Tag Archives: shouldn’t

What you should say to somebody who has miscarried – and what you shouldn’t | Janet Murray

“At least you know you can get pregnant,” said my doctor friend when I told her I’d had a miscarriage, 12 weeks into my first pregnancy, and following a painful struggle with infertility. “There was probably something wrong with the baby,” said one relative. “Just think of all the fun you’ll have trying again,” said another.

After my second miscarriage – a rare form of ectopic pregnancy – the focus was on the fact I was already a mother. “At least you’ve already got a child,” well-meaning friends told me, as did the surgeon who delivered the news that the pregnancy – and subsequent surgery – had left me infertile.

Not only did these insensitive comments hurt. They also made me feel diminished, as if I had no right grieving for a baby that never existed. As if I were greedy to want another child when I already had one.

As many as one in four pregnancies end in miscarriage so you would think we’d be better at talking to women who have lost a baby. But if you’ve experienced miscarriage – or are close to someone who has – you’ll know how clumsy people can be with their words.

Perhaps it’s because it can be uncomfortable discussing “female” things such as bleeding and cramps. Or maybe it’s because people don’t associate early miscarriage (generally defined as a loss that occurs before the 20th week of pregnancy) with a “real” baby. Whatever the reason, when you experience miscarriage you quickly discover that even the nicest people can say the most insensitive things.

I had a miscarriage. Why can’t we talk about losing a baby?

Almost every woman I know who has experienced miscarriage has a story about something inappropriate someone said following her loss.

After losing twins, one friend was told it was for the best “as she wouldn’t have been able to cope anyway”. Another endured speculation about whether her migraines were to blame, as “stress [caused by migraines] can kill babies in the womb”. “At least it was nice and early” offered little comfort to the colleague who lost babies six and seven weeks into her pregnancies.

But while words can wound, saying nothing can be just as bad.

I’m generally a positive person but both times I miscarried, I experienced extreme hopelessness. One minute I was imagining holding my baby in my arms, reading her a bedtime story or helping her take her first steps. The next I was in this dark, shadowy place, where I couldn’t see anything to live for. I thought I would never be able to stop crying. The worst thing was the crushing loneliness: the phone stayed silent – most people were too afraid to call.


I’m generally a positive person but both times I miscarried, I experienced extreme hopelessness

When a friend or loved one loses a baby, the worst thing you can do is stay away. Picking up the phone or calling round to their home – even when you don’t know what to say – takes guts, but is better than doing nothing at all. Offering to cook, babysit, run errands – or any other practical help – can be enough to show you care.

Acknowledge the loss by asking when the baby was due to be born. If she doesn’t want to share she’ll say so. But steer clear of meaningless platitudes such as “everything happens for a reason” or “you can try again” (she can’t – that baby is gone for ever – and that was the baby she wanted). Anything that starts with “at least” will sound like you’re trying to minimise the loss – so don’t go there.

Do remember that everyone experiences grief and loss differently. I left a party in tears last year after someone made a point of telling me they’d miscarried twins and it hadn’t really bothered them. The conversation that followed was so painful – even 10 years after my last miscarriage – it took my breath away. So you had a miscarriage yourself and got over it in a few days. That’s great, but it doesn’t mean everyone else should do.

In fact a 2011 study found that the depression and anxiety experienced by many women after a miscarriage can continue for years, even after the birth of a healthy child.

If you’ve recently found out you’re pregnant yourself you can’t avoid the subject for ever. But a sensitive phone call (rather than a scan picture on a Facebook message – yep, that happened to me) is probably a better bet.

Remember, also, that miscarriage hurts dads too, but they are often so busy looking after their partner that their grief goes unacknowledged. A simple hug or “how are you doing?” can go a long way.

I was saved by a wise friend who didn’t try to offer explanations, “fix” things or tell me about her friend/sister/aunt who miscarried umpteen times but went on to have a healthy baby. Who was brave enough to turn up on my doorstep with a hug and box of chocolates and just listen. Who understood that “I’m sorry” was all I needed to hear. That alone was priceless.

Janet Murray is a writer, speaker and fundraiser for miscarriage awareness. She is running the 2018 London Marathon raise money for the Ectopic Pregnancy Trust

  • Comments on this thread are will be pre-moderated.

What you should say to somebody who has miscarried – and what you shouldn’t | Janet Murray

“At least you know you can get pregnant,” said my doctor friend when I told her I’d had a miscarriage, 12 weeks into my first pregnancy, and following a painful struggle with infertility. “There was probably something wrong with the baby,” said one relative. “Just think of all the fun you’ll have trying again,” said another.

After my second miscarriage – a rare form of ectopic pregnancy – the focus was on the fact I was already a mother. “At least you’ve already got a child,” well-meaning friends told me, as did the surgeon who delivered the news that the pregnancy – and subsequent surgery – had left me infertile.

