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Warning pregnant women over dangers of alcohol goes too far, experts say

Women are being unfairly alarmed by official guidelines that warn them to avoid alcohol completely during pregnancy, experts claim.

Some mothers-to-be may even be having an abortion because they are worried they have damaged their unborn child by drinking too much, it is claimed.

The British Pregnancy Advisory Service, maternal rights campaign group Birthrights and academics specialising in parenting say official advice on drinking in pregnancy is too prescriptive.

Revised guidelines that came into force in January 2016 are not based on reliable evidence, they say. The advice, endorsed by the four UK nations’ chief medical officers, deleted a longstanding reference to pregnant women potentially having one or two units of alcohol once or twice a week while expecting and instead said that they should not drink at all.

“We need to think hard about how risk is communicated to women on issues relating to pregnancy. There can be real consequences to overstating evidence or implying certainty when there isn’t any,” said Clare Murphy, director of external affairs at BPAS, the contraception and abortion charity.

“Doing so can cause women needless anxiety and alarm, sometimes to the point that they consider ending an unplanned but not unwanted pregnancy because of fears they have caused irreparable harm.”

Ellie Lee, director of Kent University’s centre for parenting culture studies, said the advice means pregnant women also shun social occasions unnecessarily.

“As proving ‘complete safety’ [of drinking in pregnancy] is entirely impossible, where does this leave pregnant women? The scrutiny and oversight of their behaviour the official approach invites is not benign. It creates anxiety and impairs ordinary social interaction. And the exclusion of women from an ordinary activity on the basis of ‘precaution’ can more properly be called sexist than benign,” Lee added.

Last year’s revised guidelines followed the first in-depth UK review of the evidence on drinking in pregnancy since 2008. It concluded that “definitive evidence, particularly on the effects of low-level consumption [on a baby’s health] remains elusive”. Despite that, it nevertheless recommended that: “If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.”

The NHS’s start 4 life website, which promotes healthy behaviour, says: “What you drink, your baby drinks too. Play safe and cut out alcohol.”

Jennie Bristow, senior lecturer in sociology at Canterbury Christ Church University, criticised the negative effects of advice to mothers to be. “Does it simply make for healthier pregnancies or is it scaring women about their bodies and their babies? Promoting fear is not a good way to care for pregnant women.”

The guidelines state that: “Alcohol, like a numbr of drugs, is a teratogen, which means something that can disturb the deveopment of a fetus. Teratogens may cause a birth defect, or may halt the pregnancy.” The risks to the child also include the child being born prematurely or very small or having behavioural problems.

The Royal College of Midwives believes that any woman who is or is trying to become pregnant should shun alcohol altogether. “Our message [is]… that there is no evidence that any level of consumption is safe for the growing baby,” it said when the guidelines came out last year.

Warning pregnant women over dangers of alcohol goes too far, experts say

Women are being unfairly alarmed by official guidelines that warn them to avoid alcohol completely during pregnancy, experts claim.

Some mothers-to-be may even be having an abortion because they are worried they have damaged their unborn child by drinking too much, it is claimed.

The British Pregnancy Advisory Service, maternal rights campaign group Birthrights and academics specialising in parenting say official advice on drinking in pregnancy is too prescriptive.

Revised guidelines that came into force in January 2016 are not based on reliable evidence, they say. The advice, endorsed by the four UK nations’ chief medical officers, deleted a longstanding reference to pregnant women potentially having one or two units of alcohol once or twice a week while expecting and instead said that they should not drink at all.

“We need to think hard about how risk is communicated to women on issues relating to pregnancy. There can be real consequences to overstating evidence or implying certainty when there isn’t any,” said Clare Murphy, director of external affairs at BPAS, the contraception and abortion charity.

“Doing so can cause women needless anxiety and alarm, sometimes to the point that they consider ending an unplanned but not unwanted pregnancy because of fears they have caused irreparable harm.”

Ellie Lee, director of Kent University’s centre for parenting culture studies, said the advice means pregnant women also shun social occasions unnecessarily.

“As proving ‘complete safety’ [of drinking in pregnancy] is entirely impossible, where does this leave pregnant women? The scrutiny and oversight of their behaviour the official approach invites is not benign. It creates anxiety and impairs ordinary social interaction. And the exclusion of women from an ordinary activity on the basis of ‘precaution’ can more properly be called sexist than benign,” Lee added.

Last year’s revised guidelines followed the first in-depth UK review of the evidence on drinking in pregnancy since 2008. It concluded that “definitive evidence, particularly on the effects of low-level consumption [on a baby’s health] remains elusive”. Despite that, it nevertheless recommended that: “If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.”

