Bitter irony: I wanted to speak out about mental health but my anxiety stopped me | Marian Faa

I think and write a lot about mental health. Since being diagnosed with anxiety and clinical perfectionism, writing has become an important way of coming to terms with my own psychiatric ailments, while trying also to raise public awareness. It’s not an easy task. Despite my eagerness and many importunate attempts to give a voice to mental illness, I am often left feeling like the world isn’t ready to listen.

But when mental health week ticked around this year, ears pricked up. My news feed was awash with articles about mental health, friends brandishing popular hashtags and events popping up all around my city.

Finally, a week where mental health was a hot topic, where my issues were on the frontline. If ever there was a time when my humble opinions on the human brain might count for something, this was sure to be it. I panicked.

Determined to seize the opportunity, I started bashing out stories and pitches with intensity, like I was trying to give my computer’s motherboard some kind of frantic deep tissue massage. My mind turned cartwheels. Within 20 minutes I had chewed all my fingernails back to the quick and yanked out a few generous handfuls of hair – telltale symptoms of my escalating anxiety.

I forgot to have lunch. I forgot to pick my little sister up from school. I missed two calls from my partner. But somehow I still managed to singlehandedly pluck all the tiny hairs on my leg, another delightful habit I tend to deploy with fervour whenever I need to curb my anxiety.

As time ticked by and the pressure mounted, I realised I was heading for a nervous breakdown. Maybe I was making too big a deal of mental health week, but that is the very nature of my mental illness – the tendency to inflate and catastrophise. It was a bitter irony: my anxiety was the very thing that stopped me from writing about it.

So I closed my laptop and resolved to stay silent for mental health week. I decided that protecting my own mental state was more important than writing about it. And I reassured myself there would be other opportunities.

See, that’s just it with mental illness. Often we cannot talk about it when the world wants us to – whether that be our families, therapists or the media. And when we are ready to speak up, we can’t find the ears.

Even with efforts to reduce stigma, mental health is an extremely sensitive topic. It takes a long time to develop the personal insight and vocabulary to be able to communicate about our mental states. In my experience, you can only really talk (or write) about it on your own terms and in your own time. This means we need a culture that is receptive to discussions the year round, not just at designated calendar points.

While initiatives like mental health week are exceedingly important, they are not always as beneficial to sufferers in the ways they intend to be. The sudden spike in publicity may feel like a fleeting injection of sympathy that leaves us even more isolated once the week is over and our issues fall into the background once again.

The ephemeral support for mental illness shines with a suspicious veneer, tarnished by the knowledge that talking about mental illness might earn you a hundred likes on Facebook on one day but compromise your job application the next.

On the other hand, the sudden spotlight on mental health can also cause people with mental illness to cringe and withdraw, unnerved (so to speak) by the unfamiliar pressure of public exposure. And then there is the risk of triggers that comes with a disordered flurry of news articles and tweets about mental health.

I am not disputing the merits of mental health week and the media’s reporting of it. I think these initiatives are noble and necessary. I think they are crucial to creating a society that makes it easier to live with a mental illness. But if listening to people with mental illness and understanding their experiences is the most important step in dissolving the silence and stigma, we need to be open on a more general, everyday basis.

We need a culture that is attuned to the nuances of mental illness and accepting of the silences as well as the disclosures. We need a world where mental health is an acceptable topic regardless of time and place, beyond the field days and short-lived social media campaigns.

Bitter irony: I wanted to speak out about mental health but my anxiety stopped me | Marian Faa

Painkillers at £8.50 per pack are a bitter pill to swallow

I was admitted to a private London hospital off Harley Street for a minor operation. Before the procedure, I discussed pain relief with the anaesthetist and said I rarely take painkillers as I have a high pain threshold. I was surprised, just before my discharge, to be given three lots of pain relief of varying strengths, with only vague instructions from the nurse about how to take them.

I was even more surprised to receive a bill from the owner and healthcare provider, Phoenix, for a whopping £25.50 for the drugs (£8.50 a pack), which I presumed to be part of any day package involving surgery requiring a general anaesthetic.

I took a few paracetamol, which I would normally buy at 30p per pack of 16 tablets, but returned the other two packs (ibuprofen and dihydrocodeine) to the hospital. I was covered by private medical insurance via AXA PPP but consider this level of overcharging to be unprofessional and excessive. How can they get away with it? SR,Suffolk

They often get away with it because they can. You contacted your insurer, which explained that this pain relief was not covered by your policy as home drugs are an additional item, and suggested you take it up with the hospital. You would have been given the opportunity to decline the drugs – not necessarily practical if you were a bit woozy post-operation.