Not only did these insensitive comments hurt. They also made me feel diminished, as if I had no right grieving for a baby that never existed. As if I were greedy to want another child when I already had one.

As many as one in four pregnancies end in miscarriage so you would think we’d be better at talking to women who have lost a baby. But if you’ve experienced miscarriage – or are close to someone who has – you’ll know how clumsy people can be with their words.

Perhaps it’s because it can be uncomfortable discussing “female” things such as bleeding and cramps. Or maybe it’s because people don’t associate early miscarriage (generally defined as a loss that occurs before the 20th week of pregnancy) with a “real” baby. Whatever the reason, when you experience miscarriage you quickly discover that even the nicest people can say the most insensitive things.

I had a miscarriage. Why can’t we talk about losing a baby?

Almost every woman I know who has experienced miscarriage has a story about something inappropriate someone said following her loss.

After losing twins, one friend was told it was for the best “as she wouldn’t have been able to cope anyway”. Another endured speculation about whether her migraines were to blame, as “stress [caused by migraines] can kill babies in the womb”. “At least it was nice and early” offered little comfort to the colleague who lost babies six and seven weeks into her pregnancies.

But while words can wound, saying nothing can be just as bad.

I’m generally a positive person but both times I miscarried, I experienced extreme hopelessness. One minute I was imagining holding my baby in my arms, reading her a bedtime story or helping her take her first steps. The next I was in this dark, shadowy place, where I couldn’t see anything to live for. I thought I would never be able to stop crying. The worst thing was the crushing loneliness: the phone stayed silent – most people were too afraid to call.


I’m generally a positive person but both times I miscarried, I experienced extreme hopelessness

When a friend or loved one loses a baby, the worst thing you can do is stay away. Picking up the phone or calling round to their home – even when you don’t know what to say – takes guts, but is better than doing nothing at all. Offering to cook, babysit, run errands – or any other practical help – can be enough to show you care.

Acknowledge the loss by asking when the baby was due to be born. If she doesn’t want to share she’ll say so. But steer clear of meaningless platitudes such as “everything happens for a reason” or “you can try again” (she can’t – that baby is gone for ever – and that was the baby she wanted). Anything that starts with “at least” will sound like you’re trying to minimise the loss – so don’t go there.

Do remember that everyone experiences grief and loss differently. I left a party in tears last year after someone made a point of telling me they’d miscarried twins and it hadn’t really bothered them. The conversation that followed was so painful – even 10 years after my last miscarriage – it took my breath away. So you had a miscarriage yourself and got over it in a few days. That’s great, but it doesn’t mean everyone else should do.

In fact a 2011 study found that the depression and anxiety experienced by many women after a miscarriage can continue for years, even after the birth of a healthy child.

If you’ve recently found out you’re pregnant yourself you can’t avoid the subject for ever. But a sensitive phone call (rather than a scan picture on a Facebook message – yep, that happened to me) is probably a better bet.

Remember, also, that miscarriage hurts dads too, but they are often so busy looking after their partner that their grief goes unacknowledged. A simple hug or “how are you doing?” can go a long way.

I was saved by a wise friend who didn’t try to offer explanations, “fix” things or tell me about her friend/sister/aunt who miscarried umpteen times but went on to have a healthy baby. Who was brave enough to turn up on my doorstep with a hug and box of chocolates and just listen. Who understood that “I’m sorry” was all I needed to hear. That alone was priceless.

Janet Murray is a writer, speaker and fundraiser for miscarriage awareness. She is running the 2018 London Marathon raise money for the Ectopic Pregnancy Trust

  • Comments on this thread are will be pre-moderated.

What you should say to somebody who has miscarried – and what you shouldn’t | Janet Murray

“At least you know you can get pregnant,” said my doctor friend when I told her I’d had a miscarriage, 12 weeks into my first pregnancy, and following a painful struggle with infertility. “There was probably something wrong with the baby,” said one relative. “Just think of all the fun you’ll have trying again,” said another.

After my second miscarriage – a rare form of ectopic pregnancy – the focus was on the fact I was already a mother. “At least you’ve already got a child,” well-meaning friends told me, as did the surgeon who delivered the news that the pregnancy – and subsequent surgery – had left me infertile.

Not only did these insensitive comments hurt. They also made me feel diminished, as if I had no right grieving for a baby that never existed. As if I were greedy to want another child when I already had one.

As many as one in four pregnancies end in miscarriage so you would think we’d be better at talking to women who have lost a baby. But if you’ve experienced miscarriage – or are close to someone who has – you’ll know how clumsy people can be with their words.

Perhaps it’s because it can be uncomfortable discussing “female” things such as bleeding and cramps. Or maybe it’s because people don’t associate early miscarriage (generally defined as a loss that occurs before the 20th week of pregnancy) with a “real” baby. Whatever the reason, when you experience miscarriage you quickly discover that even the nicest people can say the most insensitive things.

