For years, France fought to move beyond its sleepy image abroad as the quiet heart of fine dining and museums by heavily promoting its growing club scene, festivals and underground music culture.
But now French DJs, club owners and festival bosses are warning the nation’s ability to party is under threat from tough new restrictions on decibels and basslines.
Pioneering DJ Laurent Garnier and Jean-Michel Jarre, the godfather of French electronic pop, are among a group of music figures who have published an appeal in the daily Libération warning that new rules on lowering noise risk silencing performers and killing nightlife.
A public health decree published by the centrist government of President Emmanuel Macron in August was designed to help reduce hearing problems linked to loud music at clubs, concerts or festivals. It lowers the maximum sustained sound level by three decibels, to 102, and puts limitations on the volume of the deep basslines found in house, techno or drum’n’bass.
In their open letter, club professionals warned the decree risked curtailing the unique experience that is the French music scene after dark. The rules would “quieten down fun, muzzle music and stop artistic work living in its physical dimension”, the signatories pleaded.
“Public health worries us as much as the next citizen,” they added. “But we fear that artistic freedom is being sacrificed.” They complained that noise restrictions on amplified music were “an attack on the moral rights of performers over their work”.
They argued that powerful basslines that make people want to dance delivered a sensation “just as keenly felt as a beautiful voice is by other music fans”.
The rules are expected to come into force across France next year and will affect festivals and venues with a capacity of more than 300 people. Clubs and venues will be obliged to put up signs warning of risks to hearing from loud music as well as providing free hearing protection such as earplugs. They will also have to create quiet areas where the public can rest their ears from the music or else provide gaps in the music where the decibel level stays at 80 or lower.
Paris, which a decade ago was nicknamed the “city of sleep” for its relatively small club scene, has since seen a surge in venues in the city centre and the northern outskirts and promoters were keen not to hinder their growing success – particularly of small venues.
But music figures said it would be particularly difficult for smaller clubs across France to conform to the new rules.
A spokeswoman for the CSCAD union for music venue-holders and festival organisers told the Guardian: “This is a threat to our whole cultural aesthetic. It threatens works played and performed by artists at festivals and concerts everywhere, all types of music. You can’t ask a drummer to drum ‘softly’ even if they are playing with an orchestra.”
She acknowledged that it would be very difficult to overturn the decree but said dialogue was needed.
“We know there are health issues linked to hearing. That is worrying for the industry and we see younger audiences standing very close to speakers,” she said. “But it’s extremely important that we all sit down and talk through these measures that are almost impossible to apply. Even the fact that the decree mentions the word ‘discotheque’ – that term doesn’t exist anymore. This is going to affect all gigs and night-time music. We want to sit down and think about these problems together.”
French hearing associations estimate that between 6 million to 8 million people – 12-13% of the population – have hearing problems. Specialists say listening to loud music on headphones is the cause of increasing health problems, particularly among young people, while some experts recommend wearing earplugs at concerts or in loud clubs.
Doctors are warning that the rise of an almost untreatable superbug, immune to some of the last-line antibiotics available to hospitals, poses a serious threat to patients.
The number of lab-confirmed cases of the bug, called carbapenemase-producing Enterobacteriaceae (CPE), rose from three to nearly 2,000 in the 12 years to 2015, according to Public Health England (PHE). But that may be far short of the real number because hospitals are not compelled to report suspected cases. PHE admits it does not know where the infections are coming from or how many people are dying.
Freedom of information requests made by the Bureau of Investigative Journalism reveal that at least 81 people infected with CPE have died since 2009 at 66 NHS trusts in England – although the bug may have been a complicating factor rather than the main cause of death in some cases.
But the real figure is almost certain to be much higher. Many trusts did not respond to the requests or were unable to supply complete data. Out of 136 NHS hospital trusts that were asked for the numbers of infections and deaths between 2009 and 2016, 97 responded but nearly half did not have data on CPE or could not extract the details.
In Manchester and London, dealing with CPE has cost NHS trusts almost £10m. There have also been confirmed outbreaks in Liverpool, Leeds, Sheffield, Birmingham, Nottingham, Colchester, Edinburgh, Belfast, Dublin and Limerick, among others.
Elsewhere, Italy had only sporadic cases of CPE in 2009 but by 2014, the bugs were rife across the country. “If you look at Italy they’ve suspended bone marrow transplant programmes,” said Dr Matthew Laundy, consultant medical microbiologist at St George’s University Hospitals NHS Foundation Trust. “If you’ve got no antibiotics to treat CPEs you’re stuck.”
Experts are calling for reports of suspected CPE infections to be made mandatory. The numbers revealed by the Bureau are “shocking,” said Val Edwards-Jones, emeritus professor of microbiology at Manchester Metropolitan University.
