diet in order to compare them with a group of meat eaters, nor did it attempt to change the behaviour of participants.
The pro-vegetarian diet in the study is very similar to the Mediterranean diet. Gaynor Bussell, a dietician and member of the British Dietetic Association said: “We have known for a while that a healthy plant-based diet is associated with less obesity and this new evidence confirms this.
“Other factors could be accounting for the lower obesity in this group; I would also add that although scored negatively, foods such as fish, some meat and dairy are not associated with obesity but it is about the overall balance of the diet. The Mediterranean diet with its reliance on fruit, veg, nuts, beans and little meat is probably an ideal mix and is also associated with lower obesity rates.”
Sarah Toule from the World Cancer Research Fund said: “A mainly plant-based diet not only helps reduce obesity risk, but our own evidence shows it helps reduce your cancer risk too.
“Eating more portions of vegetables and fruit, cooking from scratch and including a wide variety of colours on your plate are all good ways to improve your diet.”
Growing up is tough enough for any young person approaching puberty. But for Aimee Challenor the challenges she faced as a 10-year-old were much harder: “It struck me when I was about 10 or 11 that I was a girl. I couldn’t put my finger on it but something wasn’t right. I was in year 6 and I left my parents a letter on their bed before I went to school one morning. When we talked about it later they were very supportive, but no one knew what trans was. So I went back into the closet.”
During the next six years Challenor, now 19, felt anxious, isolated, lonely and depressed. “I spent my time at secondary school feeling pressured by society to be somebody that I was not. I wasn’t able to be myself; there was always that nagging feeling at the back of my head, so I didn’t take opportunities and grab them. I didn’t reach my potential and my education suffered as a result.”
It wasn’t until her school graduation prom that she decided to come out as trans: “It was then that articles about trans started to appear and I discovered that there was a word for it. I found the trans guide published by the Tavistock and Portman NHS foundation trust and decided to come out at my prom – it was the day before I was due to leave school.”
Her mum helped her with her dress and one of her school’s teachers did her makeup on the night: “Some of the staff were very supportive, but they were not in the school leadership team. Generally, I didn’t get any support from my school – it wasn’t up to speed on the Equality Act and they wouldn’t let me wear a dress to the prom because they thought it was unnecessary attention seeking; they said it made the school look stupid. But I dug my heels in. I was incredibly nervous on the night, but it felt so positive – for me it reinforced what was right.”
Challenor is in the process of transitioning from male to female but feels “in limbo” as she waits to continue adult gender identity services: “I’ve been out now for three years and publicly present as female, but I wish I could have come out younger and not have had to wait until I completed puberty.”
Today Challenor speaks on LGBTIQ (lesbian, gay, bisexual, transgender, intersex and questioning) issues for the Green Party in England and Wales and also contributed to charity Stonewall’s Vision for Change report, published in April, which spells out what still needs to be done to deliver equality for the UK’s trans community. Challenor says: “I speak to schools about trans issues and I am the first openly trans person to work for a political party. I think trans [people] need to show that you can be trans and reach your potential.”
Powerful and potentially addictive opiate painkillers are being handed out too readily, leading doctors have warned after it emerged that the number of times the drugs are being prescribed in the UK has doubled in the past decade.
The Faculty of Pain Medicine and the Royal Pharmaceutical Society said they were worried about the high and growing use of opioid drugs such as codeine and tramadol – while other experts warn that hundreds of thousands of patients could be addicted to them.
Dr Barry Miller, dean of the Faculty of Pain Medicine, said that the increase in the prescription rates of painkillers in the UK should be “met with concern”, adding: “While some of the increase can be attributed to an improved understanding of the effectiveness of these medications by medical professionals, we are concerned by reports of unnecessary prescription.”
NHS Digital figures released last week showed that prescriptions of opioids have doubled in the past decade, with the number of prescriptions issued rising from 12m in 2006 to 24m in 2016. One of the highest increases in prescriptions was for oxycodone, which shot up from 387,591 to 1.5m – a 287% rise – over that period. There was a 236% increase in prescriptions for morphine sulphate and a 143% rise for fentanyl.