I had a miscarriage. Why can’t we talk about losing a baby?

Almost every woman I know who has experienced miscarriage has a story about something inappropriate someone said following her loss.

After losing twins, one friend was told it was for the best “as she wouldn’t have been able to cope anyway”. Another endured speculation about whether her migraines were to blame, as “stress [caused by migraines] can kill babies in the womb”. “At least it was nice and early” offered little comfort to the colleague who lost babies six and seven weeks into her pregnancies.

But while words can wound, saying nothing can be just as bad.

I’m generally a positive person but both times I miscarried, I experienced extreme hopelessness. One minute I was imagining holding my baby in my arms, reading her a bedtime story or helping her take her first steps. The next I was in this dark, shadowy place, where I couldn’t see anything to live for. I thought I would never be able to stop crying. The worst thing was the crushing loneliness: the phone stayed silent – most people were too afraid to call.


I’m generally a positive person but both times I miscarried, I experienced extreme hopelessness

When a friend or loved one loses a baby, the worst thing you can do is stay away. Picking up the phone or calling round to their home – even when you don’t know what to say – takes guts, but is better than doing nothing at all. Offering to cook, babysit, run errands – or any other practical help – can be enough to show you care.

Acknowledge the loss by asking when the baby was due to be born. If she doesn’t want to share she’ll say so. But steer clear of meaningless platitudes such as “everything happens for a reason” or “you can try again” (she can’t – that baby is gone for ever – and that was the baby she wanted). Anything that starts with “at least” will sound like you’re trying to minimise the loss – so don’t go there.

Do remember that everyone experiences grief and loss differently. I left a party in tears last year after someone made a point of telling me they’d miscarried twins and it hadn’t really bothered them. The conversation that followed was so painful – even 10 years after my last miscarriage – it took my breath away. So you had a miscarriage yourself and got over it in a few days. That’s great, but it doesn’t mean everyone else should do.

In fact a 2011 study found that the depression and anxiety experienced by many women after a miscarriage can continue for years, even after the birth of a healthy child.

If you’ve recently found out you’re pregnant yourself you can’t avoid the subject for ever. But a sensitive phone call (rather than a scan picture on a Facebook message – yep, that happened to me) is probably a better bet.

Remember, also, that miscarriage hurts dads too, but they are often so busy looking after their partner that their grief goes unacknowledged. A simple hug or “how are you doing?” can go a long way.

I was saved by a wise friend who didn’t try to offer explanations, “fix” things or tell me about her friend/sister/aunt who miscarried umpteen times but went on to have a healthy baby. Who was brave enough to turn up on my doorstep with a hug and box of chocolates and just listen. Who understood that “I’m sorry” was all I needed to hear. That alone was priceless.

Janet Murray is a writer, speaker and fundraiser for miscarriage awareness. She is running the 2018 London Marathon raise money for the Ectopic Pregnancy Trust

  • Comments on this thread are will be pre-moderated.

Off-duty NHS staff shouldn’t have to worry about staying sober in case of terror attacks

Speaking on the BBC’s Today programme today, Dr Malik Ramadan, an A&E consultant at the Royal London hospital, which received 12 victims of the attack at London Bridge on Saturday, recapped the realities of dealing with a major incident. Amid tales of heroic efforts, he mentioned that some of his colleagues were avoiding nights out and alcohol while they are off duty in the anticipation that they might be needed should another attack happen.

The mantra we have collectively chosen as a nation after each of the recent terrorist atrocities has been clear: we must carry on with our lives as normal. And yet how many of us might feel a fleeting guilty twinge of anxiety the next time we walk through a crowded station or into a packed nightclub: “What if it happens to me?” As a doctor or nurse, you might also ask yourself: “What if I’m needed to work?”

I can’t say that any of these events have changed the way I, as a junior doctor, act, nor how any of my medical friends and colleagues act. Dr Ramadan, however, represents a particular medical niche: he is not only an A&E consultant, but also one who works in one of four trauma centres in London, a city that has, unfortunately, become a target for terrorists. Memories of 7/7 will doubtless be particularly clear for him and his colleagues.

One might wonder how healthy such a constant state of awareness can be for NHS staff, many of whom are already tired and overworked. Downtime is important for all of us but for those who work in A&E, regularly encountering patients on the worst day of their lives, it is crucial. To spend that time worrying about hypothetical future patients is commendable but, ultimately, unsustainable.

Although Britain has had three attacks in the past few months, such events remain mercifully rare. With our police and intelligence services doing their jobs, we can hope that peace and normality will return. Doctors and nurses will be back in the pub after work, complaining about staffing cuts and underwhelming British summers. Not because they feel some obligation to put on a brave face, but because life really does go on.

LGBT people are prone to mental illness. It’s a truth we shouldn’t shy away from | Alexander Leon

I almost didn’t write this. It wasn’t from not wanting to. I cradled my head in my hands, desperate to contribute to the reams of social media positivity I had seen surrounding Mental Health Awareness Week.