“It should absolutely be mandatory for trusts to report this,” she said. “If you go back to the 1990s MRSA [reporting] wasn’t mandatory. It was only when hospitals did proper surveillance and began looking at the bugs in the blood that we knew the scale of the problem. Then it was found that there were certain things that weren’t being done correctly.”
Dr Michael Cooper, a consultant microbiologist and director of infection control at the Royal Wolverhampton NHS Trust, said: “If something’s not mandatory, it’s the places doing well that take care to report. You don’t get figures from the trusts with their head in the sand, the poor performers.
“Public Health England have no idea how many people are dying, they’ve no outcome data. This is a serious mistake.”
CPE is carried harmlessly in the gut, but may kill if it enters the bloodstream through a wound of a patient who is already sick or frail, which makes it a real danger in hospitals. About 40-50% of patients with a CPE bloodstream infection die. CPE is not untreatable, but it is difficult as antibiotic combinations or older, more toxic drugs have to be used.
CPE, dubbed the “nightmare bacteria” by Tom Frieden, former head of the Centers for Disease Control and Prevention in the USA, has developed resistance to the carbapenems, a group of “last resort” antibiotics that are used in serious infections when other drugs will not work. They include KPC (Klebsiella pneumoniae carbapenemase) and NDM (New Delhi Metallo-beta-lactamase).
Experts have warned that antibiotic resistance is a major threat to the world and could turn the clock back on medical advances by making some surgery, such as heart transplants, impossible.
There are high levels of CPE in India, Bangladesh, Pakistan, the Middle East, south and Central America, China, southeast Asia, Taiwan, Japan, some countries in southern Europe and the USA. In February the World Health Organisation named carbapenem resistant bugs a “critical priority” for which new antibiotics are urgently needed.
In 2014, the medical directors of both Public Health England and NHS England took what they called “the unusual step” of writing to all NHS Trust chief executives, urging them to take action to prevent the spread of CPE.
“CPE represents one of the most serious emerging infectious disease threats that we currently face, and the failure to control their spread now, while we still have the opportunity, could have substantial human health and financial consequences,” wrote Dr Paul Cosford and Sir Bruce Keogh.
However, Professor Alan Johnson, head of the department of healthcare-associated infection and antibiotic resistance at PHE, said patients should be reassured that infections caused by CPE can usually be treated with other antibiotics. Fewer than 2% of E coli or Klebsiella bloodstream infections are resistant to carbapenems, he said.
“We carry out enhanced surveillance on carbapenem-resistant bacteria to determine the numbers and different types of CPE. Although reports of CPE have increased recently, part of this may reflect increased laboratory testing of many sample types other than blood stream infections, as awareness of CPE has grown,” he said.
New figures show that four times as many people have died as had previously been reported in an outbreak in Manchester.
In 2009, the first cases of a type of CPE called Klebsiella pneumoniae carbapenemase were detected. In 2014, the hospital trust confirmed that 14 people had died from this infection, contracted within the hospital, in the previous four years.
But the Bureau’s research shows that there have been 61 deaths in the last seven years, including a six-year-old boy with leukaemia who caught the infection while undergoing a bone marrow transplant.
Many of those affected were very ill and had underlying medical problems and so it is not known whether the infection directly caused their death. Some may have died with a CPE infection rather than from it.
An investigation into the outbreak found in 2015 that CPE bacteria were living in the hospital kitchen sinks and handwash basins, which had drains that allowed splashback. Hugh Pennington, a leading microbiologist who chaired official inquiries into E coli outbreaks in 1996 and 2005, said such basins elsewhere in the NHS should be replaced. “It’s all about sound plumbing. It’s not rocket science. If your sink is going to spread the bug, get rid of it.”
Sarah Weddington is the lawyer who, aged just 26, represented “Jane Roe” in the landmark case Roe v Wade, which in 1973 effectively legalised abortion in the US. The daughter of a Methodist minister, she was born in 1945 in Abilene, Texas. Having graduated with a degree in English from McMurry University, she enrolled at the University of Texas Law School in 1964, one of 40 women among a student body of 1,600. “I thought I would be teaching eighth graders to love Beowulf,” she recalls. “But that wasn’t working out so well, so I decided to go to law school instead. In this, I was encouraged by the dean of my college, who told me that it would be far too tough for a woman. ‘As sure as dammit I am going,’ I thought.”
After graduating, she joined a group of students who were seeking to challenge anti-abortion laws, agreeing to file a suit against the state of Texas on their behalf. Soon after, 21-year-old Norma McCorvey was referred to Weddington and her colleague Linda Coffee, now actively looking for pregnant women who were seeking abortions. McCorvey became the plaintiff “Jane Roe”, though by the time the supreme court issued its ruling, her baby had long since been born and given up for adoption. McCorvey later became an evangelical Christian and vocal anti-abortion campaigner, and claimed to have been the “victim” of the Roe v Wade lawyers. She died last month aged 69.
