Tag Archives: it’s

UK employment is up – it’s just a shame the workers are so miserable | Faiza Shaheen

We hear it again and again – politicians boasting about “more people in work than ever before”. At the same time we hear about a woman having a baby in the Sports Direct toilet because of a culture of fear at the company, BHS workers losing their pensions, Carillion construction workers left without work and even a DPD parcel delivery driver, Don Lane, collapsing and dying after being fined £125 for going to a doctors appointment.

The gig economy has become synonymous with worker exploitation. Cases are lining up – from Pimlico Plumbers to university lecturers – the news is not one of jubilance but of desperation. So what does the headline employment statistic published this week, telling us that employment remains at near record levels, really indicate? Is it a sign that the economy is indeed doing well?

The new report from the Centre for Labour and Social Studies (Class), which looks beyond headline figures to provide a grassroots perspective, finds that workers are in a bad way. This hardship isn’t just confined to those on zero-hour contracts, or even those on low incomes. Over a third of all workers state that they do not earn enough to keep up with the cost of living, and this is true even for three in 10 of those earning over £40,000. After a decade of poor wage growth, a huge majority still do not see a light at the end of the tunnel, with only one in five believing they’ll get an inflation or inflation-beating pay rise this year. About 20% of households have taken on a second job to boost incomes, and a further 20% have tried or contemplated it.

It’s no surprise, then, that only one in four workers thinks the economy works for them. The labour market is taking its toll on our mental health. According to Class’s survey, over half of workers have noticed an increase in stress and workload over the past 12 months. In one interview we were told that half of mental health workers are themselves reporting mental health problems and feelings of failure. It’s a bitter irony.


We must take measures of wellbeing, workplace stress and perceived job security much more seriously

These findings are a stark reminder of just how inadequate the way in which we measure economic success is. There’s been a growing chorus of people that argue against the use of GDP, but the fact our top-line employment figures fail to capture an accurate picture as well is surely a sign that we need a broad overhaul of how success or failure is captured in statistics. We must start to take subjective measures such as indicators of wellbeing, workplace stress and perceived job security much more seriously.

Consumer confidence indicators are used to gauge macroeconomic conditions, but measures of confidence in the economy shouldn’t simply be about how much people are willing to consume. Measures and targets focus minds, and currently we have very little that directs our politicians to run our economy in a way that prioritises people, or indeed the planet, over profit. Ultimately recoupling the economy to workers’ livelihoods and quality of life will take more than a new measure. We found that the long-term impacts of privatisation and more recently austerity have made many workplaces a hotbed of stress. Undoing this means giving workers more power and ending the cuts.

And we need to start listening. When things don’t add up you don’t just keep plugging in the same numbers, and shouting about success. The economy may well be doing well by traditional measures, but these measures simply fail to reflect the reality of people’s lives. The chancellor, Philip Hammond, and others can continue to repeat the stats, but in doing so they are alienating millions of people while looking increasingly detached and delusional.

Faiza Shaheen is the director of the Centre of Labour and Social Studies

UK employment is up – it’s just a shame the workers are so miserable | Faiza Shaheen

We hear it again and again – politicians boasting about “more people in work than ever before”. At the same time we hear about a woman having a baby in the Sports Direct toilet because of a culture of fear at the company, BHS workers losing their pensions, Carillion construction workers left without work and even a DPD parcel delivery driver, Don Lane, collapsing and dying after being fined £125 for going to a doctors appointment.

The gig economy has become synonymous with worker exploitation. Cases are lining up – from Pimlico Plumbers to university lecturers – the news is not one of jubilance but of desperation. So what does the headline employment statistic published this week, telling us that employment remains at near record levels, really indicate? Is it a sign that the economy is indeed doing well?

The new report from the Centre for Labour and Social Studies (Class), which looks beyond headline figures to provide a grassroots perspective, finds that workers are in a bad way. This hardship isn’t just confined to those on zero-hour contracts, or even those on low incomes. Over a third of all workers state that they do not earn enough to keep up with the cost of living, and this is true even for three in 10 of those earning over £40,000. After a decade of poor wage growth, a huge majority still do not see a light at the end of the tunnel, with only one in five believing they’ll get an inflation or inflation-beating pay rise this year. About 20% of households have taken on a second job to boost incomes, and a further 20% have tried or contemplated it.

