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Fighting infection: from Joseph Lister to superbugs – Science Weekly podcast

Subscribe & Review on Apple Podcasts, Soundcloud, Audioboom, Mixcloud & Acast, and join the discussion on Facebook and Twitter

In March 1867, the Lancet published an article by surgeon Joseph Lister that would change the healthcare landscape completely. The article was the first of several, detailing the culmination of Lister’s life work exploring the connection between germs and infection. Fast forward a century-and-a-half and today Joseph Lister is widely known as the father of antiseptic surgery, saving countless lives both in hospitals and further afield. But how was it that Lister came to his groundbreaking conclusions? How did his colleagues react? And, looking at the present situation, what challenges might we face that Lister would be all too familiar with?

This week, helping Nicola Davis delve into the life and work of Joseph Lister is Dr Lindsey Fitzharris, historian of science and author of The Butchering Art. And to help join the dots between Lister’s groundbreaking work and the challenges healthcare professionals face today – including antibiotic resistance – is chief medical officer for England and chief medical advisor to the UK government Professor Dame Sally Davies.

Fighting infection: from Joseph Lister to superbugs – Science Weekly podcast

Subscribe & Review on Apple Podcasts, Soundcloud, Audioboom, Mixcloud & Acast, and join the discussion on Facebook and Twitter

In March 1867, the Lancet published an article by surgeon Joseph Lister that would change the healthcare landscape completely. The article was the first of several, detailing the culmination of Lister’s life work exploring the connection between germs and infection. Fast forward a century-and-a-half and today Joseph Lister is widely known as the father of antiseptic surgery, saving countless lives both in hospitals and further afield. But how was it that Lister came to his groundbreaking conclusions? How did his colleagues react? And, looking at the present situation, what challenges might we face that Lister would be all too familiar with?

This week, helping Nicola Davis delve into the life and work of Joseph Lister is Dr Lindsey Fitzharris, historian of science and author of The Butchering Art. And to help join the dots between Lister’s groundbreaking work and the challenges healthcare professionals face today – including antibiotic resistance – is chief medical officer for England and chief medical advisor to the UK government Professor Dame Sally Davies.

Fighting infection: from Joseph Lister to superbugs – Science Weekly podcast

Subscribe & Review on Apple Podcasts, Soundcloud, Audioboom, Mixcloud & Acast, and join the discussion on Facebook and Twitter

In March 1867, the Lancet published an article by surgeon Joseph Lister that would change the healthcare landscape completely. The article was the first of several, detailing the culmination of Lister’s life work exploring the connection between germs and infection. Fast forward a century-and-a-half and today Joseph Lister is widely known as the father of antiseptic surgery, saving countless lives both in hospitals and further afield. But how was it that Lister came to his groundbreaking conclusions? How did his colleagues react? And, looking at the present situation, what challenges might we face that Lister would be all too familiar with?

This week, helping Nicola Davis delve into the life and work of Joseph Lister is Dr Lindsey Fitzharris, historian of science and author of The Butchering Art. And to help join the dots between Lister’s groundbreaking work and the challenges healthcare professionals face today – including antibiotic resistance – is chief medical officer for England and chief medical advisor to the UK government Professor Dame Sally Davies.

Fighting infection: from Joseph Lister to superbugs – Science Weekly podcast

Subscribe & Review on Apple Podcasts, Soundcloud, Audioboom, Mixcloud & Acast, and join the discussion on Facebook and Twitter

In March 1867, the Lancet published an article by surgeon Joseph Lister that would change the healthcare landscape completely. The article was the first of several, detailing the culmination of Lister’s life work exploring the connection between germs and infection. Fast forward a century-and-a-half and today Joseph Lister is widely known as the father of antiseptic surgery, saving countless lives both in hospitals and further afield. But how was it that Lister came to his groundbreaking conclusions? How did his colleagues react? And, looking at the present situation, what challenges might we face that Lister would be all too familiar with?

This week, helping Nicola Davis delve into the life and work of Joseph Lister is Dr Lindsey Fitzharris, historian of science and author of The Butchering Art. And to help join the dots between Lister’s groundbreaking work and the challenges healthcare professionals face today – including antibiotic resistance – is chief medical officer for England and chief medical advisor to the UK government Professor Dame Sally Davies.

Fighting infection: from Joseph Lister to superbugs – Science Weekly podcast

Subscribe & Review on Apple Podcasts, Soundcloud, Audioboom, Mixcloud & Acast, and join the discussion on Facebook and Twitter

In March 1867, the Lancet published an article by surgeon Joseph Lister that would change the healthcare landscape completely. The article was the first of several, detailing the culmination of Lister’s life work exploring the connection between germs and infection. Fast forward a century-and-a-half and today Joseph Lister is widely known as the father of antiseptic surgery, saving countless lives both in hospitals and further afield. But how was it that Lister came to his groundbreaking conclusions? How did his colleagues react? And, looking at the present situation, what challenges might we face that Lister would be all too familiar with?