The NHS’s start 4 life website, which promotes healthy behaviour, says: “What you drink, your baby drinks too. Play safe and cut out alcohol.”

Jennie Bristow, senior lecturer in sociology at Canterbury Christ Church University, criticised the negative effects of advice to mothers to be. “Does it simply make for healthier pregnancies or is it scaring women about their bodies and their babies? Promoting fear is not a good way to care for pregnant women.”

The guidelines state that: “Alcohol, like a numbr of drugs, is a teratogen, which means something that can disturb the deveopment of a fetus. Teratogens may cause a birth defect, or may halt the pregnancy.” The risks to the child also include the child being born prematurely or very small or having behavioural problems.

The Royal College of Midwives believes that any woman who is or is trying to become pregnant should shun alcohol altogether. “Our message [is]… that there is no evidence that any level of consumption is safe for the growing baby,” it said when the guidelines came out last year.

Warning pregnant women over dangers of alcohol goes too far, experts say

Women are being unfairly alarmed by official guidelines that warn them to avoid alcohol completely during pregnancy, experts claim.

Some mothers-to-be may even be having an abortion because they are worried they have damaged their unborn child by drinking too much, it is claimed.

The British Pregnancy Advisory Service, maternal rights campaign group Birthrights and academics specialising in parenting say official advice on drinking in pregnancy is too prescriptive.

Revised guidelines that came into force in January 2016 are not based on reliable evidence, they say. The advice, endorsed by the four UK nations’ chief medical officers, deleted a longstanding reference to pregnant women potentially having one or two units of alcohol once or twice a week while expecting and instead said that they should not drink at all.

“We need to think hard about how risk is communicated to women on issues relating to pregnancy. There can be real consequences to overstating evidence or implying certainty when there isn’t any,” said Clare Murphy, director of external affairs at BPAS, the contraception and abortion charity.

“Doing so can cause women needless anxiety and alarm, sometimes to the point that they consider ending an unplanned but not unwanted pregnancy because of fears they have caused irreparable harm.”

Ellie Lee, director of Kent University’s centre for parenting culture studies, said the advice means pregnant women also shun social occasions unnecessarily.

“As proving ‘complete safety’ [of drinking in pregnancy] is entirely impossible, where does this leave pregnant women? The scrutiny and oversight of their behaviour the official approach invites is not benign. It creates anxiety and impairs ordinary social interaction. And the exclusion of women from an ordinary activity on the basis of ‘precaution’ can more properly be called sexist than benign,” Lee added.

Last year’s revised guidelines followed the first in-depth UK review of the evidence on drinking in pregnancy since 2008. It concluded that “definitive evidence, particularly on the effects of low-level consumption [on a baby’s health] remains elusive”. Despite that, it nevertheless recommended that: “If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.”

The NHS’s start 4 life website, which promotes healthy behaviour, says: “What you drink, your baby drinks too. Play safe and cut out alcohol.”

Jennie Bristow, senior lecturer in sociology at Canterbury Christ Church University, criticised the negative effects of advice to mothers to be. “Does it simply make for healthier pregnancies or is it scaring women about their bodies and their babies? Promoting fear is not a good way to care for pregnant women.”

The guidelines state that: “Alcohol, like a numbr of drugs, is a teratogen, which means something that can disturb the deveopment of a fetus. Teratogens may cause a birth defect, or may halt the pregnancy.” The risks to the child also include the child being born prematurely or very small or having behavioural problems.

The Royal College of Midwives believes that any woman who is or is trying to become pregnant should shun alcohol altogether. “Our message [is]… that there is no evidence that any level of consumption is safe for the growing baby,” it said when the guidelines came out last year.

Warning pregnant women over dangers of alcohol goes too far, experts say

Women are being unfairly alarmed by official guidelines that warn them to avoid alcohol completely during pregnancy, experts claim.

Some mothers-to-be may even be having an abortion because they are worried they have damaged their unborn child by drinking too much, it is claimed.

The British Pregnancy Advisory Service, maternal rights campaign group Birthrights and academics specialising in parenting say official advice on drinking in pregnancy is too prescriptive.

Revised guidelines that came into force in January 2016 are not based on reliable evidence, they say. The advice, endorsed by the four UK nations’ chief medical officers, deleted a longstanding reference to pregnant women potentially having one or two units of alcohol once or twice a week while expecting and instead said that they should not drink at all.

“We need to think hard about how risk is communicated to women on issues relating to pregnancy. There can be real consequences to overstating evidence or implying certainty when there isn’t any,” said Clare Murphy, director of external affairs at BPAS, the contraception and abortion charity.