It’s no surprise, then, that only one in four workers thinks the economy works for them. The labour market is taking its toll on our mental health. According to Class’s survey, over half of workers have noticed an increase in stress and workload over the past 12 months. In one interview we were told that half of mental health workers are themselves reporting mental health problems and feelings of failure. It’s a bitter irony.


We must take measures of wellbeing, workplace stress and perceived job security much more seriously

These findings are a stark reminder of just how inadequate the way in which we measure economic success is. There’s been a growing chorus of people that argue against the use of GDP, but the fact our top-line employment figures fail to capture an accurate picture as well is surely a sign that we need a broad overhaul of how success or failure is captured in statistics. We must start to take subjective measures such as indicators of wellbeing, workplace stress and perceived job security much more seriously.

Consumer confidence indicators are used to gauge macroeconomic conditions, but measures of confidence in the economy shouldn’t simply be about how much people are willing to consume. Measures and targets focus minds, and currently we have very little that directs our politicians to run our economy in a way that prioritises people, or indeed the planet, over profit. Ultimately recoupling the economy to workers’ livelihoods and quality of life will take more than a new measure. We found that the long-term impacts of privatisation and more recently austerity have made many workplaces a hotbed of stress. Undoing this means giving workers more power and ending the cuts.

And we need to start listening. When things don’t add up you don’t just keep plugging in the same numbers, and shouting about success. The economy may well be doing well by traditional measures, but these measures simply fail to reflect the reality of people’s lives. The chancellor, Philip Hammond, and others can continue to repeat the stats, but in doing so they are alienating millions of people while looking increasingly detached and delusional.

Faiza Shaheen is the director of the Centre of Labour and Social Studies

Gaming addiction as a mental disorder: it’s premature to pathologise players

Gaming addiction is expected to be classified as a mental disorder by the World Health Organisation (WHO) but – while concerns over the addictive properties of video games are reasonable – there is a lack of rigorous research to back it up

The WHO needs better quality evidence before drawing conclusions about gaming addiction.


The WHO needs better quality evidence before drawing conclusions about gaming addiction. Photograph: Frederic J. Brown/AFP/Getty Images

Video games played on smartphones, tablets, computers and consoles have been a popular form of leisure for some time now. In Europe, recent figures indicate that games are played by more than two thirds of children and adolescents, and a substantial number of adults now play games – 38% in the UK, 64% in France, 56% in Germany and 44% in Spain.

The WHO will publish the next revision of its manual – the International Classification of Diseases (ICD-11) – by mid-2018 and gaming disorder has been included in the draft for the first time.

The ubiquity of mobile devices means electronic games can be played at any time and their sales eclipse both music and video sales in the UK. Given the growing popularity and motivational pull of video games, concern over their addictive potential is inevitable.

As psychology experts who have studied video games through an empirical lens for years, we share many of these concerns and fully endorse continued scientific research on the topic. But the WHO’s tentative move to pathologise digital play is premature.

Last year, nearly 30 academics wrote a paper in which they opposed the gaming disorder classification, arguing there was a lack of consensus among researchers who study games and that the quality of the evidence base was low.

We have collected responses from researchers who disagree with our position that the WHO’s move is premature and have addressed their points in a new paper. It highlights a key question that is still to be answered: how should gaming disorder be defined?

Gaming vs gambling

Criteria for gaming disorder in the WHO draft are very similar to those used to define gambling disorder. It’s an interesting approach, but it risks pathologising behaviours that are normal for hundreds of millions of regular gamers. In technical terms, this means the criteria have low specificity: the thoughts or feelings of many normal gamers will be flagged as pathological. This could stigmatise many highly engaged people for whom gaming is one of their main hobbies.

It’s been argued that – like debates surrounding gaming and aggression – concerns about gaming addiction might reflect a moral panic instead of solid science.

Because nearly half of gamers are under 18, there is a strong desire to “save the children” over concerns about the possible harmful effects of games. This anxiety incentivises scholars seeking grants, high impact journal articles, and prestige to mobilise against a possible social harm.

Though often well meant, the publish or perish culture in academia means that statistical noise can become part of the scientific record. Because null findings seldom get published, garner press attention or attract career advancing research funding, the false facts arising from a panic can take on a life of their own.