This week, helping Nicola Davis delve into the life and work of Joseph Lister is Dr Lindsey Fitzharris, historian of science and author of The Butchering Art. And to help join the dots between Lister’s groundbreaking work and the challenges healthcare professionals face today – including antibiotic resistance – is chief medical officer for England and chief medical advisor to the UK government Professor Dame Sally Davies.

Fighting infection: from Joseph Lister to superbugs – Science Weekly podcast

Subscribe & Review on Apple Podcasts, Soundcloud, Audioboom, Mixcloud & Acast, and join the discussion on Facebook and Twitter

In March 1867, the Lancet published an article by surgeon Joseph Lister that would change the healthcare landscape completely. The article was the first of several, detailing the culmination of Lister’s life work exploring the connection between germs and infection. Fast forward a century-and-a-half and today Joseph Lister is widely known as the father of antiseptic surgery, saving countless lives both in hospitals and further afield. But how was it that Lister came to his groundbreaking conclusions? How did his colleagues react? And, looking at the present situation, what challenges might we face that Lister would be all too familiar with?

This week, helping Nicola Davis delve into the life and work of Joseph Lister is Dr Lindsey Fitzharris, historian of science and author of The Butchering Art. And to help join the dots between Lister’s groundbreaking work and the challenges healthcare professionals face today – including antibiotic resistance – is chief medical officer for England and chief medical advisor to the UK government Professor Dame Sally Davies.

Until hospitals learn from their mistakes, babies like my son will continue to die | James Titcombe

Between 2004 and 2013, 16 babies and three mothers died in a maternity unit at Furness general hospital. One of those babies was my own son. Joshua died on 5 November 2008 of profuse internal bleeding to his left lung. A series of serious failures before and after his birth resulted in an infection that could have easily been cured with antibiotics going untreated until he collapsed 24 hours after he was born.

After nine days of fighting for his life, Joshua died at the Freeman hospital in Newcastle despite the very best efforts of the dedicated neonatal intensive care staff.

The trauma of Joshua’s death will be forever etched on our minds, but it is no exaggeration to say that the hardest part of coming to terms with his loss was the way Morecambe Bay NHS trust (responsible for the hospital) and the wider healthcare system, responded.

Critical medical records mysteriously went “missing”, and various local investigations were less than honest. In March 2015, Dr Bill Kirkup published his long-awaited report looking at provision of maternity care at Furness general hospital (FGH) between 2004 and 2013. It found “a lethal mix” of failings had contributed to the deaths of babies and mothers. Ultimately, other babies have continued to die in the years since Joshua’s death, and I’ve met dozens of families whose experience has, sadly, been strikingly similar.

While we have now finally seen transformational progress at the hospital that failed Joshua, yet another report was published this week highlighting the urgent need for national change. It looked at the quality of care in the case of stillbirths and neonatal deaths that occurred in 2015, reviewing a sample of 78 of the 225 cases. The report echoes the findings of a number of other recent maternity reports, concluding that eight in 10 of the deaths were potentially avoidable, and that in around a quarter of deaths there was ineffective communication between the health professionals delivering care. The report found a “common issue” of staff failing to recognise an evolving problem, or the transition from normal to abnormal.


This is the ultimate response to Morecambe Bay and other tragic cases that could be avoided with safer maternity care

Although the report falls short of spelling it out, these findings highlight the importance of the recent move away from the national Royal College of Midwives campaign for “normal” – in other words, non-medical birth – towards a focus on ensuring women and their babies get the best and most appropriate care for them. The report also highlights that in around a quarter of cases, “capacity issues” were identified as a problem. Having the right number of appropriately skilled staff is crucial for the provision of all safe healthcare, but the issues affecting maternity safety are clearly much wider and complex than whether we have enough midwives and obstetricians.

Perhaps of most concern, the report found that most local investigations into the cases reviewed were of poor quality, with 90% failing to fully follow the existing guidelines. This shows the extent to which our health system isn’t learning from serious errors that lead to tragic and unnecessary deaths; rather, these sorts of mistakes continue to repeat themselves.