“Our greater understanding of these medications can improve the quality of life for tens of thousands of patients in the UK living with complex pain. However, all NHS staff prescribing these medications need to ensure they are not doing more harm than good,” said Miller, whose organisation represents anaesthetists who specialise in the relief of acute, chronic and cancer pain.
Doctors have warned about the numbers of people in Britain who may be addicted to these drugs as a result, with recent estimates suggesting over 192,000 could be dependent, partly because some medics prescribe them too readily.
In the US, since 1999 the number of overdose deaths involving opioids such as oxycodone, hydrocodone and methadone has more than quadrupled. The number of prescriptions of these drugs rose dramatically – from 76m to 219m a year between 1991 and 2011. This comes despite the fact there has been no change in the amount of pain Americans report.
Harry Shapiro of the DrugWise information service warned of the growing risks of addiction in the UK and said the growing prescription of painkillers was leading to a “public health disaster hidden in plain sight”. He is calling for more dedicated specialist centres to help people with painkiller addiction and also to help track the scale of the problem.
“People are not staggering around the streets and buying dodgy drugs off dealers, they are getting painkillers. It’s a problem hidden in plain sight – a problem in every GP surgery and pain specialist clinic,” he said.
Martin Johnson, clinical lead for chronic pain at the Royal College of General Practitioners, raised concern about the number of people who may be on repeat prescriptions. He said those with other conditions such as diabetes were monitored while on medication, but it doesn’t always happen for people with chronic pain. He called for an annual review, potentially conducted by pharmacists, to check in on those given these drugs. “So many say painkillers don’t do anything, but they keep getting prescribed them,” he said.
Many patients also reportedly use these drugs recreationally, obtaining them non-prescriptively after being introduced to them by their doctors. In Britain, there is less recreational use and most people are given opioids by their doctor for chronic pain.
Opioids act on different parts the brain and nervous system, including the spinal cord. The latter receives sensations from the body before sending them to the brain. Opioids work on this area to decrease feelings of pain, even after injury. One of the risks with the drugs is that they are addictive, with users complaining of withdrawal symptoms when they stop taking them.
But doctors say that while medications such as codeine can be effective for cancer patients and for tissue damage, they do not always help the growing number of patients now taking them for long-term pain. These drugs also have side effects such as severe constipation and dangerous sedation.
Dr Jane Quinlan, consultant in anaesthesia and pain management at Oxford University Hospitals NHS foundation trust, said: “For the majority of patients with chronic pain opioids don’t reduce their pain, but the side effects can significantly worsen their quality of life. Over time opioids can actually make people more sensitive to pain, she added.
One former user, who asked to remain anonymous, said: “I was prescribed tramadol for about three years for my ongoing back condition. I was addicted to them after a few months, it got to the stage where it became part of my routine. I suffered awful withdrawal when I stopped taking them. Without them my pain was overwhelming.”
Yasir Abbasi, a psychiatrist with Mersey Care NHS trust, said: “Being dependent or addicted to prescribed painkillers can lead towards a slippery slope of illicit behaviour, which can pave the way for hardcore drugs. There are not enough non-pharmacological interventions available to reduce our reliance on opioid medication.”
Cathryn Kemp, 45, from Hastings: ‘I ended up in rehab after taking 60 fentanyl lozenges a day’
I was working as a journalist when, after a period of illness, I was finally diagnosed with a disorder of the sphincter. I had lots of scary procedures to make me better. I was very ill and eventually discharged with a repeat prescription for fentanyl lozenges. I’ve since been told that fentanyl is 100 times stronger than heroin.
At the time, I was told to take a maximum of eight lozenges a day. I was also on fentanyl transdermal patches – 100mg ones, the strongest. That shows the level of pain I was in. Then one day I took an extra lozenge and after that my use of the drug spiralled.