It’s aggravated by the fact there is no consensus on the definition of video game addiction, the essential symptoms or indicators, or the core features of the mental health condition. Evidence from clinical studies show that problematic gaming is best viewed as a coping mechanism associated with underlying problems such as anxiety or depression.

Low quality research

Studies show that research on the effects of technology on human behaviour is riddled with methodological errors. They tend to lack scientific transparency, have low statistical power and show an alarmingly high level of statistical reporting errors. In our study of this literature we found nearly one paper in six has an error that changes the conclusions of the study. In our response to those pushing to pathologise play, we argue addiction research is no exception.

Estimates of gaming addiction vary wildly as a function of questionnaires used and samples recruited. Population representative studies using the draft official guidance suggest possible addiction rates are less than 0.5%, whereas other studies, carried out with a range of conveniently available samples (such as Reddit or online self-help forums), report rates that are ten to 100 times higher.

Although some portray the academic field at consensus on this issue based in solid research, it is important to understand this evidence is largely exploratory, where data analysis plans and hypotheses are settled on after data collection. What is currently missing is a body of studies where scientists preregister their methods and hypotheses prior to collecting data samples online.

We have conducted studies using this more stringent approach and our findings indicate gaming addiction may not be directly related to mental or physical health on its own. The results suggest that the diagnosis of video game addiction is not stable over time, because scholars pushing for gaming disorder to be recognised do not distinguish between the different types of research. We argue the evidence supporting gaming disorder is based on an unsound scientific basis.

We are concerned that a small subset of gamers might be struggling, but we do not believe critical standards of evidence have been met to merit a new diagnostic category for gaming disorder by the WHO.

Instead, we believe rigorous scientific research into gaming addiction is essential. Now is not the time to pathologise one of the most popular leisure activities of the digital age.

This article was originally published on The Conversation. Read the original article.

Gaming addiction as a mental disorder: it’s premature to pathologise players

Gaming addiction is expected to be classified as a mental disorder by the World Health Organisation (WHO) but – while concerns over the addictive properties of video games are reasonable – there is a lack of rigorous research to back it up

The WHO needs better quality evidence before drawing conclusions about gaming addiction.


The WHO needs better quality evidence before drawing conclusions about gaming addiction. Photograph: Frederic J. Brown/AFP/Getty Images

Video games played on smartphones, tablets, computers and consoles have been a popular form of leisure for some time now. In Europe, recent figures indicate that games are played by more than two thirds of children and adolescents, and a substantial number of adults now play games – 38% in the UK, 64% in France, 56% in Germany and 44% in Spain.

The WHO will publish the next revision of its manual – the International Classification of Diseases (ICD-11) – by mid-2018 and gaming disorder has been included in the draft for the first time.

The ubiquity of mobile devices means electronic games can be played at any time and their sales eclipse both music and video sales in the UK. Given the growing popularity and motivational pull of video games, concern over their addictive potential is inevitable.

As psychology experts who have studied video games through an empirical lens for years, we share many of these concerns and fully endorse continued scientific research on the topic. But the WHO’s tentative move to pathologise digital play is premature.

Last year, nearly 30 academics wrote a paper in which they opposed the gaming disorder classification, arguing there was a lack of consensus among researchers who study games and that the quality of the evidence base was low.

We have collected responses from researchers who disagree with our position that the WHO’s move is premature and have addressed their points in a new paper. It highlights a key question that is still to be answered: how should gaming disorder be defined?

Gaming vs gambling

Criteria for gaming disorder in the WHO draft are very similar to those used to define gambling disorder. It’s an interesting approach, but it risks pathologising behaviours that are normal for hundreds of millions of regular gamers. In technical terms, this means the criteria have low specificity: the thoughts or feelings of many normal gamers will be flagged as pathological. This could stigmatise many highly engaged people for whom gaming is one of their main hobbies.

It’s been argued that – like debates surrounding gaming and aggression – concerns about gaming addiction might reflect a moral panic instead of solid science.

Because nearly half of gamers are under 18, there is a strong desire to “save the children” over concerns about the possible harmful effects of games. This anxiety incentivises scholars seeking grants, high impact journal articles, and prestige to mobilise against a possible social harm.

Though often well meant, the publish or perish culture in academia means that statistical noise can become part of the scientific record. Because null findings seldom get published, garner press attention or attract career advancing research funding, the false facts arising from a panic can take on a life of their own.

