Scanxiety: why private baby scans are on the rise

Anxiety may be the scourge of our times, but it now appears we have “scanxiety”, too. According to a study of 2,000 women, the phenomenon of pregnant women paying for extra private scans is on the rise. Almost a third paid for scans during pregnancy, with 36% citing anxiety as a reason. The NHS offers routine scans at 12 and 20 weeks, although more may be given for medical reasons.

“For the last 20 years, it’s been quite common for women to access private facilities for scans,” says Dr Christoph Lees, a consultant in foetal and maternal medicine and obstetrics and a spokesman for the Royal College of Obstetricians and Gynaecologists. “Sometimes it’s simply for reassurance, or because they don’t feel they’re getting sufficient scans on the NHS. Sometimes they’re accessing a service that isn’t routinely provided, such as 3D and 4D scans. Many are what you might call souvenir scans.”

For Lauren McGlynn, who has two boys aged four and nine months, anxiety was the main reason for paying for private scans. “Before my first son, I had two miscarriages,” she says. “I just couldn’t deal with waiting until 12 weeks. I had a private scan at seven weeks, which is the earliest they will let you do it.” Did she speak to her midwife or doctor about her worries and ask for an early scan on the NHS? “I didn’t say anything,” she says. “I just assumed the NHS wouldn’t be able to give an extra scan to every woman who had a miscarriage.”

Mandy Forrester of the Royal College of Midwives believes the rise may be partly explained by the shortage of 3,500 midwives in England (Lees also points to the national shortage of sonographers). “Midwives are pressurised during antenatal appointments and continuity of care is an issue,” she says. “If a woman is seeing the same midwife, it’s more likely they will build a good relationship. It may be that women are not getting the reassurance they need.”

There is also the issue of the small, unconfirmed risk to the foetus associated with ultrasound, which is why multiple scans without sufficient medical reason are not recommended. “And it’s difficult to know the quality of the service,” Lees adds. “While there are many private providers that are extremely good, there are pop-up services where the person doing the scan doesn’t have any training in ultrasound. You don’t need to have a licence to do an ultrasound scan privately.” Does he often see women who have had private scans that have worried them? “I do see women who come back to me with a private scan report,” he replies. “Quite often we have to repeat the scan and sometimes the advice is not correct. [Private scans] can cause concerns that are not necessarily merited, which rather negates their point.”

Scanxiety: why private baby scans are on the rise

If basic healthcare is a privilege, what rights do we have? | Jamie Peck

A right-wing hero was born this past Sunday during the combination bikini contest and civics test that is the Miss USA pageant. In an effort to probe how she’d solve our nation’s problems, host Julianne Hough asked Miss Washington DC (aka Kara McCullough) if she believed “affordable healthcare for all US citizens” was “a right or a privilege,” and why. McCullough answered by saying:

“I’m definitely going to say it’s a privilege. As a government employee, I’m granted healthcare and I see firsthand that for one to have healthcare, you need to have jobs. So therefore, we need to continue to cultivate this environment that we’re given the opportunity to have healthcare as well as jobs to all American citizens worldwide.”

Currently unemployed people, as well as those with bad jobs that don’t provide healthcare, are presumably out of luck. That McCullough wants to help women find work in Stem jobs is admirable, but does nothing to help the vast majority of people.

Of course, her statement is technically true. As things currently stand in the US, healthcare is a privilege, and one you likely need a job to access. (And not just any job … a salaried and/or union one, a holy grail that’s fast disappearing.) As a person with both a job and healthcare, she’s observed this firsthand. But as Ms McCullough is a nuclear scientist, I will assume she understood the question was about how she believes things should be, not how they are. In which case, she’s as wrong and out of touch as any DC royalty currently making policy on this issue.

Now, I’ll admit it’s tough to prove beyond the shadow of a doubt that people deserve basic levels of physical safety simply by virtue of being human. To do so would require a philosophical deep dive above my level of expertise. But our founding documents — which I’d hope someone with the surname “USA” respects — have already sided with the “yeas” on the existence of certain inalienable rights, chief among them “life.” And an estimated 45,000 Americans die each year from lack of health insurance. This is not just another commodity, but a necessity on the level with food and shelter. Which, to be fair, Republicans also want to take away from the poor.