Two years later I ended up in rehab after taking 60 lozenges a day – all of them on prescription from my GP. I kept thinking I was in loads of pain and needed more.
I felt like I was taking control of things, which is completely insane. I hid the problem brilliantly from my family and friends. I used to hide lozenges around the cottage where I lived, putting them in tampon boxes so no one would know how many I was taking. Taking fentanyl would make me woozy and then about an hour or two between doses I would go to withdrawal – vomiting, shaking and hallucinating.
In the morning I would wake up, crawl to the bathroom and take six lozenges. This would stop me shaking. I would then be well enough to get a cup of tea and then have to take six more. This would go on all day. The tiny bit of me that was still myself at this point knew I was abusing drugs, but I was afraid to stop as I feared living in pain again.
At this stage I was dangerously dependent. My GP said he would write me my last fentanyl prescription and I was forced to borrow lots of money from my parents and sell my cottage in order to pay for private rehab. My GP applied for NHS detox for me, but I was told that I was refused it because I wasn’t homeless and I wasn’t offending.
By then I knew going to die if I carried on so I did whatever it took to get help. Coming off it I had to go through a pain barrier. The body stops producing endorphins, the body’s natural painkillers, because it is receiving opiates instead.
I lost everything. I had to leave work because I was so ill. I lost my relationship, my career and my home – I lost everything I had built up over my writing career. I nearly lost my life.
I now run a charity dedicated to helping people cope with painkiller addiction. I haven’t come across anyone who has had such a complete breakdown like me. But I hear from lots of people, mainly women, who say they have kids to sort out and they cannot stop to have a pain condition. They think they have to keep going and so become trapped by the drugs they are taking.
What I am really hearing is the fact in the medical community there is still no support for dealing with these cases – no specific or very few specific resources to refer people too, so many are left hanging. We really need to engage NHS England in accepting that we need proper treatment services to deal with chronic pain as well as the addiction side.
It’s heartbreaking because it’s everyday people who are affected. We look at America and are horrified that opioid deaths are higher than deaths caused by car crashes. We do have a different system here, but estimates suggest hundreds of thousands of patients in the UK today are addicted to prescribed painkillers.
A skin patch costing as little as 39p could revolutionise stroke treatment, significantly increasing the chances of survival, researchers have found.
The patch contains glyceryl trinitrate (GTN), which lowers blood pressure and opens up blood vessels, helping reduce the damage caused in the immediate minutes and hours following a stroke.
A stroke is usually caused by an artery clot or burst blood vessel in the brain and causes permanent disability in about a quarter of patients.
A small trial of 41 randomised patients in and around Nottingham found that administering the patch to a patient’s shoulder or back while they were travelling to hospital halved the stroke death rate from 38% to 16%.
As a result, the British Heart Foundation (BHF) has funded the University of Nottingham researchers to work with seven ambulance services to trial the patch on patients and chart their recovery over 12 months.
Paramedics can administer the patch in the ambulance before arrival in A&E, saving vital time.
Prof Sir Nilesh Samani, the BHF’s medical director, said: “Current treatment for stroke is fairly limited and patients are dying or suffering life-changing disabilities as a result.
“This trial uses a simple patch that can be applied rapidly by paramedics as soon as they reach the patient.
“If successful, this could revolutionise treatment for stroke patients across the UK and potentially globally and could be a huge step forward in the advancement of stroke treatment which currently lags behind heart attack treatment.”
There are more than 100,000 strokes in the UK each year, according to the Stroke Association, and the BHF says 40,000 people die as a result annually, making it the country’s fourth biggest killer. One in eight strokes are fatal in the first 30 days.
The cost to the NHS and social care system is estimated at £2bn a year in England and research has suggested the cost to society as a whole in the UK is £9bn.
Funding for stroke research, which was £56m in 2012, is approximately a tenth of the £544m spent on cancer research. Cancer’s cost to the health and social care system is estimated at £5bn a year.