I was very nervous. It was like going down a street with no street lights. But there was no other way to go
Weddington remains the youngest person ever to have argued a successful case at the supreme court. In 1973, she was elected to the Texas House of Representatives, where she served for three terms. In 1973, she became the first female General Counsel at the US Department of Agriculture. From 1978 until 1981, she served as assistant to President Carter, directing his administration’s work on women’s issues. She now runs the Weddington Center, Austin, whose work focuses on women and leadership. She recently told NBC news that the election of Donald Trump may pose the biggest threat yet to abortion rights in the US.
Where were you on election night? Did you sense that Trump was going to win? Austin is one of the more liberal towns in Texas, though the state itself is barely liberal. Most people I know strongly expected Hillary to win. But I’d been on a panel a few weeks before where a man had said: “You liberals think Hillary is going to win. Well, let me tell you, there are a lot of people out here who are voting with our finger – the middle finger.” So I knew there was… resistance. There were a lot of parties on the night, but I had enough concerns to be afraid that going to one might turn out to be too depressing. So I came here to my office, and watched it on the New York Times website.
What’s your impression of the president so far? I thought he would be terrible, and he has proven me correct. In Texas, we have a lot of people from Mexico and El Salvador, and a lot of them are worried family members will be deported.
What do you make of the growing fear that under this administration Planned Parenthood [a 100-year-old nonprofit organisation that is the largest single provider of reproductive health services, including abortion, in the US] will lose its federal funding? The federal government has never given money to Planned Parenthood for abortion. It gives money to it for the provision of contraception and well woman care: for the treatment of venereal disease, mammograms, and so on. The anti-abortionists recognise that the money is not used for abortion, but they want it cut off anyway. It is a real threat. But Planned Parenthood may ultimately benefit from what Trump is doing and saying. Last week, I was in Houston for a Planned Parenthood event. Usually, there would be about 1,000 people in the audience. This time, we had 2,500. People are very worried, and they are giving more generously.
What about abortion? Is it possible it could become illegal again in the US? Trump has always said that he would try to appoint people who were strongly against abortion to the supreme court. But Neil Gorsuch [a conservative judge, and Trump’s nomination to the supreme court] has never said that much about abortion. States can’t make abortion illegal. But some have been passing laws that make it much less available, for instance by saying that no abortion can be done except in a facility that meets the requirements for emergency care. In other words, they make the cost of abortion much higher. A lot of women are already crossing state lines, and in that sense, a lot of what is happening is just like it was before Roe v Wade was decided. You’ve got one vacancy now on the supreme court. But Ruth Bader Ginsburg, who is helping to keep abortion available, is 83, and there are a couple of older male judges too. If Gorsuch’s nomination is approved, will abortion be illegal the next day? No. One new judge won’t necessarily make much difference. But two or three might.
How did you feel on hearing that Norma McCorvey had died? Well, I was sad. I appreciate that she was once concerned with overturning the law on abortion. But on the back of being Jane Roe, she ended up going on all these pro-choice tours. I learned to be very careful about believing what she said.
You worked somewhat against the odds on the case in which she became involved. That’s right. There was a building across the street from the University of Texas and a lot of student organisations had cubby holes there, with desks rescued from the garbage. In one little nook, women and some men were trying to work on women’s issues. One thing that was upsetting was that the university health centre did not give out information about, or prescriptions for, anything relating to contraception. A couple of these women had gone to New York and got a copy of Our Bodies Ourselves [a landmark book of 1971 that dealt plainly and openly with women’s health and sexuality] – I still have this mental image of them in a closet with a flashlight reading this book – and they began to give the relevant information out to women. As they did, women would sometimes say: “I’m already pregnant. Where can I get an abortion?” So they started going to places where abortion was available, and they’d write up that information, too. Sometimes, for instance, they’d write: “This person does not seem very skilled: never send anyone here.” A lot of women were going to Mexico. Abortion was illegal there, too, but it was close to Texas, and sometimes women ended up in the wrong hands because people there wanted to make money out of the situation.
The upshot of all this was that the women students were getting worried the police might arrest them for being accomplices to abortion. We were sitting at the snack bar in the law school one day and one of them, Judy Smith, said: “We need to get a lawsuit filed and try to overturn the Texas law. Would you be willing to do it?” I told her she would be better off with someone with more legal experience. I’d only done uncontested divorces, wills, one adoption for my uncle; I had no experience at all in federal court. “How much would you charge?” she asked. When I admitted I would do it for free, she said: “OK, you are our lawyer.”