“Doing so can cause women needless anxiety and alarm, sometimes to the point that they consider ending an unplanned but not unwanted pregnancy because of fears they have caused irreparable harm.”

Ellie Lee, director of Kent University’s centre for parenting culture studies, said the advice means pregnant women also shun social occasions unnecessarily.

“As proving ‘complete safety’ [of drinking in pregnancy] is entirely impossible, where does this leave pregnant women? The scrutiny and oversight of their behaviour the official approach invites is not benign. It creates anxiety and impairs ordinary social interaction. And the exclusion of women from an ordinary activity on the basis of ‘precaution’ can more properly be called sexist than benign,” Lee added.

Last year’s revised guidelines followed the first in-depth UK review of the evidence on drinking in pregnancy since 2008. It concluded that “definitive evidence, particularly on the effects of low-level consumption [on a baby’s health] remains elusive”. Despite that, it nevertheless recommended that: “If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.”

The NHS’s start 4 life website, which promotes healthy behaviour, says: “What you drink, your baby drinks too. Play safe and cut out alcohol.”

Jennie Bristow, senior lecturer in sociology at Canterbury Christ Church University, criticised the negative effects of advice to mothers to be. “Does it simply make for healthier pregnancies or is it scaring women about their bodies and their babies? Promoting fear is not a good way to care for pregnant women.”

The guidelines state that: “Alcohol, like a numbr of drugs, is a teratogen, which means something that can disturb the deveopment of a fetus. Teratogens may cause a birth defect, or may halt the pregnancy.” The risks to the child also include the child being born prematurely or very small or having behavioural problems.

The Royal College of Midwives believes that any woman who is or is trying to become pregnant should shun alcohol altogether. “Our message [is]… that there is no evidence that any level of consumption is safe for the growing baby,” it said when the guidelines came out last year.

Labour expels three members over attempt to unseat Jeremy Hunt

Labour has expelled three senior members in Surrey for trying to unseat the health secretary, Jeremy Hunt, by forming a progressive alliance with local Greens and Liberal Democrats to unite behind an NHS doctor standing against him.

Kate Townsend, the South West Surrey party secretary who stood in last week’s local elections, and Steve Williams, a party member for 46 years who sits on the constituency party’s executive committee, were notified of their expulsion this week.

Robert Park, a Labour member for almost five decades who chaired the Surrey Fabians and ran the regional remain campaign, has also been expelled.

Townsend and Williams have been leading figures in the campaign for a progressive alliance between local parties, where the Conservative cabinet minister has a 28,000 majority.

Williams has been working on behalf of Compass, the centre-left thinktank and champion of grassroots progressive alliance initiative, in defiance of the national party, which has said it will not entertain any notion of local party cooperation at election time. Party rules state that members must not support any other candidate for election who is running against Labour.

“We have massive support from the local party,” Williams told the Guardian. “It is such an overkill reaction to a group of people who are trying to unseat the health secretary. There was a campaign meeting last night, we only found out a few hours before that we had been expelled from the party so we weren’t able to go. People were storming out of the meeting, really very, very upset and angry.”

In a letter from the party’s head of disputes, Sam Matthews, Williams was told: “It has been brought to our attention with supporting evidence that you have publicly stated your support for a party that is standing against the Labour party in the 2017 general election, which is incompatible with membership of the Labour party.”

Williams was “ineligible to remain a member of the Labour party and have been removed from the national membership system”, the letter said, adding that he was no longer entitled to attend local Labour party meetings.

The party will consider an application for readmission only after five years, the letter said, though Williams said he was planning to appeal. The letter included supporting evidence, including Williams’ appeal for signatures for a letter to the Guardian supporting Irvine’s candidacy.

“We have been doing our best to unseat Jeremy Hunt, to hold him to account on his record because of what he has done to the health service over the last five years,” Williams said.

The initiative to back the National Health Action party’s Dr Louise Irvine, who received just over 8% of the vote in 2015, has the backing of local Labour leaders, including Townsend. Irvine, a GP, was the chair of the Save Lewisham hospital campaign, which defeated the government in court over the proposals to downgrade A&E and maternity units.

Williams said Irvine was “able, articulate, very capable of being able to hold Jeremy Hunt to account, when the NHS is such a key issue in his constituency”.

Local Lib Dem activists have also agreed not to campaign, after a meeting in Farncombe organised by Compass with members from progressive parties. The Green party has said it will not field a candidate.

Neal Lawson, chair of Compass, said: “Steve Williams has given 46 years of service to Labour and was backing a local doctor to take on Jeremy Hunt and defend the NHS. For this he got expelled by email. Labour is a tribal party in a non-tribal age.”