Beyond that, it comes down to a simple matter of preference: do you want to live in a society that codifies some level of responsibility to our fellow citizens, or would you rather roll the dice on a Randian dystopia where the lazy, unlucky or otherwise uncompetitive are liquefied into paleo shakes for rich people? Maybe I can’t objectively prove which is “better,” but I know which I’d prefer. Contrary to what social Darwinists would tell you, one cool thing about being human is we (theoretically) get to decide which ideals we want to pursue.

When healthcare is a for-profit enterprise, costs skyrocket and access plummets. While the Affordable Care Act reined in some of the industry’s worst abuses, an estimated 27 million are left uninsured under it, a number that’s slowly climbing as companies raise premiums and pull out of exchanges.

Even those who are insured report problems paying for care due to high deductibles, and, more generally, to being insured by companies whose business model is to dole out as little coverage as they can legally get away with. The Republican party is currently in the process of turning 27 million into 52 million with their ironically named “American Healthcare Act.” Soon, 45,000 deaths a year will seem like the good old days.

As every other country in the developed world knows, the only way to increase coverage to 100% — as well rein in absurdly high per capita spending on a bloated private industry — is with a system of state-funded healthcare. It works everywhere else, and many experts say it would work here.

The American people are on board. A 2017 Economist/YouGov poll found about 80% of Democrats and 40% of Republicans — yes, Republicans! — favor a federally funded health insurance system that covers all Americans. All race, age, income, and gender demographics favor it by simple majorities, and many — particularly the most marginalized — by strong ones. Even Republicans and conservatives approach 50%. Those who voted for Hillary Clinton favor it at a rate of some 85%.

Unfortunately, this is one of many areas where the country’s political class refuses to even remotely entertain the will of the people. Neither Democrats nor Republicans are willing to do the empathetic, fiscally responsible thing.

We all know Republicans will happily let people die to pay for oligarchs’ tax breaks. But even most elected Democrats remain irrationally committed to compromising with an industry that wants you dead. This becomes more comprehensible when you look at the amount of money the insurance lobby gives to both parties. Despite its immense popularity with voters, single-payer will be on neither party’s agenda in 2018.

In stating that affordable healthcare is a privilege that should be reserved for gainfully employed people, McCullough showed she’ll fit in just fine with the other undemocratically elected rulers in DC. President Trump might not own the Miss USA pageant anymore, but his cutthroat spirit lives on.

If basic healthcare is a privilege, what rights do we have? | Jamie Peck

Omid has an incurable condition and wants to die – it’s time the law changed | Saimo Chahal

Omid, a 54-year-old man who lives and works in London, was diagnosed with multiple system atrophy in 2014, a condition that cannot be cured and affects the nervous system. He has a wife and children but rarely sees them in order to spare them the agony. He attempted suicide in 2015 and was then moved to a nursing home. Even with care and family support, Omid wants to die to relieve his suffering. The alternative is to seek assistance to die abroad, but this will cost £10,000-£14,000, and he can’t afford this.

Omid wants to change the assisted dying law in England and Wales – a courageous and selfless act considering his condition. He wants to help others and to leave a legacy. The current law, although it does not criminalise suicide, forbids helping or encouraging suicide.

Omid argues that the law violates his right to private life, in breach of the Human Rights Act. The law does not allow him, and other competent and informed people in his situation, to choose how and when to die. He wants the high court to declare the law incompatible with the concept of human rights.

Rather than being terminally ill Omid has several years to live in this unbearable condition. Previous, failed attempts to change the assisted dying law, by Lord Falconer and Rob Marris, restricted assisted dying to terminally ill people with six months to live. This is a crucial difference with the current, ongoing Noel Conway case. Omid is asking for a change of the law for those with incurable conditions who may have many years of misery and pain ahead. The passing of an assisted dying law for terminally ill people would not have helped him.

The most recent right-to-die case in the UK involved Tony Nicklinson and Paul Lamb in 2014. A majority of judges (5-4) in the supreme court said that, although the court could make a declaration that the law on assisted dying was incompatible with the concept of human rights, they would allow parliament the opportunity to debate the issue first.

Parliament has recently considered the law on two occasions: in 2013, Lord Falconer’s bill proposed that terminally ill, competent adults should be allowed to request and receive assistance in dying after approval by two doctors. The bill did not have enough time for a full review in parliament, but in any case, would have been too narrow to help Omid who has an incurable, yet non-terminal condition.