Were you nervous? I was very nervous. It was like going down a street with no street lights. But there was no other way to go, and I didn’t have any preconceived notions that I would not win. In 1965, there was a case, Griswold v Connecticut, involving doctors and the supply by doctors of contraceptive devices to a married couple. [Connecticut was then one of two states where contraception was effectively illegal, even if the law was rarely enforced.] Yes, neanderthal. That case was won in the US supreme court, and in its ruling, the court had talked about the right of privacy under the constitution. It was, the court said, for the married couple to decide whether or not to use contraception. So there was a precedent. But I certainly was not confident.
You won in the federal court, but the case still went to the supreme court. Why? In Dallas, the court ruled there was a right of privacy, that abortion should be legal. Henry Wade, the district attorney, then unwittingly helped us. At a press conference, he said: “I don’t care what any court says; I am going to continue to prosecute doctors who carry out abortion.” There was a procedural rule that said if local elected officials continue to prosecute after a federal court had declared a law unconstitutional, there would be a right to appeal to the supreme court.
Did you have any hint at all as you addressed the supreme court that you might win? No, it was impossible to read the justices’ faces. The attorney on the other side started by saying something inappropriate about arguing a case against a beautiful woman. He thought the judges would snicker. But their faces didn’t change a bit.
It was a while before the verdict was released, wasn’t it? I had to argue it twice in the supreme court – in 1971, and again in 1972. On 22 January 1973, I was at the Texas legislature when the phone rang. It was a reporter from the New York Times. “Does Miss Weddington have a comment today about Roe v Wade?” my assistant was asked. “Why?” she said. “Should she?” It was beginning to be very exciting. Then we got a telegram from the supreme court saying that I had won seven to two and that they were going to airmail a copy of the ruling. Nowadays, of course, you’d just go online. I was ecstatic, and more than 44 years later we’re still talking about it.
When you published your book A Question of Choice in 1992, you decided to reveal that in 1967 you’d had an abortion yourself, while you were still a law student. Why did you wait so long to reveal this? Just before the anaesthesia hit, I thought: I hope no one ever knows about this. For a lot of years, that was exactly the way I felt. Now there’s a major push to encourage women to tell their stories so people will realise that it is not a shameful thing. One out of every five women will have an abortion. I was lucky because the man I was planning to marry [Ron Weddington; they divorced in 1974] was with me. He drove me to Mexico. We had gotten information from a woman he knew about where to go, and luckily I was working three jobs so I had the money to pay. It was anxiety-inducing. You’re going across the border to see someone you don’t know. But it turned out that my doctor was very good. I wish I had his name, so I could thank him.
Are you still able to get in touch with the young woman you once were, or does she feel very far away? Well, my hair is white now, so in one way, I don’t see myself as her at all, even if, whatever else I do in my life, the headline on my obituary is always going to be: “Roe v Wade attorney dies.” But in terms of my emotions, yes: I think most women of my generation can recall our feelings about the fight. It’s like young love. You may not feel exactly the same, but you remember it.
Authorities in the Channel Islands are looking at ways to protect residents and visitors from toxic beach gases after the death of a jogger in France that has been linked to the fumes from rotting seaweed.
The government of Jersey said on Monday it was considering the installation of devices to check gas levels from deposits of sea lettuce. Warning signs could also be erected on affected coastlines to tell people of the potential danger posed by rotting green algae.
Jean-René Auffray collapsed while jogging at a river estuary in Brittany, about 50 miles south-west of Jersey. French authorities concluded he died of a heart attack. But they are exploring the theory that he may have been overcome by sea lettuce fumes, following pressure from environment experts.
Gas from decomposing sea lettuce in northern France has been linked to the deaths of wild boars in 2011 and a horse in 2009.
St Aubin’s Bay in Jersey often has sea lettuce infestations. The island’s government, the States of Jersey, said it would monitor the situation and could introduce safety measures, but does not believe people are currently at risk.
The infrastructure minister, Eddie Noel, said the quantity of sea lettuce on Jersey were not at the same level as in France and elsewhere in the world.
“The levels are monitored and if there were to be any buildup, action would be taken to protect public safety,” he said, adding that heavy deposits of rotting sea lettuce – Ulva lactuca – may produce gases, including hydrogen sulphide.
Noel said contractors removed the algae for the Jersey government last summer and trialled the use of gas monitors, which were not activated.
But he said: “A review of operations for the 2017 summer season will include considering greater use of these monitors and possible public safety signage in extreme conditions to warn of the risk, however small, of walking, jogging or exercising dogs in heavily affected areas.”
Noel said it was unreasonable to connect Auffray’s death with the sea lettuce at St Aubin’s Bay and doing so could harm tourism on the island.
Auffray’s death has focused attention on what causes Jersey’s sea lettuce growth, which Noel said was owing to “several elements”. It tends to proliferate in warm, clear, calm, nitrate-rich waters. St Aubin’s Bay is a perfect breeding ground because of its position– it is sheltered and sandy – and because it is rich in nitrates washed from farms in Jersey and northern France, and from the Bellozanne sewage treatment works.