I almost didn’t – couldn’t – because I was depressed.

There came a certain point in my experience of being LGBT where I accepted that I had to be strong and uncompromising in the face of disapproving glances and withering remarks. I made a pact to throw myself into my community with zeal, no matter how exhausting, and to make full use of the privileges I was afforded in the tolerant metropolis I’d landed in.

And yet, for some reason, I find this an incredibly difficult attitude to transfer over to my struggle with depression. I will share with my co-workers that I am going on a date with a man or going to an LGBT-themed event with an almost belligerent pride, but am overwhelmed with fear in having to admit to those same people that I’m leaving slightly early to see my therapist or that I need to take some time off due to another episode.

Indeed, the word “depression” still has a bite to it, in the way that the word “gay” did when I first dared to say it to someone else in reference to myself. The tone of my voice takes on an odd quality as I approach it in a sentence, to the point where I sound intolerably meek by the time “depression” tumbles out.

The thing is, in many cases, mental illness and being queer go hand in hand. It’s an uncomfortable but important reality that LGBT youth are four times more likely to kill themselves than their heterosexual counterparts. More than half of individuals who identify as transgender experience depression or anxiety. Even among Stonewall’s own staff, people who dedicate themselves to the betterment and improved health of our community, 86% have experienced mental health issues first-hand. It’s a morbid point to make, but it makes perfect sense that we, as a community, struggle disproportionately.

At a recent event I attended, set up to train LGBT role models to visit schools and teach children about homophobia, no one explicitly mentioned their struggles with mental illness. We told one another stories of how we had come to accept ourselves in the face of adversity, talking in riddles about “dark times” or “feeling down” or being a “bit too much of a party animal”. But these problems have other names – depression, anxiety, addiction – that we consistently avoid, despite being in a community in which a large percentage of us will have undergone similar experiences.

And this phenomenon replays itself over and over. Despite there being a common understanding between me and my queer friends that we’ve probably all been vilified in the same way and made to feel a similar flavour of inadequate, we will rarely acknowledge, even within the safe boundaries of friendship, that this has had a lasting impact on our ability to maintain a healthy self-image.

But part of being proud of who we are as LGBT people is being able to be open about the struggles we’ve faced. It’s in naming and wearing the uncomfortable badges of anxiety, depression and addiction that we take the first step towards fully accepting mental illness as an important part of our collective identity. After all, how can we be true role models to the next generation if we refuse to tell the whole story?

And so, this Mental Health Awareness Week, I’m issuing a challenge to my community. If you are LGBT and suffer from a mental illness, be defiant in your acceptance of it in the same way that you would about your sexuality or gender identity. Bring it up, speak it out and feel sure that your voice, however seemingly small or insignificant, is a valid one. After all, we have been, and will always be, a community of fighters – it’s about time we dared to show our battle scars.

As a prison doctor I’ve seen the crisis in jails – half the inmates shouldn’t be there | Gordon Cameron

I have worked as a GP over the past decade in about a third of the around 140 prisons in England and Wales – all categories, male and female – and in all there has been a gradual increase in the prison population, leading to overcrowding.

This reflects the national situation. Ministry of Justice figures show that between June 1993 and June 2012 the prison population in England and Wales increased by 41,800 prisoners, to more than 86,000. Without urgent steps aimed at cutting the prison population this could exceed 100,000 by 2020. However, this has not been matched by a corresponding increase in the number of prison officers. On the contrary, their numbers have been cut.

When our prisons are at crisis point, amid continuing controversy about incidents such as the recent killing at Pentonville, consider our direction of travel. Take HMP Berwyn, the so-called super prison expected to open in February 2017.

Built at the cost of £212m and located at Wrexham in Wales, HMP Berwyn is expected to accommodate 2,100 category C prisoners – those who cannot be allowed to move freely but are considered unlikely to try to escape. Instead of taking steps to radically reduce the UK prison population the government keeps building more prisons to house even more prisoners.

I have come across numerous cases over the years where a noncustodial sentence would have been more appropriate than imprisonment. I recall a heavily pregnant lady suffering from a life-threatening condition who was jailed for breaching a restraining order. What was to be expected of a pregnant sufferer confined for a good deal of the time in a small, poorly ventilated prison cell? During her time behind bars she was rushed to hospital several times. Whenever she was there, for sometimes up to a week and longer, she was guarded round the clock by prison officers.


Sending people to jail in the hope of ridding society of the menace of drug abuse is a woefully inadequate approach

I recall another instance when the nurse, seeing the new arrivals on reception duty, sent me the following message, asking me to prescribe a short course of sleeping tablets for a recent arrival. She was in prison for failing to pay a bill. Her partner was supposed to be looking after their young children but, the message said: “she does not believe he is up to the task. She is in a very weepy state and unable to sleep. She has another four weeks to do – could you please help?”