GTN is used for chest pain associated with angina, but the use of the drug for treating hyperacute stroke is new and the researchers believe they are the only people in the world testing it.
Prof Philip Bath, a BHF researcher from the University of Nottingham, said: “We believe that by improving blood flow in the brain in stroke patients we can dramatically improve their survival chances and recovery.
“This patch enables us to do this within minutes and early trials have been very promising.”
With a general election around the corner, the call has gone out to work out what can be done about an NHS and social care system in meltdown. What is needed is a group of staff who can reduce unnecessary hospital admissions, slash delayed discharges, prevent readmissions, and help the NHS and social care system work seamlessly together.
Occupational therapists, represented by the officially renamed Royal College of Occupational Therapists, are that group.
Our data shows that putting occupational therapy at the frontline of the NHS cuts unnecessary A&E admissions by up to 80% and reduces delayed transfers of care by eight days. Another recent study found that “occupational therapy is the only category where additional spending has a statistically significant association with lower readmission rates”. This evidence cannot and must not be ignored.
The same applies in social care. For too long, we’ve collectively wrung our hands and exclaimed that something must be done to fix the system. Later this year we will publish a report which will reveal that putting occupational therapy at the heart of social care results in higher quality, person-centred services at lower overall cost. Occupational therapists respond to 40% of social care referrals but make up just 2% of the workforce. Imagine what we could achieve if more of us were deployed to lead services.
The astute reader will have noticed that I am using our professional title in full. Calling us OTs is no longer acceptable. I refuse to allow my profession to be reduced to two letters. I am an occupational therapist, not an acronym, and so are each of the newest Royal College’s 32,000 members.
Unless there is greater recognition of occupational therapy the system will continue to waste time reinventing the wheel
Occupational therapists evaluate a person’s home environment, examining the challenges it presents and suggesting how they might be overcome. We assess for care and support packages and home adaptations, and provide rehabilitation and reablement. We work to build self-reliance, rather than dependence on services.
The NHS can’t wait for a long-term funding plan or for a new government, whatever its colour, to yet again rethink the health and social care system. People who need support shouldn’t suffer while they wait for politicians to figure out the answers. And although there is increasing recognition of the vital contribution we make, I highly doubt any of this year’s political manifestos even mention the potential of the occupational workforce.
Unless there is greater recognition of the value of occupational therapy, the system will continue to waste time reinventing the wheel. One possible solution to this would be to widen the pool of allied health professionals (AHPs) in leadership positions in the NHS. Too many people secure top posts through clinical directorships, and therefore have to be a medic or nurse. This discriminates against AHPs and prevents us from bringing our unique perspective to board level discussions.
The professional body of occupational therapists might now have royal status but, to quote a famous former prime minister, “this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning”. Expect to hear a lot more from occupational therapists. Just don’t call us OTs …
Julia Scott is chief executive of the Royal College of Occupational Therapists
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Millions of Britons could have their access to free health insurance taken away after Brexit, a parliamentary report has said.
MPs on the health select committee urged the government to offer more guarantees for Britons visiting the continent after hearing evidence that without the right to receive treatment in countries that are part of the European Economic Area, people with cancer could find it too expensive to go to Europe.
In a strongly worded report on the effect of Brexit on health and social care, the committee said the challenges created by losing reciprocal health arrangements should not be underestimated.
British travellers can currently use the European health insurance card, which guarantees access to healthcare free or at a reduced cost in Europe. The EU member state providing treatment is able to claim back costs from the patient’s home country. Some estimates suggest that up to 27 million Britons have the cards.
The inquiry heard evidence that losing this agreement could create challenges for many travellers, including disabled people and those with mental or physical health conditions. Prof Martin McKee of the London School of Hygiene and Tropical Medicine said a week’s full private health insurance for a holiday in France for someone with diabetes or mild depression would cost between £800 and £2,500.