Park, who also stood for election for Labour last week, told the Guardian he had been expelled after an interview with the BBC’s Today programme in which he expressed cautious support for Labour standing aside.

“I have to say, I was upset,” he said. “It was a blunt, legalistic email message, I joined the party as student in 1963, I had thought particularly that somebody might have phoned to talk to me first, I’ve spent most adult life helping the cause.

“The irony is that [we are] three most loyal Labour members you could hope to get; when people were attacking [Labour leader Jeremy] Corbyn, we’ve stuck by him. Now we’re all out on our neck.”

Park said he still intended to volunteer to help Labour MPs in marginal seats, as well as considering campaigning to help the Lib Dem former cabinet minister Vince Cable regain his seat in Twickenham, south-west London.

“Whatever we do, the likelihood is that Jeremy Hunt going to win,” he said of his constituency. “Nonetheless we’re tired of having a small share of the vote and we do feel that if we get behind one candidate we can stand some chance of denting his majority.”

Labour has selected IT manager David Black to fight the seat for the party after the CLP chair, Howard Kaye, the party’s candidate in 2015, has said he would not stand again. The Lib Dems have also selected a candidate, Ollie Purkiss.

The Green party co-leader Caroline Lucas has called for talks with Corbyn, and the Lib Dem leader, Tim Farron, to make a “series of electoral alliances” in some areas against the Conservatives before the election, though both have publicly rejected her entreaties.

Local Greens made the decision to stand down in the recent Richmond Park byelection, in which the Lib Dems’ Sarah Olney unseated the former Tory mayoral candidate Zac Goldsmith.

The party has also decided to stand aside in several seats at the general election in June, including Ealing Central and Acton, to bolster the chances of Labour’s Rupa Huq in the marginal.

Lucas has called for Labour and the Lib Dems to respond similarly to strengthen her party’s chances of taking the Isle of Wight, where the party hopes to capture the traditionally Conservative seat after its good showing in local elections.

E-cigarette companies fined over false claims about toxic chemicals

Australia’s competition regulator has become the first in the world to successfully take legal action against e-cigarette companies for making false and misleading claims about the carcinogens in their products.

Federal court Justice John Gilmour ordered three online e-cigarette retailers – The Joystick Company Pty Ltd, Social-Lites Pty Ltd and Elusion Australia Ltd – and their individual CEOs and directors to pay penalties for breaching consumer law.

In separate proceedings the court found each of the companies had claimed their products did not contain harmful carcinogens and toxins, when this was not the case. It also found that the directors of Joystick and Elusion, and the CEO of Social-Lites, were knowingly involved in this deception.

Joystick and Social-Lites have been ordered to pay a penalty of $ 50,000, while the company heads have been ordered to pay $ 10,000. Elusion has been ordered to pay $ 40,000 and its director $ 15,000.

All three retailers admitted the conduct alleged by the ACCC and consented to the amounts of the penalties.

According to the case brought by the Australian Competition and Consumer Commission (ACCC), statements on the company websites led consumers to believe they would not be exposed to the harmful chemicals found in ordinary cigarettes.

However independent testing commissioned by the ACCC identified the presence of carcinogens and toxic chemicals, such as formaldehyde, acetaldehyde and acrolein in the products of Joystick, Social-Lites and Elusion, as well as acetone in Social-Lites’ products.

Formaldehyde is classified by the World Health Organisation International Agency for Research on Cancer as a Group 1A carcinogen, meaning it causes cancer, while acetaldehyde is classified as possibly carcinogenic. Acrolein is classified as a toxic chemical.

Dr Becky Freeman, a tobacco control researcher with the University of Sydney’s school of public health, said some consumers thought e-cigarette companies were “small artisan companies interested in improving health” when in fact most were owned by big tobacco.

Many advertisements for e-cigarettes and related products claimed they were less toxic and therefore less harmful than tobacco, she said. “But I’d challenge you to find something that isn’t less toxic than tobacco,” Freeman said. “We have no long-term data on e-cigarettes to show that they’ve help people quit for good or that they’re safe.”

The federal court ruling was “enormously significant”, said Simon Chapman, an emeritus professor of public health. He was aware that other complaints about e-cigarette advertising have been made to the ACCC. “These are by no means isolated examples,” Chapman said.

“Tobacco companies want to walk on both sides of the street. They try to argue that e-cigarettes are simply an ordinary consumer product and not a therapeutic device and therefore shouldn’t be subject to the same regulations, yet they often make statements that these things are excellent ways of quitting.”

He said it was “insulting to science” to claim the products were harmless or safe given the lack of evidence about long-term effects.