These women represent a not insignificant proportion of the prison population who are not a “danger to the public”. So why is the state spending large sums to keep them behind bars?

Ministry of Justice figures from 2013 revealed that 55% of prisoners connected their offences to drug-taking, with the need for money to buy drugs the most commonly cited factor. Eliminating the addiction factor could lead to the closure of about half the prisons in the UK and free resources for other matters.

‘Prison is punishment enough’: are inmates paying price of industry politics?

Sending these people to jail in the hope of ridding society of the menace of drug abuse is a woefully inadequate approach to the complex problem of drugs. It is akin to a doctor treating the symptoms of a disease without concerning themselves with its cause or its future prevention. There should instead be a holistic approach to the problem of drug addiction, with treatment and rehabilitation forming the centrepiece.

And then there are the inmates with mental health issues. Surely these are best handled in psychiatric institutions rather than prison. Instead of spending millions on “super prisons”, the state would be better employed building additional psychiatric hospitals and homes to accommodate the hundreds, if not thousands, of them languishing in jail. Instead of helping them to overcome their mental impairment, society is punishing them for a condition they cannot help having. Labelling them criminals on a par with those who commit armed robbery, rape and murder is antiquated at best and nonsensical at worst. Samuel Butler lampooned this stance in his classic satire, Erewhon, describing a culture who imprisoned the sick for the crime of not being well. That was published in 1872, but what has changed since then?

A report published last month by the RSA’s Future Prison project says the prison and probation services in England and Wales are failing to protect the public because they do not rehabilitate offenders, and that they should be radically restructured. I welcome the rehabilitation aspect, but it still ignores the central issue of population.

We need urgently to address sentencing, because too many offenders are being sent to prison for short terms. A record-breaking case was that of a lady who was jailed one evening only to be released the next day. I believe any sentence below three months should be suspended, turned into fines or whatever other punishment society deems appropriate short of an actual prison sentence.

As for drug addicts, the power to sentence them to drug rehabilitation homes makes sense for everybody. Keeping the most dangerous criminals – sex offenders, murderers, terrorists, armed robbers, and so on – in jail, and finding alternative punishment for those committing petty crimes, would not only lead a radical reduction in the prison population, it would also allow for the proper supervision of extremely dangerous inmates.

Whatever else is said this week, population reduction is where our focus is and it is quite achievable. What is really needed is the will.

Dr Gordon Cameron is a pseudonym. Memoirs of Her Majesty’s Prison Doctor by Dr Cameron is available now. Visit hmpdoctorsmemoirs.com

Mental health at university: ‘Students shouldn’t have to suffer like I did’

As a student, I used to have a ritual. I would wake up and immediately jump up and down 100 times. Then I would start work at 9.21am precisely. I would eat dinner at 5pm on the dot, and I’d finish work at 10pm. Before going to bed, I would touch wood five times. Whenever the cycle was broken, I would break down.

I would tell myself that this was normal, that this was how you make a success of yourself. I wouldn’t be doing my academic work any justice if I wasn’t constantly on the verge of a breakdown, right?

My OCD routine was damaging. I didn’t feel I could seek help because my problems seemed so trivial compared to others’.

It is often said that when it comes to mental health, ignoring your problem – if it is even recognised in the first place – is not the solution. But dealing with it alone isn’t either, since certain neuroses will intensify in solitude. Mine certainly did. I never ate with people, and in a way it helped to lower my anxiety levels in the short term. I was “managing”.

But over time I became more and more anxious, until one day I had a panic attack while walking to university. I didn’t want to face this alone anymore; I had to be brave and get help without feeling I was merely attention-seeking.

But going to the doctors didn’t help much. It was an impersonal experience, where I was told to fill out forms on how to “rate” my level of anxiety. I knew full well that I’d been suffering from OCD, a borderline eating disorder and depression for around four years. I was at breaking point, I was suicidal, I couldn’t face the day anymore without becoming overwhelmed with emotion.

That is where the role of university counselling comes in, or at least it should have. The value of speaking to someone external about your problems is often overlooked – but I wasn’t even aware of this service as an undergraduate student.

The large number of students on campus can make it difficult for individuals to form their own support networks, to fit in and to feel like they are part of a wider whole. The prevalence of mental illness in students will likely become worse without adequate funding for support. A new report that came out today recommends that some universities increase their spending in this area threefold.

There needs to be a more open and inclusive dialogue on campus about mental health, and where students can get support – whether that is through formal counselling services or peer-support networks. This would work to break down the stigma I found myself trapped by when I was at my lowest ebb.

Support should not come as the last resort when students are at breaking point. Problems need to be tackled as early as possible, no matter how small the students – or their peers – believe them to be.