The report also noted that hundreds of thousands of expats living abroad could lose reciprocal healthcare rights, leaving some facing hardship. McKee, a professor of European public health, said many Britons in Spain have properties that are now worth little. “Many will come back in a state of poverty because they bought properties in Andalusia and other places … They will be throwing themselves on the mercy of the state when they come back,” he said.
Christopher Chantery, a British resident in France, told the committee many pensioners moved to the country “in good faith on the implicit promise that these arrangements would continue. Suddenly, something happens that brings those arrangements to an end. It is absolutely terrible for many people”.
British nationals living abroad have to get an S1 form, which gives them health cover, paid for by the UK, within Europe.
The committee, which includes Labour and Conservative MPs, called on the government to preserve the existing system as opposed to seeking a new arrangement. What was currently in place offered taxpayers good value for money, it said.
In the same report, the committee warned that the Brexit vote could lead to a brain drain, with morale among EU nationals in the NHS low due to uncertainty about their future. It called for more reassurances and said the government should continue to be able to recruit the “brightest and best from all parts of the globe” after Britain leaves the EU.
The Department of Health could not comment due to general election purdah rules. But when asked about reciprocal healthcare at the start of the year, the health secretary, Jeremy Hunt, said it was one of the rights of those who retired to Spain or France and he wanted to secure it early on in negotiations, but could not guarantee this.
Speaking to the Guardian, Prof Jean McHale, the director of the Centre for Health Law, Science and Policy at the University of Birmingham, said: “If questions of healthcare provision and patient mobility are not included in the negotiations, if there is not a transitional period and we move to hard Brexit, there will be major practical questions. What happens at midnight on Brexit D day to the person in hospital in another EU member state who has been in a car accident?”
The most important part of every night shift is matching your scrub top to your bottoms. Odd shades, bad luck. Match for the best chance of success.
I’m full of superstition because fate doesn’t follow conventional rules. I sit, cross-legged comparing until I’m satisfied with my choice. I pull my clothes off and my blue scrubs on. Stethoscope, badge and water bottle. Downstairs, grab phone and rush to handover, hoping I’ve remembered my pen.
Back of house, but this is no theatre production. A list of jobs to mop up from the day. Twelve wards, the nurse practitioner and me, “Let’s hope they all behave tonight”.
First up, fluids. Ward 50 needs a cannula, or two, or three – while I’m there. A couple of bags of normal saline go up and it’s time for me to go down to ward 20 where a lovely woman has slipped off the commode. She’s ever so embarrassed. A check from head to toe, some reassuring words and an offer of a gingernut. Then back to the desk to scribble down the story.
The phone rings, again and again, sore foot, chest pain – blood pressures through the floor and in the clouds. A woman sobers up and wants to leave – listening, persuading, assessing and eventually letting her sign the papers to walk out the door, no doubt next week we’ll meet again for the same dance.
A warm hand on my shoulder and cup of tea beside my hand. “Do you want some cake doc?” – I want nothing more. The 3am slump is here and sugar is my drug of choice. I sit, and chat – and melt into the ward for a few minutes.
An unfamiliar sound from round my neck – I answer, crash call. I drop everything and run. Down two flights of stairs, along the corridor. Turn right. I see a set of anaesthetic greens in front of me. “Bay four, bed six” a voice shouts, we pile in.
A man lies on the floor, breathing hard. Oxygen on. Pulse felt. No response to voice, grumbling to pain. Eyes deviating to the left. I grab the notes and start piecing together the history. Mild upper body weakness, query stroke, a head scan showed nothing much. Back to airway, gurgling noises from his throat. A tube down the nose to help get air into the lungs. We take an arm each, one for arterial blood and one for venous. My hands don’t shake.
Stabilised, we need imaging and fast. I ring the radiologist, ready to plead my case. “Send him down” she says. The ease of the phonecall doesn’t fill me with hope. My senior house officer grabs the emergency drugs from the crash trolley and a fresh faced nurse clutches the oxygen ready to transport. They follow him down. The ward becomes quiet.