Jersey’s government stressed that the sea lettuce problem was not unique to the island: there have been blooms in Kent, Ireland, Portugal and Italy, commonly in bays with similar features to St Aubin’s.
Possible solutions for the problem include towing it out to sea and dumping it, and the introduction of oysters that feed on nitrates.
The campaign group Save Our Shoreline Jersey (SOSJ) said there was no doubt that sea lettuce released sulphurous gases. “These ‘rotten egg’ smells mean local residents have to shut their windows in hot weather, tourists and locals complain, and seaside cafes suffer from a marked decrease in custom,” the group said.
“Bouncing on the piles of dried lettuce runs the risk of toxic gas escaping, so we recommend small children and dogs are kept from [doing so because] they are much closer to the ground and could be affected before the wind disperses the gas.”
SOSJ said hundreds of tonnes of fertiliser was being used by farms growing Jersey Royal potatoes, and that the island’s growing population was creating more sewage.
Jacqui Carrel, an environmental scientist for SOSJ, said the group had suggested measures such as ploughing shallow furrows at angles to the sea in these areas, dislodging the weed before it takes root. “[But] successive governments have said there is nothing they can do.”
This week, vaccine skeptic Robert F Kennedy Jr announced that he’d been nominated by President Elect Donald Trump to chair a commission on vaccine safety. A few hours later, the transition team issued a statement saying that that Trump was “exploring the possibility of forming a committee on autism”. Last summer, Trump met with Andrew Wakefield, who lost his medical license and was found to have produced fraudulent research linking vaccines to autism. Whether Trump is creating a commission on vaccine safety or autism, the message is clear. Trump is offering prominent support to the conspiracy theory that vaccines cause autism.
The science on vaccines is very clear: they are safe and effective. Vaccines do not cause autism. It’s a waste of our tax dollars to rehash this issue yet again. Vaccines are one of the greatest triumphs of modern medicine. Let’s consider measles, just one of many vaccine-preventable diseases. Before 1963, when the measles vaccine became widely available, 3-4 million Americans got measles each year, of whom 48,000 were hospitalized, 4000 developed encephalitis resulting in long-term brain damage, and 4-500 died. The country’s population has almost doubled since that time.
Trump and others have advocated delaying and spacing out vaccinations. But it’s important to understand that vaccination schedules are based on our scientific understanding of the immune system and disease transmission. A mother passes antibodies to her baby through the placenta as well as breast milk, thereby protecting her child against some infections. These antibodies don’t last forever. If you vaccinate a baby too early, the mother’s antibodies prevent the vaccine from taking effect. But if you wait too long to vaccinate, you leave the child unprotected. For example, studies have shown that by six months of age, over 95% of infants have lost the protection of their mother’s antibodies to measles.
At least until now, we’ve reaped the benefits of high vaccination rates: far less measles than in other parts of the world. When a disease becomes less common, the probability that you’ll come into contact with it goes down, actually giving us more wriggle room in our vaccination schedule. The measles vaccine also works a bit better if you wait until 12 months of age. But if you wait to vaccinate against measles until you’ve got a walking, talking toddler who’s around other kids, you’re putting that child at risk. Moreover, in the past two decades, more and more parents have chosen not to immunize their children, so much so that vaccination rates in some parts of the country are well below those seen in much poorer developing countries.
Parents want to do what’s best for their children. But in many cases, parents’ attitudes about vaccination have little to do with their understanding of the science and are driven by their distrust of the government on the right and the pharmaceutical industry on the left. Lack of trust in government – specifically its ability to create and sustain well-paying jobs in this country – helped elect Trump. As distrust in public institutions rises, conspiracy theories abound. Saying “I don’t believe you” is a way of saying “I don’t trust you,” no matter how much science there is to support a specific policy or course of action.
This isn’t the first time we’ve seen conspiracy theories proliferate about medical science – and it won’t be the last.
I spent two months as an aid worker in Guinea during the Ebola epidemic. In that time, I learned far more about the politics of science and medicine than about the virus itself. West Africans have very little trust in their public institutions – for good reason. These are among the most corrupt, least democratic nations in the world. And they have reason not to trust foreigners: a long history of slave trading followed by the stripping of natural resources for the profit of multinational corporations. We heard on the news that West Africans resisted recommendations about hand washing, safe burials, contact tracing and quarantines. On the ground, they told me that public officials were using the epidemic for political purposes and that expats were mercenaries. Yet we in the West dismissed their cynicism as primitive superstition.