Only 13% of the NHS budget is currently committed to mental health services, despite the fact that mental ill-health accounts for 28% of the total burden of disease. The problem in many universities across the UK is the same: the underfunding of support services doesn’t accurately reflect today’s reality. We need to debate this openly, and more often so that students don’t suffer in silence like I did.

Keep up with the latest on Guardian Students: follow us on Twitter at @GdnStudents – and become a member to receive exclusive benefits and our weekly newsletter.

Statins: Patients are allowed to make poor choices but the media shouldn’t help them | Ranjana Srivastava

It’s clear that her symptoms are advancing and that she was right on the futility of further chemotherapy. She is having trouble staying awake, her appetite is deteriorating, and she is weaker by the day. This may well be our last appointment.

“We can get rid of a number of your medications,” I say, frowning at the long list that her daughter says is proving increasingly difficult to administer.

“Let’s do that,” she says joyfully.

So in one of my favourite acts, I slash half her list, explaining why as I go along.

But she stops me at the statin, an anti-cholesterol drug she was prescribed 20 years ago for a barely elevated cholesterol detected on an insurance test.

“I need that so I don’t die from a heart attack.”

“Not quite,” I say soothingly. “Statins exert their benefit over many years and we agree that now, it’s more important to maintain comfort.”

“I can’t imagine my day without my statin,” she declares, leaving me to wonder somewhat enviously how her cardiologist managed to evince such devout compliance for a questionable cause.

Just then her husband pipes up. He is a sprightly 74, still working, and unlike his wife, detests medications, including the statin he was prescribed after a serious heart attack some years ago.

“Well, I’ve decided that at 75, I am swapping the statin for sausages. From what I hear, the two are as bad as each other.”

She has heard this before because the wife adds with a smile, “At 75 or when I die, whichever happens sooner.”

I urge the husband to discuss his decision with his doctor before stopping treatment, I tell my patient to stop her statin and I bid them both a fond goodbye.

As they leave, I find myself thinking about many recent conversations I have had with patients about statins. With cancer patients who have a limited life expectancy, stopping the statin is both safe and right. But during my stints in general medicine, where we treat heart attacks, strokes and dementia, the answer is more nuanced.

Does everyone need a high-dose statin? How many will experience side effects? Is lifestyle modification a reasonable starting point or should every patient be commenced on a statin? The reality of most hospital management is that a drug is prescribed and the patient finds out as an afterthought. But if a statin, once started, is likely to become a lifelong drug, what considerations are important beforehand?

Many patients have heard of statins but awareness does not mean familiarity and it certainly does not mean being informed. For every person who trusts a doctor’s recommendation to take a statin, someone else suspects a conspiracy theory fuelling the prescription of the world’s highest-selling drug.

For the patient who wants to know more, things can get complicated. A cursory internet search warns that statins make women (but not men) more aggressive, accelerate ageing, damage stem cells, worsen heart disease, cause dementia and are “unhealthy and unethical” to prescribe.

Alongside are studies asserting that statins significantly reduce the incidence of heart attacks and strokes and improve mortality. Their benefits are evident within the first year of intake and accumulate over time, making them among the few drugs to have a dramatic impact on health outcomes. Considering that heart disease is the number one killer in many parts of the world, this is no ambit claim. But pity the hapless patient trying to make an informed choice – it’s hard to know which “expert” advice to heed because everyone sounds knowledgeable.


Very few patients needed to stop statins due to adverse effects.

When I recently prescribed a statin to a young woman with a heart attack and a host of coronary risk factors, she expressed concern. I explained that no drug was without side effects but a new, rigorous, non-industry funded, meta-analysis by the clinical trial service unit of Oxford University, shows that the benefits of statins have been underestimated and harms exaggerated. The results were published in the Lancet medical journal.

Treating 10,000 high-risk patients with a low-cost, generic statin for five years prevented 1,000 strokes and heart attacks and treating 10,000 lower-risk patients prevented 500. Of 10,000 patients, five might suffer muscle aches, up to 100 may develop diabetes and five to 10 may suffer a brain haemorrhage but these side-effects have been included in the estimate of the absolute benefit.

Very few patients needed to stop statins due to adverse effects. It may not be the absolute final word but the meta-analysis concludes that many problems have been misattributed to statins, therefore planting fear in the minds of those at high cardiovascular risk and dissuading them from taking a potentially life-saving drug.

But how did these rare toxicities garner so much attention in the first place?

In October 2013, the British Medical Journal, as part of its mission to promote rational prescribing, published a paper quoting the incidence of statin-related side effects being as high as 18% and thus concluding that statins did not provide an overall health benefit to those patients deemed at low risk. But the 18% figure was based on flawed research and it was apparent that even in the quoted research, the figure was closer to 9%, but without the inclusion of a placebo-controlled group, which meant even the 9% could not be genuinely attributed to statins. (The meta-analysis says that statins are “no less well-tolerated than placebo”).