I flick through a thin set of notes to try and build a picture. Lives with a loving wife. Walks his dog every day. Gave up smoking years ago – drinks a couple of pints on a Friday. Not too bad for a man in his 70s. Children and grandchildren.
A bed slides through the doors and he returns, the report is back. Large bleed. Blood pushing the brain against the skull. Neurosurgical opinion advised. My registrar arrives, talking fast to someone. I hear “grave”, I hear “imminent”. The bleed is too big and his brain is crushed. There is nothing we can do. Keep him conscious, keep him comfortable, next of kin.
The newly qualified nurse goes white. The notes are in my hand. “I’ll call,” the words leave my mouth before my lips move. A 4am phonecall to a telephone number. A quiet voice answers. She only left at 11pm, the nurses say. “I’m calling from the ward, about your husband, things have changed and I think you need to be here”. She’ll be here as soon as she can. Panic seeps through the phone and into my hand. “Will I make it?” her voice cracks. “Will I see him before he dies?”.
“Call me as soon as she arrives” my registrar says. I nod. She leaves. I stay, breathe in, walk around the corner, shut myself in the clean utility and put two hands up to my wet face. These aren’t my tears to cry but they still come. I push them all back in. Professional.
Years of training do not prepare you for this. Nothing prepares you for your role in someone else’s tragedy. I will leave the hospital in four hours and his wife will still be clinging to his hand. I will come back in 16 hours and they will both be gone. A new name earmarked for his bed. Another story that might end a different way.
The phone rings, and someone needs something. A temperature, a catheter and some laxatives. I glance down at my trousers. They were a perfect match.
Some details have been changed to protect patient confidentiality.
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While experts are right to congratulate Prince Harry (Harry praised for telling of ‘chaos’ over Diana’s death, 18 April), and call for more spending on mental health, there is an elephant in the room. Mental health services are dominated by an outdated, simplistic medical model of distress that is rather at odds with the prince’s views. While he makes the obvious link between painful life events and mental health difficulties, our services are still telling distressed people that they have illnesses, like major depressive disorder, caused by chemical imbalances – an unsubstantiated drug company creation – and by inferior genes that make them more vulnerable than others to depression, anxiety, psychosis etc.
Unlike Harry’s psychosocial approach, this socially blind bio-genetic model actually increases prejudice, by using stigmatising labels and exaggerating differences. It has also led to over 62m prescriptions of antidepressants annually in England, at a cost of about £800m a day to the NHS. Our children too are being labelled and drugged at an equally alarming rate. Time for psychiatric services to move on from the failed diagnose-and-medicate approach and start asking us what happened to us, and what we actually need. Professor John Read University of East London
• Is bereavement a mental illness? Does grief require medical treatment? It is a profound mistake to treat such essential aspects of the human condition, and our responses to them, as purely personal “in-the-mind” medical crises, evidence of “ill-health”.
It is the overwhelming assault of our culture on our sense of personal space, time to be, not just to do; that generates much of the distress. The shame and stigma won’t be removed from this distress until we realise that it is not simply an individual, personal illness – though sometimes it becomes that – but a social, cultural malaise that will be deepened, not alleviated, by pills or sometimes misdirected talk therapies. Keith Farman St Albans, Hertfordshire
• Although Prince Harry’s revelations have rightly been praised by mental health experts, it would be helpful to focus on the particular issues surrounding those of us who have been bereaved in childhood.
First, the adults around us do not know how to approach us; second, we are commonly isolated in terms of the experience within our peer group; third, we have not yet developed the means to express our feelings effectively to the adult world around us. Add to that the “scorched earth of English repression”, as Richard Beard so brilliantly described it (Family, 8 April), and the fact that you miss out on natural processes in relationships that are part of growing into adulthood, and you may well finish up with a toxic foundation of anger within you.