President Elect Donald Trump has been a vocal proponent of numerous other conspiracy theories – about climate change, the media, our elections, Obama’s place of birth, the government’s role in the 9/11 attacks, the Deepwater Horizon oil spill, and the deaths of White House deputy counsel Vince Foster and Supreme Court Justice Antonin Scalia – to name just a few. As these false stories circulate, people lose trust in all institutions, especially the government and the media.
For now, Americans still trust scientists to act in the public’s best interest. We have a duty to live up to their trust. The lives of many Americans, our country’s future and the world’s are at stake.
Trainee doctors in the NHS are often so sleep-deprived that they are in danger of harming patients, the medical profession’s regulator has said.
Increasingly heavy workloads and widespread staff shortages mean the UK’s 54,000 junior doctors are being left to look after wards of patients without proper experience, according to the General Medical Council’s biggest annual survey of trainee medics’ experiences
One in four doctors below the level of consultant say their schedule leaves them sleep-deprived and 43% describe their workloads as heavy or very heavy. Those with the most intense schedules are much more likely to encounter patient safety being put at risk, the survey found.
In one unnamed hospital, a junior doctor was the sole medic left in charge of 300 patients overnight – a case the GMC’s chief executive, Charlie Massey, said was extremely concerning. The risk of the doctor being unable to deal with two medical emergencies happening simultaneously meant such lack of cover should never happen, he said.
“Patients who are in hospital overnight are in a hospital for a good reason and if something should happen to one or more patients during that nightshift, and that trainee has been left alone, that creates real potential risk to patients,” Massey said.
He said he was “astonished” to have learned that a single doctor had been left unsupervised and having to handle the care of so many patients.
The proportion of trainees describing themselves as sleep-deprived rose from 21% in 2012 to 24.4% this year. “This is an increasing and worrying trend and it’s very concerning when doctors say that it’s jeopardising their ability to make good judgments and to provide safe care,” Massey told the Guardian in his first interview since taking up his role last month.
“Sleep deprivation matters because [tired] doctors may not remember all of the things that they should remember – for example, all the things to do to safely intubate an individual – because they are so knackered or may not remember all the patient’s history and may therefore make the wrong clinical judgment about them.”
Massey is so worried by the potential for patients being harmed by rising fatigue and workload pressure among hospital doctors that he has written to every NHS provider of care across the UK warning them to take steps to ensure the safety and quality of care are protected.
“Those responsible and accountable for the delivery of medical education locally must take the appropriate steps to ensure the training of doctors remains protected, particularly as medical training is so often a bellwether for the quality and safety of patient care, and because patients are directly at risk if the support and supervision of doctors in training is inadequate,” he wrote in the letter.
A separate survey of junior doctors, undertaken by the Royal College of Physicians and published on Wednesday, found that 80% of trainee medics say their job sometimes or often causes them excessive stress.
One in four of the 498 junior doctors surveyed by the RCP said their job seriously affected their mental health and 54% said it affected their physical health. Pressure on trainees had reached a “harmful and unsustainable level”, the college said.
Massey said the demands being placed on trainees were now so great that there was a risk of some being “used and exploited” by their hospitals because there were too few staff to cope with the work that needed to be done.
“We have seen some signs that that is beginning to happen,” he said. The GMC, which supervises all doctors’ training, fears that some are not getting the training they need and the next generation of consultants may not be as highly skilled as they need to be.
Massey also voiced unease that the quality of handovers from one set of doctors to another – which are integral to patients receiving good care – had emerged as a growing concern. Young doctors’ clinical education is also being interrupted by them being called out of training sessions to attend to problems involving patients, the GMC found.
Key medical specialties that have seen some of the sharpest rises in demand from patients – such as A&E, acute internal and general medicine, respiratory medicine and gastroenterology – are those where trainee doctors’ workloads have increased significantly in recent years, the GMC found. A total of 53,835 junior doctors – just under 99% of the 54,563 across the UK who were eligible to complete the GMC survey – took part.
Dr Pete Campbell, of the British Medical Association’s junior doctors committee, said: “Patients and the public may be shocked by these findings, but no junior doctor will be surprised. It is still far too common that junior doctors are left sleep-deprived after regularly working beyond their rostered hours, on rotas that are desperately short of doctors.”
NHS Employers said the new contract being imposed on junior doctors in England, which prompted the recent year-long industrial dispute between the BMA and the government, would remove or mitigate many of the concerns behind their rising dissatisfaction.
“We want to support our junior doctors,” a Department of Health spokesman said. “That’s why the NHS has employed 11,900 more doctors since 2010. Yesterday, the health secretary announced plans to improve junior doctors’ training, including more support from consultants, more notice of future placements including where couples are placed, reviewing the appraisals process and investing £10m to bring doctors back up to speed when they take time out to have a family or other caring responsibilities.”