Seven months later the BMJ corrected the erroneous statements but did not retract the entire paper. Sir Rory Collins, the lead author of the Oxford meta-analysis, warned at the time that without full retraction, doctors and patients would continue to be misinformed. It turns out he was prescient.


Medical journal editors … owe it to society to publish papers that “first do no harm”.

Misleading media reports followed and led to increased reticence among doctors to prescribe or even discuss statins and increased unwillingness among patients to take them. Statins were already being under-used but a new wave of adverse media meant a further reduction in use.

In the UK, 200,000 patients stopped taking statins. 60,000 fewer statin prescriptions were dispensed in Australia following a now-withdrawn television program. If those patients avoided statins for the next five years, researchers estimated that a few thousand would suffer a fatal heart attack or stroke. For a disease that kills 17 million people around the world each year, an ounce of prevention is not to be sniffed at.

So what does the statin saga teach us? For one, it underlines the power of the media and in turn, the responsibility of health reporters and newspaper editors to think twice before exploiting health news to suit their audience.

“Beloved grandma loses mind to cholesterol drug” and “How statins ruined my life” might be guaranteed click-bait but responsible reporting might instead discuss the dreadful statistic of one Australian dying of cardiovascular disease every 12 minutes and how to prevent it. Statins are no panacea but combined with diet, exercise and curbing cigarettes and alcohol, they have a role.

Second, it reminds medical journal editors that they owe it to society to publish papers that “first do no harm”. If Big Pharma can’t be trusted to provide unbiased data and to base advice on sensational tabloid fare makes a mockery of medicine, doctors must put their faith in someone to provide credible information.

There is an old joke that the majority of academic papers are read only by the author and the editor – this may be a little harsh but busy clinicians mostly flick through abstracts and note key points rather than read even a fraction of the million scientific papers published annually with an interrogating mind. It is up to journal editors to simplify the task and spell out the difference between interesting research and findings that transform patient care.

Finally, better health arises from better health literacy. In a free society, patients are allowed to make poor choices but the media shouldn’t facilitate it. Just this week an acquaintance asked me what I thought of her daughter’s “courageous” bid to not vaccinate her child for fear of “giving her autism”. I reminded her that the fraudulent data had long been exposed and retracted but she said she had seen it on the net and that was that. Dashing my hopes, she next took on statins.

“What do you make of the controversy?”

“There is no controversy,” I replied. “Read the report.”

“You would say that, wouldn’t you?”

Then, after a pause, “But seriously, did you see the story about the old lady who went mad on her statin?”

No, I didn’t. But newspaper editors, please take note!

The term ‘crazy’ shouldn’t be thrown around lightly – ask any woman

Women are crazy. This isn’t me being hysterical; it’s historical. The trope of the crazy woman stretches from Plato to Plath to popular culture. Women, we have been told in thousands of ways for thousands of years, are simply more emotional and more irrational than men.

Madness-as-womanness is something we were first sold by the Ancient Greeks. The problem with women, they decided, was that they had wandering wombs. So, thanks to a few wise men, half the world’s population was diagnosed with a sex-specific disorder: hysteria. As medicine progressed, the definition of hysteria evolved until it was eventually discredited. Nevertheless the idea that women were biologically wired for instability became engrained in culture. What’s more, women started actively buying into the idea. The crazy woman began taking on a crazy appeal.

There is, perhaps, no better example of this than The Bell Jar, Sylvia Plath’s classic autobiographical novel about a woman driven to insanity, in part, by the constraints imposed on her by society. Published in 1963, the novel influenced generations of women, inspired a wave of female confessional writing, and continues to have an enduring appeal. Earlier this year it was announced that Kirsten Dunst is to direct a new movie adaptation.

There are many types of “crazy woman”, each fulfilling slightly different roles. In the taxonomy of crazy women, Plath’s protagonist, Esther Greenwood, is the doomed heroine, the woman that society wants to keep as a girl. While Esther gave crazy character, a majority of “crazy women” are caricatures of female sexuality. Hell hath no fury like a woman scorned, and history has a lot of scorned women: Miss Havisham, the psychotic spinster in Great Expectations; the bunny boiler, made famous by Glenn Close in Fatal Attraction; the psychopathically sexual Amy Dunne in Gone Girl.

What all these characters have in common, however, is that over time they have become more than a trope; they have become a cultural norm. The “crazy woman” has become a kneejerk way to put women in their place and remind them that, no matter what they achieve, they are inherently flawed.

Take Taylor Swift, for example: she is worth $ 250m (£190m) and is one of the US’s richest self-made women. Impressive, eh? However, Swift is routinely mocked by the media; painted as a clingy man-eater who races through boyfriends then enacts lyric-based revenge on her ex-lovers.