“Of course they don’t have all the products of combustion that tobacco products have, as they are vaporised and not burned. So while they’re likely to be less harmful, we do not yet know the magnitude of their harm, we just have no accurate way of estimating that yet,” said Chapman.

The ACCC’s acting chair, Delia Rickard, said businesses, including those online, must ensure they provide accurate information to customers and have a reasonable basis for making any claims. “This is particularly important for products that may cause harm to the health of consumers,” she said.

Baby boomers warned over alcohol intake as hospital admissions soar

Alcohol-related hospital admissions in England have increased by 64% in a decade and are at their highest ever level, prompting experts to warn that baby boomers are continuing to risk their health through frequent and excessive drinking.

There were an estimated 1.1m admissions where alcohol was the primary or secondary issue in 2015/16, compared with 670,000 in 2005/06, according to NHS Digital data published on Wednesday.

Separate data from the Office for National Statistics (ONS) for England shows people aged 45 and over are frequently drinking at more hazardous levels.

Married and cohabiting couples are more likely than single people to consume alcohol on five or more days a week, though they are slightly less likely to binge drink.

Surveys found 60% of women aged 45 to 64 and 69% of men of the same age had drunk alcohol in the last week – the highest proportions of any age group.

Prof Sir Ian Gilmore, a liver doctor and chair of the Alcohol Health Alliance UK, said the figures proved the UK continued to have a dysfunctional relationship with alcohol.

He said: “We know that over the long term, rates of binge drinking are falling and more people are choosing to abstain from alcohol. Worryingly, however, these trends do not appear big enough to stop alcohol harm from continuing to rise, and the sharp increase in alcohol-related hospital admissions over the last few years means hundreds of thousands more people each year are experiencing the misery associated with harmful alcohol consumption.”

Dr Tony Rao, co-chair of the Older People’s Substance Misuse working group at the Royal College of Psychiatrists, said: “These figures show that alcohol abuse is not a ‘young person problem’. While the rest of the population reduces its alcohol intake, it is very concerning that baby boomers are drinking at a similar rate as before and are exceeding recommended guidelines.”

Alcohol figures

The ONS data also shows that the proportion of adults who say they drink alcohol is at the lowest level for more than a decade.

The trend has been largely driven by an increase in the proportion of younger people abstaining, but there has been no decline in the proportion of over-65s drinking, and they are the age group most likely to have consumed alcohol on five or more occasions in the week before they were interviewed.

Such regular drinking is more than three time more likely among over-65s than in the 16-24 age group, the data shows.

Alcohol is linked to more than 60 illnesses and diseases including heart disease, liver disease, cancer and dementia. Hospital admissions due to liver disease have gone up 57% over the last decade, and the number of people diagnosed with alcohol-related cancer has risen by 8%, according to the AHA. The World Cancer Research Fund has said that if nobody drank alcohol in the UK, 21,000 cases of cancer could be prevented each year, including nearly 12,000 cases of breast cancer.

NHS Digital cautions that a narrower measure of alcohol-related hospital admissions is more reliable for tracking changes over time than the broad measure – which the 1.1 million figure relates to – because it is less affected by improvements in recording of secondary diagnoses. But even under the narrow measure, hospital admissions have risen by 22% since 2005/06, to 339,000.

The ONS data shows that 7.8 million people admit to binge drinking – defined for men as consuming more than eight units and for women more than six units – on their heaviest drinking day.

Men are more likely to drink than women and to binge drink. Higher earners, on £40,000 and above annually, are more likely to be frequent drinkers and to binge drink than the lowest earners.

Gilmore said: “The data released today should be sobering reading for whoever wins the upcoming general election, and we would urge the next government to make tackling alcohol harm an immediate priority to save lives, reduce harm, and reduce the pressure on the NHS.”

The Alcohol Information Partnership, which is funded by global drinks companies, said binge drinking and harmful drinking had declined by 17% and 23% respectively since 2005.

The controversy over statins has revealed something: the nocebo effect is real | Ann Robinson

Statins are back in the news; a new study shows that media-fuelled controversy among health experts has dented public confidence in the cholesterol-lowering drugs that prevent 80,000 heart attacks and strokes every year in the UK. The benefits far outweigh the harm from rare side-effects, according to a review of the evidence in the Lancet medical journal. But 200,000 people stopped taking their statins in 2013 following six months of “disputed research and tendentious opinion” on their potential side-effects.