Phoenix reiterated its policy on home drugs, apologised for any lack of communication and agreed to refund £17 to your credit card. This is not a huge amount of money, but we can imagine how extras such as this add up. As for private prescriptions costing a whopping £8.50 for tablets costing pennies on the high street, welcome to the wasteful world of private medical insurance.

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Painkillers at £8.50 per pack are a bitter pill to swallow

FDA approval of "female Viagra" leaves bitter taste for critics

It is the modest pink pill that its manufacturers hope will do for girls what Viagra did for men. The choice to give the drug a advertising licence in the US has been cheered on by campaigners for women’s rights, but the question remains no matter whether Addyi is the breakthrough medicine claimed.

Men have the blue diamond-shaped Viagra pill and 25 other individuals as well (even though 17 of individuals are kinds of testosterone), although there has so far been no counterpart for women until finally now. But sex and relationship therapists say Addyi is only moderately powerful, need to not be taken with alcohol, and has potentially severe side-effects which includes fainting and abnormally minimal blood pressure.

Related: FDA approves ‘female Viagra’ pill Flibanserin right after two rejections

Some of the women who testified before the US drug licensing committee, the Foods and Drug Administration, seemed to think the pill would bring back the passion and romance of times past, but there are fears they are currently being sold an unfulfillable dream.

“I am concerned about the expectations that ladies have,” said Cynthia Graham, professor in sexual and reproductive overall health at the University of Southampton. “Among women who spoke at the FDA there had been expectations that you can have sexual desire that is at a large level and absolutely nothing is going to influence it – that it will be correct back the place it was when you met your companion.”

The trials display that Addyi gave females who took it day-to-day a single added sexually satisfying expertise per month.

Graham and other critics believe the FDA was pressured and half-shamed into approving Addyi (generic identify flibanserin) by a campaign headed by a vocal group called Even the Score, which pitched the absence of medication to help females with reduced libido as a gender inequality issue.

It describes itself as a campaign for women’s sexual wellness equity which was “created to serve as a voice for American females who believe that it is time to level the enjoying field when it comes to the treatment method of women’s sexual dysfunction”. On the front page of its internet site now runs a banner saying “Thank you, FDA”. Sprout Pharmaceuticals, which owns Addyi, is one particular of the funders, as is Trimel, one more organization in the very same discipline.

Sprout strategies to enlarge the organization. Its shareholders ought to be in for a windfall if the drug generates even a fraction of the good results and profits Viagra did for Pfizer right after winning a licence.

Sprout’s chief executive, nevertheless, hailed the FDA selection as a victory for females. “It has been a outstanding journey to get to this breakthrough minute. Today we celebrate what this approval implies for all women who have prolonged awaited a medical remedy alternative for this daily life impacting condition,” stated Cindy Whitehead. “We applaud the FDA for putting the patient voice at the center of the conversation and for focusing on scientific proof.”

The determination was not clearcut. The drug, an antidepressant which works on the brain, in contrast to Viagra, was rejected twice by the FDA on the basis of a small benefit and considerable side-results. The last vote was an 18 to six, with none of the panel willing to endorse it without having caveats. Addyi will have a black box warning, that means there are significant side-effects. It is not accepted for girls past the menopause or anyone with an impaired liver. It can lead to lower blood pressure and reduction of consciousness. These dangers are increased if ladies drink.

“Because of a possibly critical interaction with alcohol, remedy with Addyi will only be offered by means of licensed wellness care pros and licensed pharmacies,” stated Dr Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Analysis. “Patients and prescribers must completely realize the risks connected with the use of Addyi ahead of taking into consideration treatment.”

The FDA needs Sprout to do even more research of the impact of alcohol. The one it carried out concerned 25 folks, of whom 23 were males. Graham believes there is small possibility physicians will hold off prescribing it for women who drink or who are publish-menopause. Even in the hours right after the announcement of the licence “we could see indications that the drug is not going to be prescribed only to ladies who are pre-menopausal and really do not drink”, she stated.

Dr Irwin Goldstein, who heads the San Diego sexual medication centre and has been a advisor to Sprout, informed the New York Occasions he would not refuse to give it to casual drinkers.

There are also queries about the accurate scale of unmet need to have. The typically utilised statistic that far more than two-fifths of all women – 43% – knowledge loss of sexual desire dates from a survey in 1999 which failed to ask females no matter whether they have been actually bothered by that. The larger and more current National Attitudes and Sexual Lifestyles study in the Uk found that about ten% of girls had minimal libido and had been experiencing distress as a outcome.