Swift could have ignored the persona the media had created for her but she chose to satirise it with her hit single Blank Space. This featured lyrics like: “Got a long list of ex-lovers/They’ll tell you I’m insane,” and was accompanied with an over-the-top music video in which she acts out the crazy woman she is painted to be. “Everybody in these tabloidy gossipy blogs thinks they have you pegged, like ‘Taylor’s boy-crazy,” she told Vanity Fair. “I’m work-crazy. That’s the thing that I’m crazy about, that I don’t stop thinking about.”

Swift isn’t the only woman to have subverted the entrenched narrative around “crazy women”. Indeed the TV show Crazy Ex-Girlfriend (on Netflix), tackles it head on and has become an unexpected hit. The musical-comedy features Rebecca Bunch, a high-flying but depressed New York lawyer, who quits her job and moves to California because her boyfriend from summer camp lives there. So far, so “crazy woman”. But the show’s theme song dramatises its tension and demonstrates there is more: “She’s the crazy ex-girlfriend!” the chorus trills. “What? No, I’m not! That’s a sexist term!” replies the star. “The situation’s a lot more nuanced than that.”

One person I’d wager would not be able to see that nuance is Donald Trump. The presidential nominee routinely calls women “crazy” and reduces them to their bodily functions. In an ironic twist, however, it looks like Trump might be getting served a little taste of the crazy medicine society has been serving women up for centuries.

“Is Donald Trump just plain crazy?” asked the Washington Post. “During the primary season, as Donald Trump’s bizarre outbursts helped him crush the competition, I thought he was being crazy like a fox,” the article explained. “Now I am increasingly convinced that he’s just plain crazy.”

It wasn’t just that particular journalist who gave Trump the benefit of the doubt at the start of his campaign. Initially, his eccentricities were largely explained away. Trump was a man, so he wasn’t mad – he was a maverick. He was crazy like a fox. Now, however, people are starting to wonder whether he is crazy like, you know, a woman.

Related: Time to change the language we use about mental health | Mind your language

As more people start to diagnose Trump as crazy, discussion has sprung up around the suitability of the word. Stop calling Trump “crazy”, urges a recent CNN article. It makes the rational argument that crazy stigmatises mental illness and equates mental illness with incompetence. Basically, it explains, “crazy” is not a nice term and you should be careful how you use it.

Call me crazy, but women are painfully aware of this. Perhaps the ultimate irony is that in thousands of years of dismissing crazy women, it will take one of the craziest men of the 21st century to make us rethink how we’ve used and abused the word.

‘Juicing shouldn’t be taken care of like a slimming craze’

With juice bars popping up all in excess of London, juicing appears like the latest craze. But there is also a whole lot of confusion around the topic –we’ve been told that fruit juices are total of sugar, that cold pressing is the greatest way to extract vitamins and that orange juice in a box is the most evil of them all. So in which does that depart the beginner juicer?

‘We see juices as an addition to a wholesome balanced diet program, when enjoyed with other food items, they can have actual overall health positive aspects, from greater digestion, higher energy ranges and brighter skin,’ Lily Simpson from the Detox Kitchen says.

Earlier this month she invited nutritionists and fitness pros to speak about juicing. ‘With celebrities and versions as frequent ambassadors of juicing, many folks assume it indicates starving by yourself,’ Danielle Copperman, a nutritionist, model and founder of Qnola, a granola-based mostly breakfast merchandise, says. ‘I personally think it is critical to supplement your diet with fresh juice.’

Nutritionist Yvonne Wake agrees: ‘We would be a significantly healthier nation if we had been to take juicing a bit more critically and not treat it as the most current slimming craze. The truth that antioxidants are abundant in a good green juice and we could be so significantly healthier if juicing was part of our everyday existence.’

Now we’re supposed to be consuming at least ten portions of fruit and vegetables per day, in accordance to a 12-year study by UCL in March, and primarily vegetables, which were found to be 4 occasions healthier than fruit. But this, Wake says, is straightforward when you juice. ‘All it takes is one particular juice in the morning, stuffed full of kale, cucumber, celery, spinach and an apple and we would have fulfilled most of our green needs for the day.’

Three juice recipes to attempt at home

And what about sugar? ‘There are so many green juices as options now which can incorporate no sugar at all,’ Simpson says. Companies this kind of as Imbibery London, exactly where all their juices are cold pressed – meaning no heat to destroy off the nutrients. They say their green juice, containing spinach, cucumber, celery, apple and lemon, is their most common (they also have a more tough core version, Phyto, which has parsley instead of apple). One particular bottle includes 1 to two kilos of produce.

Which has the comfort marketplace cornered. But if you do not want to (or cannot afford to) commit £7 for 250ml of juice per day, the nutritionists were in agreement that the very best way is just to do it yourself. ‘Don’t worry also significantly about what you’re carrying out, what machine you are using or what components you are placing in,’ Rhian Stephenson, nutritionist at Psycle London says, ‘just do it.’

Read: Word of mouth: Detox Kitchen, a service producing dieting less dull