People get worried about their cholesterol level without always appreciating that it’s all about risk. There’s little value in an isolated cholesterol number without knowing what your individual risk is. And that’s calculated using a tool that inputs factors including age, gender, smoking habits, blood pressure, and ratio of harmful cholesterol (LDL) to non-harmful cholesterol (HDL). If your risk is 15%, that means that over the next 10 years, 15 out of 100 people who are similar to you will have heart or brain disease that can lead to a heart attack or stroke. You may be able to reduce this risk by stopping smoking, losing weight, exercising and changing to a more Mediterranean-style diet. But cholesterol levels are partly determined by genetics and you may find that, despite your best efforts, your risk remains higher than you’d like. At that stage, if your risk remains over 15%, you may benefit from taking a statin. If you’re at higher risk of cardiovascular disease anyway because you’re diabetic, or have already had a heart attack or stroke, you’ll probably be advised to take a statin if your cholesterol is above 5 or LDL above 3.

I saw a woman in her early 60s today who had a stroke last year and, after a shaky start, made a fantastic recovery. She’s stopped smoking, which is the most important factor in preventing a recurrence. But she remains at high risk. She’s slim with an impeccable diet and walks every day. But her total cholesterol is 7 and most of that is the bad type. She’s adamant that she doesn’t want to take statins. I ask why not. “Because I tried and they made me ache all over. I read in the paper that they cause muscle pains,” she says. And so she stopped them a few months ago. I ask how she is now. “Oh I still ache all over,” she says.

And this is nocebo at work. Nocebo is the opposite of placebo, something we’re all familiar with. A placebo is an inert pill or treatment that can work wonders if it’s prescribed with enough persuasiveness. It’s a very well-recognised phenomenon and contributes to the healing power of many treatments. A sham injection into a painful, arthritic knee gives nearly as much relief as a steroid injection.


A sham injection into a painful, arthritic knee gives nearly as much relief as a steroid injection

And nocebo is at least as powerful as placebo. If you’re very concerned about the negative potential of a treatment, it may work less well and you may experience more side-effects. Take the drug amlodipine, prescribed for high blood pressure. A common side-effect is headache. If I prescribe amlodipine for you without a proper discussion and full buy-in and you then get a bad headache, you may well read the drug leaflet and decide to stop the drug. Add in a scary headline about blood-pressure drugs, and the nocebo effect is compounded.

But I feel wary of the term nocebo. It implies a potentially dismissive approach to people’s legitimate concerns, scepticism and curiosity about the treatments they take. It’s a good thing to be well-informed of new research about drugs that you take. And it’s perfectly valid to raise concerns with your GP. It pays to balance healthy scepticism with rational testing. So if you read about statins and muscle pains, take a break and monitor whether the symptoms improve on stopping and recur on restarting. And if your blood-pressure pill does increase your frequency of headache, ask yourself whether you can tolerate this side-effect when you weigh it against its potential benefits.

The key, as always, is the mature and informed discussion that needs to happen between the prescriber and the patient. If patients abandon potentially beneficial treatments or report more side-effects than seem attributable to the drug alone, it’s not nocebo. It’s a lost opportunity.

Are NHS transformation plans a sticking plaster over big funding gaps? | Paul Briddock

Almost every day there’s a new report on the state of NHS finances. With so many negative headlines, it can be difficult to keep sight of what the extent of the problem is and what solutions might fix it.

Many NHS organisations are under severe financial pressure. The planned savings are still ambitious and, after speaking to finance directors, our research has found they lack confidence about whether they can deliver the annual 2–3% savings needed to close the £22bn funding gap.

Most finance directors see sustainability and transformation plans (STPs) as a cornerstone of reducing the deficit – but an overwhelming majority also voiced concerns about the way they are set up, with nearly three-quarters (72%) concerned about their governance. STPs were met with enthusiasm and positivity when they were first introduced, but there is increasing scepticism about whether they can actually work in practice.

Only 54% of finance directors believe that the risks associated with STPs have been recognised and just 5% believe adequate risk management arrangements are in place. Warnings of “heroic saving assumptions” and “a need for more financial realism” echo loudly.

In particular, finance directors have limited confidence in their ability to deliver both STPs and organisational financial objectives simultaneously. Only 6% of trust finance directors and 17% of clinical commissioning group chief finance officers believe both are deliverable.


We’ve reached the point where more financial realism is desperately needed

Nonetheless, it is encouraging to see improvements in collaboration between clinical commissioning groups and providers. Back in July 2016, finance directors saw STPs as a way of driving better collaboration and reshaping services effectively. The majority of our members still talk positively about STP leadership, with more than half (58%) of NHS finance directors witnessing clear and effective leadership and an improvement in the relationship between commissioners and providers.

It’s a positive step forward. But let’s not forget the challenging job STPs have in delivering efficiency savings and productivity gains, and working through other pressures facing the NHS, such as sustainable workforce planning and reducing agency costs.