Rob Marris’s bill was hastily defeated by the House of Commons on 11 September 2015 by 330 to 118 votes. Many found the debate unimpressive, raising questions as to whether parliament is the right forum for such legally complex and morally charged questions.

The main arguments against Omid’s case are that it will lead to a “slippery slope” (for instance, assisted dying leading to the legalisation of euthanasia) and that it will make weak and vulnerable people susceptible to harm. But there is no evidence from other countries that problems of this sort have occurred. It would not be difficult to devise a system that makes sure that the system is not abused – for example by having two independent doctors certify that the decision is freely made and without pressure from relatives.

The courts have tried to duck out of the responsibility once for not making the decision – they cannot afford to do it again if society is to have confidence in the legal system. The pain and misery this is causing is unbearable for people like Omid. They require and deserve the protection of the courts. The time has come for a change in the law.

• To find out more about Omid’s case, click here

Omid has an incurable condition and wants to die – it’s time the law changed | Saimo Chahal

3D-printed ovaries allow infertile mice to give birth

Infertile mice have given birth to healthy pups after having their fertility restored with ovary implants made with a 3D printer.

Researchers created the synthetic ovaries by printing porous scaffolds from a gelatin ink and filling them with follicles, the tiny, fluid-holding sacs that contain immature egg cells.

In tests on mice that had one ovary surgically removed, scientists found that the implants hooked up to the blood supply within a week and went on to release eggs naturally through the pores built into the gelatin structures.

The work marks a step towards making artificial ovaries for young women whose reproductive systems have been damaged by cancer treatments, leaving them infertile or with hormone imbalances that require them to take regular hormone-boosting drugs.

“Our hope is that one day this ovarian bioprosthesis is really the ovary of the future,” said Teresa Woodruff at Northwestern University in Chicago. “The goal of the project is to be able to restore fertility and endocrine health to young cancer patients who have been sterilised by their cancer treatment.”

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Of seven mice that mated after receiving the artificial ovaries, three gave birth to pups that had developed from eggs released by the implants. The mice fed normally on their mother’s milk and went on to have healthy litters of their own later in life.

Writing in the journal Nature Communications, the scientists describe how they printed layered lattices of gelatin strips to make the ovary implants. The sizes and positions of the holes in the structures were carefully controlled to hold dozens of follicles and allow blood vessels to connect to the implants. Mature eggs were then released from the implants as happens in normal ovulation.

Chemotherapy and high doses of radiation used in cancer treatment can destroy some or all of a woman’s eggs, putting them at risk of infertility and an early menopause. And while doctors have had some success in restoring women’s fertility from frozen ovarian tissue, an implant could potentially help those who do not bank healthy tissue when they are children.

Monica Laronda, a co-author on the study, said that an ovary implant could also help cancer survivors whose eggs are so damaged that they need hormone replacement therapy to trigger puberty. “We’re thinking big picture, meaning every stage of the girl’s life, so puberty through adulthood to a natural menopause,” she said.

A microscopic image of an immature mouse egg, surrounded by supportive cells, after it has been housed in a bioprosthetic ovary scaffold for six days. Photograph: Northwestern University

Scientists have made artificial ovaries for mice before, but the latest research is believed to be the first time that researchers have used 3D printing to manufacture them. It is not clear if the same approach will work in people because human follicles are much larger and grow rapidly until they are visible to the naked eye.

Other animal experiments performed nearly a decade ago hinted that women who had ovarian tissue transplants later in life might enjoy broader benefits from the procedure than restored fertility. In 2010, scientists at Kato Ladies Clinic in Tokyo found that ovarian transplants extended the lives of old mice, and led older females, who were normally inactive, to seek out mates and have babies. The researchers conceded that far more work was needed to assess the effects in women.

Advances in 3D printing have already transformed some areas of medicine by allowing the doctors to make bespoke body parts that can be directly implanted into patients. Last year, South Korean surgeons printed a titanium heel bone for a man who had a tumour removed from his foot.

Meanwhile, researchers in North Carolina announced that they had made ears, jawbones and skeletal muscles by 3D printing structures laced with living cells. Other groups have printed vascular networks that will be vital for creating large synthetic organs in the lab.