The Morecambe Bay inquiry recommended that all stillbirths and neonatal deaths should in future be subject to a standardised process of independent investigation, including input from and feedback to families. While it can certainly be argued that progress could have been quicker, this week the health secretary, Jeremy Hunt, has announced some monumental changes that I’ve long campaigned for. From April 2018 all cases of term stillbirths, neonatal deaths, brain-damaged babies and mothers who die giving birth will be independently investigated under the leadership of the new Healthcare Safety Investigation Branch (HSIB).

This is the ultimate response to Morecambe Bay and many other tragic cases that we know could be avoided with safer maternity care. These expert investigations will be a major step towards ensuring that no bereaved family is left having to fight for answers about what happened and why, and will hopefully provide a framework that can be expanded to other areas of healthcare in the future. Such expertise should provide great reassurance to healthcare staff by ensuring the focus is on system learning and not unwarranted blame.

As Bill Kirkup wrote in his report, “all healthcare – everywhere – includes the possibility of error. The great majority of NHS staff know this and work hard to avoid it. They should not be blamed or criticised when errors occur despite their best efforts. But in return, those who work for the NHS owe the public a duty to be open and honest when things go wrong … to learn from what has happened. This is the contract that was broken in Morecambe Bay.”

Providing safe healthcare is a hugely complex task; overnight transformation is unlikely. But I believe that the reforms announced by Jeremy Hunt this week offer by far the best hope yet of ensuring that in future the unwritten contract Kirkup describes in his report is never broken again. While we may never be able to eradicate NHS tragedies like Joshua’s death, we can and must ensure we do everything possible to learn from them.

James Titcombe OBE is a patient safety campaigner and father of Joshua Titcombe, who died nine days after being born in 2008 at Furness general hospital

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When a deaf singer gets death threats from other deaf people, something’s wrong | Josh Salisbury

When the America’s Got Talent finalist Mandy Harvey first appeared on the show, she caused a social media storm. Harvey became deaf due to an illness, but decided to pursue her love of music, feeling the beat of the music through her feet. However, her singing caused a backlash among a very small minority, who sent Harvey death threats for promoting a “hearing” activity.

There is a long history of oppression faced by profoundly deaf individuals of which most hearing people are too little aware. Sign languages have historically been the target of repression, and many who are profoundly deaf have suffered at the hands of hearing people. Oralism – the practice of favouring speech over sign in deaf education – and the assumption that speech is an inherently superior form of communication can be damaging, both to deaf individuals and the deaf community. Even today, organisations will equate speech with potential, ignoring an equally valid language and culture in sign.

Deaf people – those whose preferred language is sign and belong to the capital D “Deaf community” – have had to fight for their rights, language and culture against this oppression. In that context, the strong feelings of an unrepresentative few can be understood, even if their behaviour can’t be condoned.

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Mandy Harvey: Deaf Singer Earns Simon’s Golden Buzzer With Original Song – America’s Got Talent 2017

The Harvey story, however, reopened the binary oralist versus signing argument. A recent segment on BBC’s Newsnight reporting on the story asked whether we should “promote oralism in the deaf community”. That’s such a frustrating way of framing the debate. The focus should be how we can spread awareness and greater accessibility for everyone, not forcing deaf or hard-of-hearing people to declare themselves as belonging to a speaking or signing camp.

Increasing our deaf awareness is a lesson we can all continually learn, even those with the best of intentions. Newsnight’s producers deserve some kudos for attempting to draw attention to an under-represented issue, and for inviting deaf guests on television. Paradoxically, however, the clip was not accessible to many viewers. There were no subtitles for those struggling to follow the British Sign Language interpreter. The camera panned away from signing guests, breaking the flow of conversation for anyone following along.

I’m severely deaf, and was born to a hearing family. Instead of being taught sign, I was taught to lip-read, and went to speech therapy classes. I rely on my hearing aids and I have a well-honed instinct for when to smile and nod during a conversation, if what’s being said escapes me. But the dichotomy between sign and speech can leave people like me feeling stuck between two worlds: too deaf for the hearing, too hearing for the deaf.

It also risks promoting a myth of a militant deaf community, acting as jealous gatekeepers of what it really means to be deaf. A casual observer reading the story about Harvey could be forgiven for thinking that the deaf community, in America or elsewhere, is far more intolerant than it really is.

It would be more productive to ask how we can make things more accessible for deaf people, accounting for their needs and choices. Deafness is a spectrum, and our needs will vary. For some people, signing is a more accessible way of communicating than speaking. For others, speaking and lip-reading work for them.

Hearing people need to play their part in this. Practically, this can be something as small as not turning your back when speaking, or enunciating clearly to make lip-reading easier. But more fundamentally, it means a normative change in how deafness and deaf people are viewed. Deaf people are commonly seen as broken – in need of fixing. But with deafness can come a rich and vibrant language in sign, and a culture and community based on that.