We’ve reached the point where more financial realism is desperately needed. To echo a recent report by NHS Providers, the government needs to be more realistic, both about what can be delivered within the current budget and the pressures placed on finance professionals.

More collaboration and transparency between individual organisations is needed, because the lack of clear governance is causing some angst. Understandably, finance directors want to prioritise their organisational objectives rather than their STP objectives. More than 80% of finance directors therefore believe that the regulatory regime needs to change to support the delivery of STPs, and 79% believe the financial regime needs to change too.

Our recent briefing explores the emerging governance arrangements being developed to support the delivery of STPs. We hope it will be a useful tool for staff to use in developing their own governance arrangements. In order to maintain momentum, STP models must be clear, robust and flexible. STPs help ensure that health and social care services are built around the needs of local populations, so it is clear that each governance model will develop at its own pace, with tailored arrangements to suit the community and organisations in question. There are, however, many general issues that need to be considered, such as leadership, resources and risk management. Finance directors can use our online checklist to make sure they have considered all the key areas.

It is still very early days for STPs. Many organisations are yet to find a balance and there are clearly still issues that will need to be worked through, but doing this in an open and transparent manner will be key to achieving success. Yet even when we reach a position where STPs are in place and working effectively, the task ahead is vast. A frank discussion is needed about what services are affordable in the future. Current plans could merely be a sticking plaster covering up a much bigger problem.

Paul Briddock is director of policy at the Healthcare Financial Management Association

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When my neighbor got a heart attack everyone fussed over him. How can I have that?

When I was a kid, if I were told that I’d be writing a book about diet and nutrition when I was older, let alone having been doing a health related radio show for over 36 years, I would’ve thought that whoever told me that was out of their mind. Living in Newark, New Jersey, my parents and I consumed anything and everything that had a face or a mother except for dead, rotting, pig bodies, although we did eat bacon (as if all the other decomposing flesh bodies were somehow miraculously clean). Going through high school and college it was no different. In fact, my dietary change did not come until I was in my 30′s.

Just to put things in perspective, after I graduated from Weequahic High School and before going to Seton Hall University, I had a part-time job working for a butcher. I was the delivery guy and occasionally had to go to the slaughterhouse to pick up products for the store. Needless to say, I had no consciousness nor awareness, as change never came then despite the horrors I witnessed on an almost daily basis.

After graduating with a degree in accounting from Seton Hall, I eventually got married and moved to a town called Livingston. Livingston was basically a yuppie community where everyone was judged by the neighborhood they lived in and their income. To say it was a “plastic” community would be an understatement.

Livingston and the shallowness finally got to me. I told my wife I was fed up and wanted to move. She made it clear she had to be near her friends and New York City. I finally got my act together and split for Colorado.

I was living with a lady in Aspen at the end of 1974, when one day she said, ” let’s become vegetarians”. I have no idea what possessed me to say it, but I said, “okay”! At that point I went to the freezer and took out about $ 100 worth of frozen, dead body parts and gave them to a welfare mother who lived behind us. Well, everything was great for about a week or so, and then the chick split with another guy.

So here I was, a vegetarian for a couple weeks, not really knowing what to do, how to cook, or basically how to prepare anything. For about a month, I was getting by on carrot sticks, celery sticks, and yogurt. Fortunately, when I went vegan in 1990, it was a simple and natural progression. Anyway, as I walked around Aspen town, I noticed a little vegetarian restaurant called, “The Little Kitchen”.

Let me back up just a little bit. It was April of 1975, the snow was melting and the runoff of Ajax Mountain filled the streets full of knee-deep mud. Now, Aspen was great to ski in, but was a bummer to walk in when the snow was melting.

I was ready to call it quits and I needed a warmer place. I’ll elaborate on that in a minute.

But right now, back to “The Little Kitchen”. Knowing that I was going to leave Aspen and basically a new vegetarian, I needed help. So, I cruised into the restaurant and told them my plight and asked them if they would teach me how to cook. I told them in return I would wash dishes and empty their trash. They then asked me what I did for a living and I told them I was an accountant.

The owner said to me, “Let’s make a deal. You do our tax return and we’ll feed you as well”. So for the next couple of weeks I was doing their tax return, washing their dishes, emptying the trash, and learning as much as I could.

But, like I said, the mud was getting to me. So I picked up a travel book written by a guy named Foder. The name of the book was, “Hawaii”. Looking through the book I noticed that in Lahaina, on Maui, there was a little vegetarian restaurant called,” Mr. Natural’s”. I decided right then and there that I would go to Lahaina and work at “Mr. Natural’s.” To make a long story short, that’s exactly what happened.