Those bereaved in childhood have been widely misunderstood and ignored; the prince’s remarks allow us at least to start a debate as to how we should treat this most vulnerable group. Alison Sesi Billericay, Essex
• Suzanne Moore writes (Harry got help. Many others deserve it too, 18 April) that no one touched the two young princes during their mother’s funeral service. But why would anyone want to display public emotion, knowing that columnists were looking down on them? The family she saw that day was no different to other families who do not show their emotions at a funeral. Many people, frozen in grief, cognitive processing and exhaustion, are paralysed when it comes to being on display while they deconstruct and reconstruct what is in the coffin in front of them.
One message of the royals’ Heads Together campaign is not to judge other people, because you don’t know their circumstances. Miriam Fitzpatrick Dublin, Ireland
• Prince Harry is fortunate to have had what is increasingly being called “real therapy”, meaning in-depth and enjoying a trusted relationship with the “shrink” (to use his word). This kind of private practice therapy has almost completely vanished from the NHS and the public sector because all funding is being sucked up by the Improving Access to Psychological Therapies scheme. In this manualised and medicalised state therapy system, with economic rather than psychological goals, it takes a long time and much judgmental evaluation before a few get even cognitive behavioural therapy. We can be pretty sure that CBT is not what was offered to the prince.
It is time for the Department of Health to acknowledge that the old-style psychotherapy and counselling did a lot of good, and that it is still possible to restore it. Professor Andrew Samuels Centre for Psychoanalytic Studies, University of Essex
• I read, with interest and admiration, Prince Harry’s comments regarding how boxing helped him (Report, 18 April). This is something we, at Empire Fighting Chance, already know. We have had massive success with our own non-contact boxing programme for people with mental health issues, often engaging those that traditional services fail.
My co-founder and I have spoken at numerous all-party parliamentary groups about how it is possible to help those most in need by offering something different. However, there seems a real reluctance to invest in and integrate credible, community-based programmes.
Yet everyone can benefit from a community intervention: treatments are not class, race or postcode dependent. Deprivation is a huge factor for poor mental health and the poorer you are the less likely you are to know about or access services. Having something based in your community, provided by a name you know and trust, works. People are not embarrassed to attend – in our case they are proud to say they are going to the boxing gym. Once in it, they train like everyone else, they are not “on display” in some sterile leisure centre, so we get better results.
Finally in a time where funding is hard to come by, budgets are stretched and the health service is under tremendous pressure, we must recognise the role within that sports-led community projects can offer and look to innovate delivery. Resourcing them adequately appears to make sense from a business and, much more importantly, human angle. Martin Bisp Chief executive officer, Empire Fighting Chance
• Today’s underfunded NHS is unlikely to increase access to the support needed by those processing emotional trauma. I and many others, in UK and internationally, have found help from co-counselling, a peer-support system that, after a 40-hour training course, gives access to lifelong listening support that is comfortable with emotions. Pills and professionals have their place, but, as Harry said, listening is more helpful than advice for working through emotional issues that are an inherent part of being human. Jean Brant Birmingham
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Scientists have reversed memory and learning problems in aged mice with infusions of a protein found in human umbilical cord blood.
The striking results have raised hopes for a treatment that staves off mental decline in old age, but researchers stressed that more studies, including human trials, are needed before the therapy can be considered for clinical use.
Tests on frail rodents found that the protein therapy rejuvenated an area of the brain called the hippocampus, which is crucial for memory formation, and one of the first and most important regions to deteriorate in old age.
Older mice that received the treatment reacted like younger animals in a series of behavioural tests, according to researchers at Stanford University in California. They escaped from a maze faster than before, had better memories, and started building nests again, a skill the animals tend to lose in old age.
Researchers led by Tony Wyss-Coray made the discovery after they noticed that human umbilical cord blood had unusually high levels of a protein called TIMP2 when compared with blood from older people. When injected into mice, the protein ramped up the activity of a group of genes that revitalised the hippocampus, and made it more able to adapt to new information. Details of the study are reported in Nature.
The work is the latest in a string of studies that suggest molecules found in young blood may be able to rejuvenate old brains and other tissues. If the therapies are effective in humans, they could become a potent weapon against the cognitive decline that comes with old age, and also neurodegenerative diseases such as Alzheimer’s.