It’s aggravated by the fact there is no consensus on the definition of video game addiction, the essential symptoms or indicators, or the core features of the mental health condition. Evidence from clinical studies show that problematic gaming is best viewed as a coping mechanism associated with underlying problems such as anxiety or depression.

Low quality research

Studies show that research on the effects of technology on human behaviour is riddled with methodological errors. They tend to lack scientific transparency, have low statistical power and show an alarmingly high level of statistical reporting errors. In our study of this literature we found nearly one paper in six has an error that changes the conclusions of the study. In our response to those pushing to pathologise play, we argue addiction research is no exception.

Estimates of gaming addiction vary wildly as a function of questionnaires used and samples recruited. Population representative studies using the draft official guidance suggest possible addiction rates are less than 0.5%, whereas other studies, carried out with a range of conveniently available samples (such as Reddit or online self-help forums), report rates that are ten to 100 times higher.

Although some portray the academic field at consensus on this issue based in solid research, it is important to understand this evidence is largely exploratory, where data analysis plans and hypotheses are settled on after data collection. What is currently missing is a body of studies where scientists preregister their methods and hypotheses prior to collecting data samples online.

We have conducted studies using this more stringent approach and our findings indicate gaming addiction may not be directly related to mental or physical health on its own. The results suggest that the diagnosis of video game addiction is not stable over time, because scholars pushing for gaming disorder to be recognised do not distinguish between the different types of research. We argue the evidence supporting gaming disorder is based on an unsound scientific basis.

We are concerned that a small subset of gamers might be struggling, but we do not believe critical standards of evidence have been met to merit a new diagnostic category for gaming disorder by the WHO.

Instead, we believe rigorous scientific research into gaming addiction is essential. Now is not the time to pathologise one of the most popular leisure activities of the digital age.

This article was originally published on The Conversation. Read the original article.

It’s very rare to wake up during a general anaesthetic | Letters

Anaesthetists respond to a recent Guardian article

An anaesthetist administering general anaesthetic in France


An anaesthetist administering general anaesthetic in France. Photograph: BSIP/UIG via Getty Images

Accidental awareness (when a patient becomes conscious during a general anaesthetic) is an incredibly important issue to both patients and anaesthetists (The long read, 9 February). Patients undergoing surgery can be assured that it is highly uncommon to wake up during a general anaesthetic.

The largest ever research study (NAP5) performed on this topic was carried out in 2014 by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. It showed that approximately one person in 20,000 reported awareness, and it most commonly occurred before surgery started or after it finished.

Anaesthetists work extremely hard to ensure that the approximately 3m general anaesthetics performed each year deliver safe, comfortable and stress-free surgery – we always put patient safety first. Anaesthesia is a highly complex medical speciality and all anaesthetists undergo rigorous education and training programmes and continuous performance appraisals.

The risk of accidental awareness differs according to certain patient characteristics and the type of surgery and anaesthetic the patient requires. Our 2014 NAP5 report makes clear recommendations on what steps anaesthetists can take to minimise the risk of awareness and address any psychological harm from these rare events.

Important and accurate information about anaesthesia can be found online at http://bit.ly/rcoa_patientinfo
Dr Liam Brennan President, Royal College of Anaesthetists
Dr Paul Clyburn President, Association of Anaesthetists of Great Britain and Ireland

General anaesthetics do not act by “reacting with the slick membranes of the nerve cells in the brain”. It was shown in 1979 by Franks and Lieb that general anaesthetics had no effect on membranes at physiological concentrations. In 1984 they showed that the anaesthetic molecule, halothane, inhibited the action of the protein luciferase at anaesthetic concentrations similar to those that anaesthetised animals. The most common general anaesthetic, propofol, was shown in 2013 by a team at Imperial College London to interact specifically with one site on a complex five-chain protein present in brain cells called Gamma-Amino Butyric Acid Receptor type A (GABAR-A). Another anaesthetic, etomidate, interacts with the same protein but at a different site. These interactions cause the receptor to remain in the “open” state for a longer period of time, thereby allowing the entry of chloride ions into the cell and “hyperpolarising” the cell, causing it to fire less often. The details of the circuitry that is then involved in shutting down areas of the brain responsible for consciousness are still being elucidated, but it probably involves the thalamus, one of the major structures deep in the brain.