Neither in Sally Phillips’ film, A World Without Down’s Syndrome, nor in your review by Julia Raeside (Last night’s TV: A documentary straight from the heart – and that’s the problem, 6 October) was there any reference to “eugenics”. Yet possibly still within living memory proponents of eugenics in America (and elsewhere) were advocating selective breeding to determine the future of society. It is worth noting that such ideas were grounded in the work of Francis Galton, who was a powerful influence on Cyril Burt, who in turn later developed the 11-plus exams. (His influence might be resurrected in the tests used to determine who is most fit for the new grammar schools we’re promised.)
Sally Phillips’ programme does, therefore, offer a timely reminder of the dangers of embarking on a determinist view of society and the risk that selective breeding is acceptable. As Phillips reported, there is a lot of pressure to avoid a potential “burden” as an outcome of the wrong sort of foetus. In America the eugenicists gathered data purporting to show which sectors of society were more (or less) fit for the future. Favoured solutions proposed to avoid a future populated by those deemed to be “unfit” for society included restrictions on immigration and enforced sterilisation. There is much in the history of that movement to warn us of the dangers of a determinist future. It is, therefore, right to have the questions raised: what kind of society do we want; and how kind do we want society to be? Dr Simon Gibbs Reader in educational psychology, University of Newcastle
• Hadley Freeman, in her opinion piece on A World Without Down’s Syndrome, writes that it is genuinely shocking that BBC 2 decided to screen such a blatantly anti-choice message (Sorry, Sally Phillips, but a woman should be able to know if her unborn baby has Down’s syndrome, theguardian.com, 6 October). Is she advocating censorship? In showing the joy her son with Down’s syndrome brings to her family, Sally Phillips is trying to counter negative headlines and arguments. She is not anti-choice. She wants people to have better information. We mothers who have or have had sons or daughters with Down’s syndrome should not be impeded from saying they enrich our families and lead valuable lives. It is important to have a debate about the kind of society we want to live in. Hazel Morgan Dorchester
All 193 United Nations member states are set to sign a declaration agreeing to combat “the biggest threat to modern medicine” in Wednesday’s high-level meeting on antibiotic resistance.
The agreement was reached just before the general assembly convened to discuss the threat of antibiotic resistance, which is only the fourth health issue to trigger a general assembly meeting.
“It’s ironic that such a small thing is causing such an enormous public threat,” said Jeffrey LeJeune, a professor and head of the food animal research program at Ohio State University. “But it is a global health threat that needs a global response.”
The declaration routes the global response to superbugs along a similar path as the one used to combat climate change. In two years, groups including UN agencies will provide an update on the superbug fight to the UN secretary general.
It is estimated that more than 700,000 people die each year due to drug-resistant infections, though it could be much higher because there is no global system to monitor these deaths. And there has been trouble tracking those deaths in places where they are monitored, like in the US, where tens of thousands of deaths have not been attributed to superbugs, according to a Reuters investigation.
Scientists warned about the threat of antibiotic resistance decades ago, when pharmaceutical companies began the industrial production of medicine. The inventor of penicillin, Alexander Fleming, cautioned of the impending crisis while accepting his Nobel prize in 1945: “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant”.
But in the last few years, studies have dramatically increased awareness about antibiotic resistance. There has also been considerable advocacy by health officials, like Sally Davies, chief medical officer of the UK.
“Drug-resistant infections are firmly on the global agenda but now the real work begins,” Davies said in a statement. “We need governments, the pharmaceutical industry, health professionals and the agricultural sector to follow through on their commitments to save modern medicine.”
Signatories to the UN declaration committed to encouraging innovation in antibiotic development, increasing public awareness of the threat and developing surveillance and regulatory systems on the use and sales of antimicrobial medicine for humans and animals.
Only three other health issues have been the subject of general assembly high-level meetings: HIV/Aids, non-communicable diseases and Ebola.
Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, said he was encouraged that unlike with HIV/Aids and Ebola, the UN is addressing this health crisis before it has spun out of control.
“It’s very serious indeed – it’s killing people around the world at the rate of hundreds of thousands of year and we all expect it to get worse if something isn’t done now,” Woolhouse said. “But the UN is coming in at just the right time, in a sense.”
Labour leadership hopeful Owen Smith is to hit out at the threat of creeping privatisation in the NHS, highlighting Department of Health accounts showing that spending on private-sector NHS providers has doubled under the Conservatives.
In a speech on Monday at a campaign trail stop at Trafford General hospital in Manchester, Smith will say that a Labour government led by him would boost health spending by 4% a year, suggesting there is “a secret Tory plan to privatise the NHS”.
Department of Health accounts published on the last day before parliament’s summer recess showed the spend on private-sector NHS providers more than doubled, from more than £4bn in 2009-10 to £8.7bn in 2015-16.