Hearing people need to be sensitive to that fact when thinking about deafness. There are, for instance, endless videos on social media of deaf children given cochlear implants, hearing sounds for the first time, often shared by hearing people as inspirational modern-day miracles. Yet to many signing deaf people, they can represent something far more sinister: the absence of choice and the removal of deaf culture. The implicit message of such videos can be to underscore the supposed superiority of speech over sign.

However, we also need to be careful about how we refer to other people with hearing loss. To refer to someone as “oral” can be an insult – a way of denoting that someone isn’t truly deaf. But being born into a speaking family, and communicating by speaking doesn’t invalidate my deafness.

We don’t need to reductively frame this as a clash of communication. Deaf people, whether they choose to sign, to speak or both ought not be forced to pick sides. In moving beyond the dualism, we can focus on what matters: making a world that is accessible to everyone who is deaf, however they may experience that.

Josh Salisbury is a freelance journalist who writes about politics, disability and books

What can Britain learn from the US on links between economic distress and poor health?

Theresa May, in her first speech as prime minister, stood on the steps of Downing Street and referred to the glaring injustice of gaps in life expectancy and declared her intention to solve it by governing for everyone. I had a moment of hope for concerted action to increase health equity. That’s not looking bright at the moment; the government’s attention is elsewhere.

For many young people in Britain today – what with student debts, rental costs, the decline in home ownership, the gig economy and the economic uncertainties of Brexit – times are challenging.

A 15-year-old boy expects to be immortal, but evidence shows that expectation is less justified in the UK than in more than a score of other countries. The probability that a 15-year-old boy will die before his 60th birthday is 85 out of 1,000 in the UK. Is that a lot? It is higher than the best, Switzerland, at 61 per 1,000.

The UK ranks 22nd among all 185 countries for which the World Health Organisation reports this measure. Not terrible, but worse than Spain, Italy, Malta, Singapore, the United Arab Emirates, the Maldives, the Nordic countries, the Netherlands and Japan.


The US has a disastrous level of health for young and middle-aged adults

My colleagues and I at University College London’s Institute of Health Equity recently drew attention to the fact that the rise of life expectancy in the UK has stalled – a much more marked slowdown than in other European countries. Most of that levelling off is because of deaths at older ages.

I want here to focus on younger adults. You may ask why I worry about 61 in Switzerland compared with 85 in the UK. It seems like a small difference. But these figures represent something deeper: the quality of social conditions, how we are doing as a society. In the UK, we are not doing so well.

The US is doing worse. It ranks 44th on the probability that a 15-year-old boy will die before his 60th birthday. Mostly, this is not due to healthcare issues. The US spends more on healthcare, per person, than any other country, but has a disastrous level of health for young and middle-aged adults.

It is worth focusing on the US because it may have lessons for the UK. Anne Case and Angus Deaton of Princeton University recently updated their 2015 report showing that there has been a big rise in mortality rates among non-Hispanic whites; a rise that that was not seen in Hispanics or African Americans. The causes: poisonings from drugs and alcohol – in part, caused by medical care, because of over-prescription of opioids; suicides; and chronic liver disease, which is commonly alcohol-related. This adds to the toll of violent deaths. Medical care will not address the underlying social angst that gives rise to these causes of death.

Two important features of this US mortality in non-Hispanic whites have lessons for the UK. First, the fewer the years of education, the steeper the mortality increase, thus contributing to increase in health inequalities.

Second, Shannon Monnat of Penn State University looked at the geographic distribution of deaths from drugs, alcohol and suicide (pdf), and found that the greater the economic distress of an area, the higher the mortality rate. Monnat found, in the industrial midwest particularly, the higher the rate of these deaths the greater the 2016 vote for Trump, compared with Romney four years earlier. Trump didn’t cause these deaths, but these deaths may have caused Trump. More precisely, economic distress led both to death by drugs, alcohol and suicide and a greater likelihood of voting Trump.

In the UK we do not have the same appalling toll of drug and alcohol deaths, but we do see higher mortality in areas of economic distress. People in those areas were more likely to vote Brexit – perhaps prompted by the same dissatisfactions that led to the Trump vote in the US.

There is, though, much that can and is being done at local level. In London, for example, there has been a sharp reduction in inequalities (pdf) between children from poor families and the average in early child development and educational performance.

Coventry has become a “Marmot city”. It has taken the recommendations from my 2010 health inequalities review, Fair Society, Healthy Lives, and is implementing the recommendations.

Elsewhere, in addition to dedicated doctors and nurses, occupational therapists are supporting older people to remain independent at home. In the West Midlands and Merseyside, fire services are, as they put it, improving lives to save lives; they use their time and community commitment to get young people active, look after their homes, support older people and engage with improving people’s social lives.