Other “hypnotic” drugs in use by anaesthetists such as nitrous oxide, ketamine, and the noble gas xenon, have been known since the late 1990s to act on different proteins in the brain, called NMDA receptors.

While the first public demonstration of anaesthesia in western society might have been in 1846, it is worth noting that the Chinese surgeon Hua Tuo (c 140–208) used a concoction of drugs called mafeisan to allow the opening of patients’ abdomens with little pain. The Japanese surgeon Seishu Hanaoka (1760-1835) used a similar combination of drugs to mafeisan which were given orally to perform major surgery. In 1805 he carried out a number of radical operations for breast cancer.
Dr Chris Edge
Consultant anaesthetist, Royal Berkshire NHS Foundation Trust; honorary senior lecturer, Department of Biophysics, Imperial College, London

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

It’s very rare to wake up during a general anaesthetic | Letters

Anaesthetists respond to a recent Guardian article

An anaesthetist administering general anaesthetic in France


An anaesthetist administering general anaesthetic in France. Photograph: BSIP/UIG via Getty Images

Accidental awareness (when a patient becomes conscious during a general anaesthetic) is an incredibly important issue to both patients and anaesthetists (The long read, 9 February). Patients undergoing surgery can be assured that it is highly uncommon to wake up during a general anaesthetic.

The largest ever research study (NAP5) performed on this topic was carried out in 2014 by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. It showed that approximately one person in 20,000 reported awareness, and it most commonly occurred before surgery started or after it finished.

Anaesthetists work extremely hard to ensure that the approximately 3m general anaesthetics performed each year deliver safe, comfortable and stress-free surgery – we always put patient safety first. Anaesthesia is a highly complex medical speciality and all anaesthetists undergo rigorous education and training programmes and continuous performance appraisals.

The risk of accidental awareness differs according to certain patient characteristics and the type of surgery and anaesthetic the patient requires. Our 2014 NAP5 report makes clear recommendations on what steps anaesthetists can take to minimise the risk of awareness and address any psychological harm from these rare events.

Important and accurate information about anaesthesia can be found online at http://bit.ly/rcoa_patientinfo
Dr Liam Brennan President, Royal College of Anaesthetists
Dr Paul Clyburn President, Association of Anaesthetists of Great Britain and Ireland

General anaesthetics do not act by “reacting with the slick membranes of the nerve cells in the brain”. It was shown in 1979 by Franks and Lieb that general anaesthetics had no effect on membranes at physiological concentrations. In 1984 they showed that the anaesthetic molecule, halothane, inhibited the action of the protein luciferase at anaesthetic concentrations similar to those that anaesthetised animals. The most common general anaesthetic, propofol, was shown in 2013 by a team at Imperial College London to interact specifically with one site on a complex five-chain protein present in brain cells called Gamma-Amino Butyric Acid Receptor type A (GABAR-A). Another anaesthetic, etomidate, interacts with the same protein but at a different site. These interactions cause the receptor to remain in the “open” state for a longer period of time, thereby allowing the entry of chloride ions into the cell and “hyperpolarising” the cell, causing it to fire less often. The details of the circuitry that is then involved in shutting down areas of the brain responsible for consciousness are still being elucidated, but it probably involves the thalamus, one of the major structures deep in the brain.

Other “hypnotic” drugs in use by anaesthetists such as nitrous oxide, ketamine, and the noble gas xenon, have been known since the late 1990s to act on different proteins in the brain, called NMDA receptors.

While the first public demonstration of anaesthesia in western society might have been in 1846, it is worth noting that the Chinese surgeon Hua Tuo (c 140–208) used a concoction of drugs called mafeisan to allow the opening of patients’ abdomens with little pain. The Japanese surgeon Seishu Hanaoka (1760-1835) used a similar combination of drugs to mafeisan which were given orally to perform major surgery. In 1805 he carried out a number of radical operations for breast cancer.
Dr Chris Edge
Consultant anaesthetist, Royal Berkshire NHS Foundation Trust; honorary senior lecturer, Department of Biophysics, Imperial College, London

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

It’s very rare to wake up during a general anaesthetic | Letters

Anaesthetists respond to a recent Guardian article

An anaesthetist administering general anaesthetic in France


An anaesthetist administering general anaesthetic in France. Photograph: BSIP/UIG via Getty Images

Accidental awareness (when a patient becomes conscious during a general anaesthetic) is an incredibly important issue to both patients and anaesthetists (The long read, 9 February). Patients undergoing surgery can be assured that it is highly uncommon to wake up during a general anaesthetic.