Smith’s early campaign has been dogged by accusations that he lobbied for further private-sector involvement in the NHS during his time as policy chief at the pharmaceuticals companies Pfizer. During his career as a lobbyist for the US firm, Smith had called on ministers to improve incentives for the pharmaceutical industry.
His speech on Monday will attempt to divert attention to his time as shadow health minister, saying that he “fought the Tories’ top-down reorganisation of the NHS line by line”. He will say: “I warned that it would lead to an explosion of privatisation – and that is exactly what has happened.”
Smith, a former shadow work and pensions secretary, has previously claimed it was a gross exaggeration to suggest he had campaigned for more privatisation of NHS services while at Pfizer, and suggested it had been an error for Labour to advocate greater choice over care providers.
He will focus his efforts on health policy a day after Corbyn’s announcement about plans for a national education service based on NHS principles.
For people living with HIV, antiretroviral treatment (ART) has been a life-saver. ART stops HIV from making copies of itself and prevents HIV from attacking the body’s immune system.
At the end of 2015, 17 million people were taking ART around the world and Aids-related deaths had fallen by 45% since the peak in 2005.
But those who don’t stick to the ART regimen set out by their doctor or health worker might become resistant to the drugs. Resistance occurs when ART regimens are not taken as prescribed, which allows HIV to make copies of itself and increases the risk that the virus will mutate and produce drug-resistant HIV. A person who is on a drugsuch as Efavirenz can develop resistance after as little as a two-day interruption of treatment.
Globally, HIV drug resistance is on the rise. The World Health Organisation (WHO) reported that up to 2010, HIV drug resistance levels remained at 7% in developing countries. However, recently, some countries have reported levels at or above 10% among those starting ART, and up to 40% among people restarting ART.
The time to act is now. If we don’t, we may find ourselves with a new global pandemic of drug-resistant HIV.
At the beginning of the epidemic in sub-Saharan Africa, there was fear among the international community that people living with HIV in resource-limited settings would not be able to adhere to their treatment due to a lack of education and resources. Would they be able to keep time well enough to take their ART at the same time every day?
However, studies have demonstrated that people in sub-Saharan Africa may be better than people in the west at taking their ART as prescribed. The issue in developing countries is that people lack the resources to get to a clinic and pick up their pills. I’ve worked in Namibia since 2009, and whenever I visit ART clinics, there are long queues stretching out the door. People often have to wait all day and many can’t afford to take this time off work every month.
The stigma associated with being seen waiting in a queue to pick up medication is also a factor in people not adhering to their treatment plans. To avoid this, some people on ARTs travel to a clinic many kilometres away from their town, so they can receive treatment without anyone recognising them. And if you took a whole day off work, borrowed money for the transport and stood in a queue all day, only to learn that the clinic had run out of your pills, what would you do?
ARTs and HIV drug resistance
As the use of ART increases, so does the risk of HIV drug resistance. It’s no surprise, then, that global HIV drug resistance is on the rise, both among those already on ART and those just starting on it.
What could happen if levels of drug resistance reached critical levels? Their ART regimens would no longer be able to stop the HIV in their bodies from making copies of itself and they would then have to be switched to second-line regimens, if available.
But second-line regimens are more expensive. For countries already struggling to provide ART to those who need it, this would is likely to mean that fewer people could be started on ART.
Related: Can WHO’s new ‘test and treat’ HIV policy reach those who need it most?
Second-line regimens may also have more negative side effects, such as nausea, vomiting, headache, weakness or changes in the shape or location of body fat. These plans can also be more challenging because of the large number of pills that need to be taken. As a clinician, I’ve seen patients who’ve reached the point where they have to take more than 10 pills a day.
Drug resistance has been a problem since the beginning of the HIV epidemic. In the west the problem was usually limited to individual patients. But in resource-limited settings, if a high percentage of the population develops drug resistance we could see large increases in Aids-related deaths and higher healthcare costs.
We must act now to help people adhere to their treatment plans, before it’s too late. Globally, there has been a huge focus on getting more people on treatment, but the quality of how it’s delivered has fallen by the wayside.
Drug resistance will rise when ART is not delivered in a well thought-out way. That requires strong drug supply systems with zero tolerance for an interruption of ART drug supply, strong and locally appropriate counselling to promote adherence, support for patients who don’t have the resources to access care, re-engagement of patients who have stopped going to the clinics, alternative ways to deliver care such as community-based ART groups, and strong medical record systems.
As we strive to end Aids as a public health threat by 2030, greater attention must be focused on identifying and correcting gaps in the quality of ART service delivery. Many lives depend on it and the time to act is now. If we don’t, we may find ourselves with a new global pandemic of drug-resistant HIV and be faced with a deadlier enemy than we started with.
Steven Hong is an assistant professor of public heath and community medicine at the Tufts University School of Medicine.
Join our community of development professionals and humanitarians. Follow @GuardianGDP on Twitter.