So, I’m working at “Mr. Natural’s” and learning everything I can about my new dietary lifestyle – it was great. Every afternoon we would close for lunch at about 1 PM and go to the Sheraton Hotel in Ka’anapali and play volleyball, while somebody stayed behind to prepare dinner.

Since I was the new guy, and didn’t really know how to cook, I never thought that I would be asked to stay behind to cook dinner. Well, one afternoon, that’s exactly what happened; it was my turn. That posed a problem for me because I was at the point where I finally knew how to boil water.

I was desperate, clueless and basically up the creek without a paddle. Fortunately, there was a friend of mine sitting in the gazebo at the restaurant and I asked him if he knew how to cook. He said the only thing he knew how to cook was enchiladas. He said that his enchiladas were bean-less and dairy-less. I told him that I had no idea what an enchilada was or what he was talking about, but I needed him to show me because it was my turn to do the evening meal.

Well, the guys came back from playing volleyball and I’m asked what was for dinner. I told them enchiladas; the owner wasn’t thrilled. I told him that mine were bean-less and dairy-less. When he tried the enchilada he said it was incredible. Being the humble guy that I was, I smiled and said, “You expected anything less”? It apparently was so good that it was the only item on the menu that we served twice a week. In fact, after about a week, we were selling five dozen every night we had them on the menu and people would walk around Lahaina broadcasting, ‘enchilada’s at “Natural’s” tonight’. I never had to cook anything else.

A year later the restaurant closed, and somehow I gravitated to a little health food store in Wailuku. I never told anyone I was an accountant and basically relegated myself to being the truck driver. The guys who were running the health food store had friends in similar businesses and farms on many of the islands. I told them that if they could organize and form one company they could probably lock in the State. That’s when they found out I was an accountant and “Down to Earth” was born. “Down to Earth” became the largest natural food store chain in the islands, and I was their Chief Financial Officer and co-manager of their biggest store for 13 years.

In 1981, I started to do a weekly radio show to try and expose people to a vegetarian diet and get them away from killing innocent creatures. I still do that show today. I pay for my own airtime and have no sponsors to not compromise my honesty. One bit of a hassle was the fact that I was forced to get a Masters Degree in Nutrition to shut up all the MD’s that would call in asking for my credentials.

My doing this radio show enabled me, through endless research, to see the corruption that existed within the big food industries, the big pharmaceutical companies, the biotech industries and the government agencies. This information, unconscionable as it is, enabled me to realize how broken our health system is. This will be covered more in depth in the Introduction and throughout the book and when you finish the book you will see this clearly and it will hopefully inspire you to make changes.

I left Down to Earth in 1989, got nationally certified as a sports injury massage therapist and started traveling the world with a bunch of guys that were making a martial arts movie. After doing that for about four years I finally made it back to Honolulu and got a job as a massage therapist at the Honolulu Club, one of Hawaii’s premier fitness clubs. It was there I met the love of my life who I have been with since 1998. She made me an offer I couldn’t refuse. She said,” If you want to be with me you’ve got to stop working on naked women”. So, I went back into accounting and was the Chief Financial Officer of a large construction company for many years.

Going back to my Newark days when I was an infant, I had no idea what a “chicken” or “egg” or “fish” or “pig” or “cow” was. My dietary blueprint was thrust upon me by my parents as theirs was thrust upon them by their parents. It was by the grace of God that I was able to put things in their proper perspective and improve my health and elevate my consciousness.

The road that I started walking down in 1975 has finally led me to the point of writing my book, “A Sane Diet For An Insane World”. Hopefully, the information contained herein will be enlightening, motivating, and inspiring to encourage you to make different choices. Doing what we do out of conditioning is not always the best course to follow. I am hoping that by the grace of the many friends and personalities I have encountered along my path, you will have a better perspective of what road is the best road for you to travel on, not only for your health but your consciousness as well.

Last but not least: after being vaccinated as a kid I developed asthma, which plagued me all of my life. In 2007 I got exposed to the organic sulfur crystals, which got rid of my asthma in 3 days and has not come back in over 10 years. That, being the tip of the iceberg, has helped people reverse stage 4 cancers, autism, joint pain, blood pressure problems, migraine headaches, erectile dysfunction, gingivitis, and more. Also, because of the detoxification effects by the release of oxygen that permeates and heals all the cells in the body, it removes parasites, radiation, fluoride, free radicals, and all the other crap that is thrust upon us in the environment by Big Business.

For more, please view www.healthtalkhawaii.com and www.asanediet.com.

Namaste!