The largest ever research study (NAP5) performed on this topic was carried out in 2014 by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. It showed that approximately one person in 20,000 reported awareness, and it most commonly occurred before surgery started or after it finished.

Anaesthetists work extremely hard to ensure that the approximately 3m general anaesthetics performed each year deliver safe, comfortable and stress-free surgery – we always put patient safety first. Anaesthesia is a highly complex medical speciality and all anaesthetists undergo rigorous education and training programmes and continuous performance appraisals.

The risk of accidental awareness differs according to certain patient characteristics and the type of surgery and anaesthetic the patient requires. Our 2014 NAP5 report makes clear recommendations on what steps anaesthetists can take to minimise the risk of awareness and address any psychological harm from these rare events.

Important and accurate information about anaesthesia can be found online at http://bit.ly/rcoa_patientinfo
Dr Liam Brennan President, Royal College of Anaesthetists
Dr Paul Clyburn President, Association of Anaesthetists of Great Britain and Ireland

General anaesthetics do not act by “reacting with the slick membranes of the nerve cells in the brain”. It was shown in 1979 by Franks and Lieb that general anaesthetics had no effect on membranes at physiological concentrations. In 1984 they showed that the anaesthetic molecule, halothane, inhibited the action of the protein luciferase at anaesthetic concentrations similar to those that anaesthetised animals. The most common general anaesthetic, propofol, was shown in 2013 by a team at Imperial College London to interact specifically with one site on a complex five-chain protein present in brain cells called Gamma-Amino Butyric Acid Receptor type A (GABAR-A). Another anaesthetic, etomidate, interacts with the same protein but at a different site. These interactions cause the receptor to remain in the “open” state for a longer period of time, thereby allowing the entry of chloride ions into the cell and “hyperpolarising” the cell, causing it to fire less often. The details of the circuitry that is then involved in shutting down areas of the brain responsible for consciousness are still being elucidated, but it probably involves the thalamus, one of the major structures deep in the brain.

Other “hypnotic” drugs in use by anaesthetists such as nitrous oxide, ketamine, and the noble gas xenon, have been known since the late 1990s to act on different proteins in the brain, called NMDA receptors.

While the first public demonstration of anaesthesia in western society might have been in 1846, it is worth noting that the Chinese surgeon Hua Tuo (c 140–208) used a concoction of drugs called mafeisan to allow the opening of patients’ abdomens with little pain. The Japanese surgeon Seishu Hanaoka (1760-1835) used a similar combination of drugs to mafeisan which were given orally to perform major surgery. In 1805 he carried out a number of radical operations for breast cancer.
Dr Chris Edge
Consultant anaesthetist, Royal Berkshire NHS Foundation Trust; honorary senior lecturer, Department of Biophysics, Imperial College, London

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

It’s very rare to wake up during a general anaesthetic | Letters

Anaesthetists respond to a recent Guardian article

An anaesthetist administering general anaesthetic in France


An anaesthetist administering general anaesthetic in France. Photograph: BSIP/UIG via Getty Images

Accidental awareness (when a patient becomes conscious during a general anaesthetic) is an incredibly important issue to both patients and anaesthetists (The long read, 9 February). Patients undergoing surgery can be assured that it is highly uncommon to wake up during a general anaesthetic.

The largest ever research study (NAP5) performed on this topic was carried out in 2014 by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. It showed that approximately one person in 20,000 reported awareness, and it most commonly occurred before surgery started or after it finished.

Anaesthetists work extremely hard to ensure that the approximately 3m general anaesthetics performed each year deliver safe, comfortable and stress-free surgery – we always put patient safety first. Anaesthesia is a highly complex medical speciality and all anaesthetists undergo rigorous education and training programmes and continuous performance appraisals.

The risk of accidental awareness differs according to certain patient characteristics and the type of surgery and anaesthetic the patient requires. Our 2014 NAP5 report makes clear recommendations on what steps anaesthetists can take to minimise the risk of awareness and address any psychological harm from these rare events.