3D-printed ovaries allow infertile mice to give birth

The Guardian view on the Labour election manifesto: widening the bounds of the thinkable | Editorial

Labour’s 2017 general election manifesto is a big break with the recent past. Whether the manifesto allows the party to make a fresh connection with the British electorate won’t be clear until 9 June. What is beyond doubt is that this manifesto proclaims that politics and government in Britain do not have to be done in the way the country has long been accustomed to. That is true, and Labour is offering the country a real choice. So far, so very good, on both counts.

Jeremy Corbyn’s biggest achievement is to put several propositions back into the arena that had been thought extinct. That does not mean all of them deserve a new lease of life equally. Nationalisation in the shape of expensive, centralised public ownership is one to treat with caution, not least because of the power it gives to trade union leaders to drive up costs. There are signs that Labour’s economic team recognises that, but not enough detail about how it can be done. Other changes, though, are more straightforwardly welcome. The most important of these concerns taxation.

For 30 years or more, taking its cue from America, British politics took it as axiomatic that all voters will always recoil from increased taxes. Understandable though this was in some ways, it was a denial of the principle of social responsibility. As a result, throughout this era, parties have had to contrive ways of providing good levels of public provision without overt tax increases. Not surprisingly, this has become increasingly hard to maintain, and the effect on public goods has often been brutal. The no-tax assumption reached its nadir in 2015 when David Cameron and George Osborne promised no rises in income tax, VAT or national insurance for all. But it was an unachievable fantasy, as Philip Hammond found in the recent budget.

Labour is right to level with voters that tax rates cannot be set in stone for ever. Governments must be able to respond to economic changes, and those that want to invest in new programmes or projects must either borrow or tax to do so. Labour proposes to do both, which may alarm some voters. But the principle that fair and necessary taxes are a mark of a civilised society is the right one, and voters understand that they must rise as well as fall. Too few parties have been honest about this in recent times – the Liberal Democrats are an exception. Today it is not just Labour that is striding boldly into this territory. Even the Conservatives see the point of keeping options open. But it is Labour that confronts the issues with welcome audacity.

The real question is whether Labour is proposing the right level of tax take and the right mix of taxes and spending. There is a discussion to be had here. Taxes on income are very important, but taxes on wealth, including houses and land, which are less easy for the asset-rich to avoid, do not get as much focus as they should. Labour’s boldness does not extend to uprating and reforming council tax bands, for instance; instead only a review into reform is promised. There is nothing in the manifesto about fuel or alcohol taxes, both of which raise money and have social dimensions too. Abolishing tuition fees is an expensive subsidy to the better-off.

It is possible that the election has simply come too quickly for Labour to work everything out properly here. Some of the changes that have been made to the leaked draft last week add to that impression, though politics is involved too. The section on Trident and Nato has been sharpened at Mr Corbyn’s expense. The earlier plan to halt NHS reforms has wisely been replaced by a review. Looked at overall, Labour’s manifesto is a mixed bag of pledges, with some strange inclusions and other surprising omissions. Though radical in some ways it is conservative in others. The section on union rights is detailed and extensive, but that on the future of the United Kingdom is perfunctory. There is not as much sense of the future as there should be.

At 124 pages, this is a long manifesto. But it is not a suicide note. In terms of its social democratic credentials, the 1983 manifesto it most resembles is that of the Liberal/SDP Alliance rather than Labour’s. Its achievement is to expand the limits of the thinkable in British politics. Its weakness is that it does too little to make the thinkable seem realistic and practical. That reflects Mr Corbyn’s preference for energising his own support rather than persuading those outside it. This manifesto may not win Mr Corbyn the general election, but it could cement his support within his party.

The Guardian view on the Labour election manifesto: widening the bounds of the thinkable | Editorial

You can cut an avocado safely, now learn to help someone with epilepsy | Letters

Last week amateur chefs everywhere were absorbing instructions on how to cut an avocado, after a post-brunch A&E influx of injuries sustained while trying to prepare the fruit (Pass notes No 3,853: Avocado hand, G2, 11 May). Now I hope the nation might broaden their knowledge further by learning how to help someone having an epileptic seizure. It’s National Epilepsy Week, and our new YouGov poll shows that two-thirds of UK adults with no experience of epilepsy would not know how to help. This is worrying when London Ambulance Service alone attends 40 epileptic seizures a day. Taking two minutes to read our seizure first aid steps – www.epilepsysociety.org.uk/10-first-aid-steps-for-convulsive-seizures – could make all the difference in a crisis.
Clare Pelham
Chief executive, Epilepsy Society

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You can cut an avocado safely, now learn to help someone with epilepsy | Letters

US teenager dies after succession of caffeine drinks in two hours

A teenager in the US died because he consumed too many high-caffeine drinks in a short space of time, a coroner has said.