None of this should let central government off the hook. We need an end to austerity, a reversal of plans to make the tax and benefit system less progressive, and real attention to regional inequalities. But the action of dedicated professionals at local level is an inspiring example of what can be done.

  • Michael Marmot is professor of epidemiology at University College London. He will be speaking at the King’s Fund annual conference on 29 and 30 November 2017

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.

What can Britain learn from the US on links between economic distress and poor health?

Theresa May, in her first speech as prime minister, stood on the steps of Downing Street and referred to the glaring injustice of gaps in life expectancy and declared her intention to solve it by governing for everyone. I had a moment of hope for concerted action to increase health equity. That’s not looking bright at the moment; the government’s attention is elsewhere.

For many young people in Britain today – what with student debts, rental costs, the decline in home ownership, the gig economy and the economic uncertainties of Brexit – times are challenging.

A 15-year-old boy expects to be immortal, but evidence shows that expectation is less justified in the UK than in more than a score of other countries. The probability that a 15-year-old boy will die before his 60th birthday is 85 out of 1,000 in the UK. Is that a lot? It is higher than the best, Switzerland, at 61 per 1,000.

The UK ranks 22nd among all 185 countries for which the World Health Organisation reports this measure. Not terrible, but worse than Spain, Italy, Malta, Singapore, the United Arab Emirates, the Maldives, the Nordic countries, the Netherlands and Japan.


The US has a disastrous level of health for young and middle-aged adults

My colleagues and I at University College London’s Institute of Health Equity recently drew attention to the fact that the rise of life expectancy in the UK has stalled – a much more marked slowdown than in other European countries. Most of that levelling off is because of deaths at older ages.

I want here to focus on younger adults. You may ask why I worry about 61 in Switzerland compared with 85 in the UK. It seems like a small difference. But these figures represent something deeper: the quality of social conditions, how we are doing as a society. In the UK, we are not doing so well.

The US is doing worse. It ranks 44th on the probability that a 15-year-old boy will die before his 60th birthday. Mostly, this is not due to healthcare issues. The US spends more on healthcare, per person, than any other country, but has a disastrous level of health for young and middle-aged adults.

It is worth focusing on the US because it may have lessons for the UK. Anne Case and Angus Deaton of Princeton University recently updated their 2015 report showing that there has been a big rise in mortality rates among non-Hispanic whites; a rise that that was not seen in Hispanics or African Americans. The causes: poisonings from drugs and alcohol – in part, caused by medical care, because of over-prescription of opioids; suicides; and chronic liver disease, which is commonly alcohol-related. This adds to the toll of violent deaths. Medical care will not address the underlying social angst that gives rise to these causes of death.

Two important features of this US mortality in non-Hispanic whites have lessons for the UK. First, the fewer the years of education, the steeper the mortality increase, thus contributing to increase in health inequalities.

Second, Shannon Monnat of Penn State University looked at the geographic distribution of deaths from drugs, alcohol and suicide (pdf), and found that the greater the economic distress of an area, the higher the mortality rate. Monnat found, in the industrial midwest particularly, the higher the rate of these deaths the greater the 2016 vote for Trump, compared with Romney four years earlier. Trump didn’t cause these deaths, but these deaths may have caused Trump. More precisely, economic distress led both to death by drugs, alcohol and suicide and a greater likelihood of voting Trump.

In the UK we do not have the same appalling toll of drug and alcohol deaths, but we do see higher mortality in areas of economic distress. People in those areas were more likely to vote Brexit – perhaps prompted by the same dissatisfactions that led to the Trump vote in the US.

There is, though, much that can and is being done at local level. In London, for example, there has been a sharp reduction in inequalities (pdf) between children from poor families and the average in early child development and educational performance.

Coventry has become a “Marmot city”. It has taken the recommendations from my 2010 health inequalities review, Fair Society, Healthy Lives, and is implementing the recommendations.

Elsewhere, in addition to dedicated doctors and nurses, occupational therapists are supporting older people to remain independent at home. In the West Midlands and Merseyside, fire services are, as they put it, improving lives to save lives; they use their time and community commitment to get young people active, look after their homes, support older people and engage with improving people’s social lives.

None of this should let central government off the hook. We need an end to austerity, a reversal of plans to make the tax and benefit system less progressive, and real attention to regional inequalities. But the action of dedicated professionals at local level is an inspiring example of what can be done.

  • Michael Marmot is professor of epidemiology at University College London. He will be speaking at the King’s Fund annual conference on 29 and 30 November 2017

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.