Important and accurate information about anaesthesia can be found online at http://bit.ly/rcoa_patientinfo
Dr Liam Brennan President, Royal College of Anaesthetists
Dr Paul Clyburn President, Association of Anaesthetists of Great Britain and Ireland

General anaesthetics do not act by “reacting with the slick membranes of the nerve cells in the brain”. It was shown in 1979 by Franks and Lieb that general anaesthetics had no effect on membranes at physiological concentrations. In 1984 they showed that the anaesthetic molecule, halothane, inhibited the action of the protein luciferase at anaesthetic concentrations similar to those that anaesthetised animals. The most common general anaesthetic, propofol, was shown in 2013 by a team at Imperial College London to interact specifically with one site on a complex five-chain protein present in brain cells called Gamma-Amino Butyric Acid Receptor type A (GABAR-A). Another anaesthetic, etomidate, interacts with the same protein but at a different site. These interactions cause the receptor to remain in the “open” state for a longer period of time, thereby allowing the entry of chloride ions into the cell and “hyperpolarising” the cell, causing it to fire less often. The details of the circuitry that is then involved in shutting down areas of the brain responsible for consciousness are still being elucidated, but it probably involves the thalamus, one of the major structures deep in the brain.

Other “hypnotic” drugs in use by anaesthetists such as nitrous oxide, ketamine, and the noble gas xenon, have been known since the late 1990s to act on different proteins in the brain, called NMDA receptors.

While the first public demonstration of anaesthesia in western society might have been in 1846, it is worth noting that the Chinese surgeon Hua Tuo (c 140–208) used a concoction of drugs called mafeisan to allow the opening of patients’ abdomens with little pain. The Japanese surgeon Seishu Hanaoka (1760-1835) used a similar combination of drugs to mafeisan which were given orally to perform major surgery. In 1805 he carried out a number of radical operations for breast cancer.
Dr Chris Edge
Consultant anaesthetist, Royal Berkshire NHS Foundation Trust; honorary senior lecturer, Department of Biophysics, Imperial College, London

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters

It’s very rare to wake up during a general anaesthetic | Letters

Anaesthetists respond to a recent Guardian article

An anaesthetist administering general anaesthetic in France


An anaesthetist administering general anaesthetic in France. Photograph: BSIP/UIG via Getty Images

Accidental awareness (when a patient becomes conscious during a general anaesthetic) is an incredibly important issue to both patients and anaesthetists (The long read, 9 February). Patients undergoing surgery can be assured that it is highly uncommon to wake up during a general anaesthetic.

The largest ever research study (NAP5) performed on this topic was carried out in 2014 by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. It showed that approximately one person in 20,000 reported awareness, and it most commonly occurred before surgery started or after it finished.

Anaesthetists work extremely hard to ensure that the approximately 3m general anaesthetics performed each year deliver safe, comfortable and stress-free surgery – we always put patient safety first. Anaesthesia is a highly complex medical speciality and all anaesthetists undergo rigorous education and training programmes and continuous performance appraisals.

The risk of accidental awareness differs according to certain patient characteristics and the type of surgery and anaesthetic the patient requires. Our 2014 NAP5 report makes clear recommendations on what steps anaesthetists can take to minimise the risk of awareness and address any psychological harm from these rare events.

Important and accurate information about anaesthesia can be found online at http://bit.ly/rcoa_patientinfo
Dr Liam Brennan President, Royal College of Anaesthetists
Dr Paul Clyburn President, Association of Anaesthetists of Great Britain and Ireland

General anaesthetics do not act by “reacting with the slick membranes of the nerve cells in the brain”. It was shown in 1979 by Franks and Lieb that general anaesthetics had no effect on membranes at physiological concentrations. In 1984 they showed that the anaesthetic molecule, halothane, inhibited the action of the protein luciferase at anaesthetic concentrations similar to those that anaesthetised animals. The most common general anaesthetic, propofol, was shown in 2013 by a team at Imperial College London to interact specifically with one site on a complex five-chain protein present in brain cells called Gamma-Amino Butyric Acid Receptor type A (GABAR-A). Another anaesthetic, etomidate, interacts with the same protein but at a different site. These interactions cause the receptor to remain in the “open” state for a longer period of time, thereby allowing the entry of chloride ions into the cell and “hyperpolarising” the cell, causing it to fire less often. The details of the circuitry that is then involved in shutting down areas of the brain responsible for consciousness are still being elucidated, but it probably involves the thalamus, one of the major structures deep in the brain.