But until the treatment has proved itself in humans, scientists are roundly cautious of the work. The lesson from Alzheimer’s research on mice is that almost everything works in the animals, and so far nothing works in humans, said Rob Howard, professor of old age psychiatry at University College London. “Having taken that on on board, this is a really interesting way to understand how we might help people who are aged or in the early stages of the disease,” he said. The protein therapy might not reverse brain ageing, or halt Alzheimer’s, but it might boost what remains of the healthy brain to at least offset some of the decline that accompanies old age.
Jennifer Wild, a clinical psychologist at Oxford University, said that while the results were interesting, it was too early to consider it as a therapy for humans. “It’s exciting for mice who have cognitive ageing, but it’s way too early to start extrapolating that to say we can help humans,”, she said.
In medicine, the private one-to-one consultation is sacrosanct.
Yet shared medical appointments have been used successfully for years at the Cleveland Clinic in the US. Patients appreciate them. They compare experiences with other patients, learn from their questions, gain more advice than they might otherwise, and improve their understanding of their symptoms.
For the hospital, the gains are seen in improved outcomes, higher patient satisfaction, dramatically reduced waiting times and lower costs.
Here, then, is an innovation that could help the NHS, caught between rising demand and squeezed budgets, which is leading to longer waiting lists and growing discontent. By sharing appointments, more patients could be treated more quickly, reducing waiting times, saving costs, yet raising standards of care.
They have been tried by GPs in Edinburgh, Sheffield and Newcastle, following the lead of doctors in the US and Australia. As a surgeon, I can see the potential benefits in bringing together patients undergoing the same procedure for pre- and post-surgical care.
Shared appointments are not appropriate for all patients or all conditions. They should always be offered, never imposed, and patients would always retain the option of a one-to-one consultation, if that was what they preferred. There might, however, be trade offs. Patients might be offered a one-to-one consultation in four weeks or a shared appointment in 48 hours.
They can yield real benefits in the routine care of chronic illnesses such as asthma, diabetes and heart disease, where patients can learn from and motivate each other. We already know the secret of Weight Watchers’ success lies in creating peer pressure among group members who compete to see who can shed most pounds. Alcoholics Anonymous similarly allows people to share a problem and begin to tackle it together. There are websites such as PatientsLikeMe which connect people to others with similar conditions.
However, shared medical appointments work differently from self-help groups. Each patient is examined by the doctor, diagnosed and prescribed treatment in exactly the same way as they would be in a one-to-one consultation. The benefit for the patients comes from observing how the other patients are managed, or manage themselves. In one example, a patient with heart disease was persuaded to get on an exercise bike by hearing about a teenager with a heart condition who had a passion for basketball.
The doctors are spared having to repeat the same information a dozen times a day, saving time and costs. Whereas a heart patient might require a half-hour appointment for a routine follow-up visit, with a shared appointment six or seven patients could be seen in 90 minutes.
In certain cases, only part of the appointment might be shared. For example, in a typical shared appointment for female patients at the Cleveland Clinic, the doctor performs breast and pelvic examinations and discusses test results in private, while the remainder of the appointment includes the other patients.
Given these benefits, it is surprising that shared appointments have not been taken up more widely. In an article in the New England Journal of Medicine, Professor Kamalini Ramdas of London Business School and I suggest there are four principal reasons: the lack of rigorous scientific evidence of their value, the absence of easy ways to pilot them, missing incentives and lack of awareness among both patients and clinicians.
There is another reason. Innovations in healthcare typically take 17 years to spread, from proof of principle to widespread uptake. And this is an average – some take decades.
We need smart ideas – and disruptive innovators to implement them – if we are to improve the outlook for patients and for the NHS. Shared appointments is an idea worth pursuing.
Lord Darzi is a surgeon and director of the Institute of Global Health Innovation at Imperial College London. He was a Labour health minister from 2007–09.
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