Davis Allen Cripe died last month, about an hour after collapsing in his high school near Columbia, South Carolina. The 16-year-old had consumed a latte from McDonald’s, a large Mountain Dew drink and a highly caffeinated energy drink in just under two hours, Richland county coroner Gary Watts said.

Doctors said Davis died from a “caffeine-induced cardiac event causing a probable arrhythmia”, according to Watts.

He added that the teenager was considered healthy and the autopsy showed no sign of an existing undiagnosed heart condition.

“This is not a caffeine overdose,” said Watts. “We’re not saying that it was the total amount of caffeine in the system, it was just the way that it was ingested over that short period of time.”

Davis weighed about 90kg but would not have been considered morbidly obese, according to Watts, who added that he would have been unharmed by the same amount of caffeine on another day.

“We’re not trying to speak out totally against caffeine,” said Watts. “We believe people need to pay attention to their caffeine intake and how they do it, just as they do with alcohol or cigarettes.”

The particular energy drink Davis drank was not known but a witness said it was from a container the size of a large soft drink.

According to caffeineinformer.com, a McDonald’s latte has 142 milligrams of caffeine, a 20-ounce Mountain Dew has 90 mg, and a 16-ounce energy drink can have as much as 240 mg.

The US Food and Drug Administration and European Food Safety Authority both say that caffeine consumption of up to 400mg a day – about four or five coffees – is believed to be safe for adults. The EFSA says 200mg a day is safe for women who are pregnant or breastfeeding and that single doses of up to 200mg do not give rise to safety concerns. The American Academy of Pediatrics discourages the consumption of caffeine and other stimulants by children and teenagers.

Caffeine has been linked to previous deaths, although the cases are few and far between and the link not always clear-cut. In 2011, 14-year-old US schoolgirl Anais Fournier, who had a pre-existing heart condition, died after drinking two cans of Monster energy drink, containing a total of 480mg of caffeine. The company denied any responsibility.

In 2015, two students at Northumbria University, were were left fighting for their lives after they were accidentally given the equivalent of 300 cups of coffee in a botched experiment. They eventually made a full physical recovery.

Tony Heagerty, professor of medicine at Manchester University, said it was likely that Davis had a genetic heart condition, which may not have revealed itself in the autopsy, and that the caffeine put stress on his heart.

“I think the caffeine must have interacted with something wrong with this heart,” he said. “If you are an unfortunate person with a pre-existing condition and put yourself in a stressful situation by drinking too much caffeine you are in danger.”

But he said the levels consumed by Davis would not be harmful to the overwhelming majority of people, except for making them feel strange.

Mike Knapton, associate medical director at the British Heart Foundation, said: “It is well known that caffeine increases a person’s heart rate but it can also trigger more serious effects, including heart palpitations, in those who are more sensitive to caffeine.

“People with cardiac abnormalities, including inherited heart conditions, and those who drink toxic amounts of caffeine are more susceptible to the side-effects of caffeine. Tragic accidents like this are rare but, with increasingly strong coffees and caffeinated drinks on the market, moderation is key to monitoring your caffeine intake.”

Caffeine – what are the dangers?

The World Health Organisation recognises caffeine use disorder and caffeine dependence as illnesses.

Drinking large amounts of coffee can lead to unpleasant side-effects such as irritability, problems sleeping, restlessness, according to the NHS.

It can also result in babies having a low birth weight, which can increase the risk of health problems in later life, or miscarriage.

Caffeine constricts the coronary arteries, leading to a temporary rise in blood pressure. If drunk in sufficient quantities it causes calcium to be discharged from inside cells and causes the heart to beat faster. In the most extreme cases – caffeine toxicity – it causes major organs to shut down.

Symptoms of a caffeine overdose include dizziness, nausea, vomiting, convulsions and a high heart rate.

US teenager dies after succession of caffeine drinks in two hours