Other “hypnotic” drugs in use by anaesthetists such as nitrous oxide, ketamine, and the noble gas xenon, have been known since the late 1990s to act on different proteins in the brain, called NMDA receptors.

While the first public demonstration of anaesthesia in western society might have been in 1846, it is worth noting that the Chinese surgeon Hua Tuo (c 140–208) used a concoction of drugs called mafeisan to allow the opening of patients’ abdomens with little pain. The Japanese surgeon Seishu Hanaoka (1760-1835) used a similar combination of drugs to mafeisan which were given orally to perform major surgery. In 1805 he carried out a number of radical operations for breast cancer.
Dr Chris Edge
Consultant anaesthetist, Royal Berkshire NHS Foundation Trust; honorary senior lecturer, Department of Biophysics, Imperial College, London

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It’s very rare to wake up during a general anaesthetic | Letters

Anaesthetists respond to a recent Guardian article

An anaesthetist administering general anaesthetic in France


An anaesthetist administering general anaesthetic in France. Photograph: BSIP/UIG via Getty Images

Accidental awareness (when a patient becomes conscious during a general anaesthetic) is an incredibly important issue to both patients and anaesthetists (The long read, 9 February). Patients undergoing surgery can be assured that it is highly uncommon to wake up during a general anaesthetic.

The largest ever research study (NAP5) performed on this topic was carried out in 2014 by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. It showed that approximately one person in 20,000 reported awareness, and it most commonly occurred before surgery started or after it finished.

Anaesthetists work extremely hard to ensure that the approximately 3m general anaesthetics performed each year deliver safe, comfortable and stress-free surgery – we always put patient safety first. Anaesthesia is a highly complex medical speciality and all anaesthetists undergo rigorous education and training programmes and continuous performance appraisals.

The risk of accidental awareness differs according to certain patient characteristics and the type of surgery and anaesthetic the patient requires. Our 2014 NAP5 report makes clear recommendations on what steps anaesthetists can take to minimise the risk of awareness and address any psychological harm from these rare events.

Important and accurate information about anaesthesia can be found online at http://bit.ly/rcoa_patientinfo
Dr Liam Brennan President, Royal College of Anaesthetists
Dr Paul Clyburn President, Association of Anaesthetists of Great Britain and Ireland

General anaesthetics do not act by “reacting with the slick membranes of the nerve cells in the brain”. It was shown in 1979 by Franks and Lieb that general anaesthetics had no effect on membranes at physiological concentrations. In 1984 they showed that the anaesthetic molecule, halothane, inhibited the action of the protein luciferase at anaesthetic concentrations similar to those that anaesthetised animals. The most common general anaesthetic, propofol, was shown in 2013 by a team at Imperial College London to interact specifically with one site on a complex five-chain protein present in brain cells called Gamma-Amino Butyric Acid Receptor type A (GABAR-A). Another anaesthetic, etomidate, interacts with the same protein but at a different site. These interactions cause the receptor to remain in the “open” state for a longer period of time, thereby allowing the entry of chloride ions into the cell and “hyperpolarising” the cell, causing it to fire less often. The details of the circuitry that is then involved in shutting down areas of the brain responsible for consciousness are still being elucidated, but it probably involves the thalamus, one of the major structures deep in the brain.

Other “hypnotic” drugs in use by anaesthetists such as nitrous oxide, ketamine, and the noble gas xenon, have been known since the late 1990s to act on different proteins in the brain, called NMDA receptors.

While the first public demonstration of anaesthesia in western society might have been in 1846, it is worth noting that the Chinese surgeon Hua Tuo (c 140–208) used a concoction of drugs called mafeisan to allow the opening of patients’ abdomens with little pain. The Japanese surgeon Seishu Hanaoka (1760-1835) used a similar combination of drugs to mafeisan which were given orally to perform major surgery. In 1805 he carried out a number of radical operations for breast cancer.
Dr Chris Edge
Consultant anaesthetist, Royal Berkshire NHS Foundation Trust; honorary senior lecturer, Department of Biophysics, Imperial College, London

Join the debate – email guardian.letters@theguardian.com

Read more Guardian letters – click here to visit gu.com/letters