Dr Petra Boynton, agony aunt and psychologist who has researched sexual working, says losing interest in sex is a actual worry for females, “But what are they truly worried about? They consider they are not standard because they do not want intercourse that a lot. They wonder ‘will my partner leave me?’ and ‘am I undesirable or inadequate?’”

There are some who wonder if they are missing out on pleasure, she mentioned, but that is not truly the principal anxiousness. “They are speaking about not currently being good adequate or not measuring up. Men and women have a perception that everyone else is possessing great intercourse all the time with exotic positions.” There is, Boynton explained, “anxiety brought about by misinformation about sex”, that is perpetuated by the media and particularly men’s and women’s magazines. “The cultural wallpaper is telling you that to keep somebody and be desirable and not left alone, which is a enormous fear, you must be possessing and providing regular intercourse.”

Addyi could support a modest number of females, but Boynton pointed out that, like the other medicines for sexual issues, it had only been examined against placebos. It would have been fascinating, she mentioned, to trial it towards candles and bathnights and sex toys – and, for that matter, romantic relationship treatment.

The drug will be on sale in the US from October. Sprout has not stated no matter whether it will apply for a licence to sell it in Europe, but if it did, the verdict may possibly not automatically be the same. “I would be stunned if it is licensed right here,” mentioned Boynton. “But regardless of whether it is licensed or not, it will nonetheless perpetuate the illusion that if you do not have desire, there is something wrong with you.”

FDA approval of "female Viagra" leaves bitter taste for critics

Bitter Pill to Swallow: Can The US Industry Bear The Value Of Sovaldi?

Sovaldi, the new drug to deal with and remedy Hepatitis C has undoubtedly brought on fairly an uproar in the US given that its FDA approval in December of 2013.  At $ one,000 per pill, the manufacturer, Gilead, has lots of men and women and payers to response to in purchase to justify this enormous cost, say sector professionals and watchdogs.

With approximately three million individuals in the US struggling from hepatitis C, the only options in the previous were Interferon and Ribavirin which led to many side effects along with unpredictable responses. Moreover, the alternative of liver transplant and ongoing end of daily life care were previously the only options for this devastating ailment.

“Sovaldi presents a dramatic example of the what-the-US-industry-can-bear pharmaceutical pricing practice,” explains John Thomas, a professor specializing in wellness law in the Quinnipiac University Schools of Law &amp Medication.

“It fees its manufacturer, Gilead, about $ 130 to produce every single pill that it then sells to US patients at $ 1,000 every,” Thomas explains. “In other nations like Egypt and India, however, Gilead provides Sovaldi at a 99% low cost off of the US price tag.”

“At the US cost, Gilead will recoup its Sovaldi growth investment of $ eleven billion in a single 12 months and then will stand to make extraordinary earnings off the backs of US consumers, who will subsidize the drug for other patients about the globe.”

According to Thomas, Gilead’s profit margin has tripled in recent instances and its at present running in the first quarter at a 44% revenue margin–which is more than double what a common pharmaceutical can make.”

The greatest illustration of the market place value of Sovaldi is primarily based on what Gilead charges to other industrialized nations—roughly half of what the US is currently being charged.

How does this happen?  According to Thomas, this is a perform of the “fractured payment system” in the US.

Thomas explains that in the United kingdom or in EU, in which they pay out half of what the US pays, there is not a lot leverage in that industry “because the single payer government technique and the payer speaks for everybody and they can negotiate half cost.”

Gilead is presently charging the US and other industrialized nations roughly twice what other countries are currently being charged.  A single explanation they can do this in accordance to Thomas is “because they can”, a perform connected to the nature of our fractured payment method. A 2nd essential reason is also since he believes Gilead is anxious about an additional drug in the pipeline 1-three many years out, and they want to make as significantly cash as they can ahead of there is another entity ready to sell a competing drug.

While Congress in theory could regulate the pricing of pharmaceuticals, there is presently no federal  legislative physique that has authority to oversee honest practices in setting pricing of pharmaceuticals–other than [e.g the FTC] addressing misrepresentations in public statements or in promoting, Thomas Explains.

One resolution, in accordance to Thomas, may possibly include creation of a single payer method, “so that we would be on par or even in a greater negotiating place than these other industrialized nations.”

Even so, Thomas believes that a far more realistic approach might involve a concerted campaign to spread the theme, “shame in the industry area, ” that might continue to spot external strain on Gilead to modify the pricing of their items.

“By publishing information, and presenting to numerous constituencies in the American wellness care technique, it may possibly be achievable to shame Gilead into retracting to some extent only what is palatable in this marketplace, ” adds Thomas.

The argument by Gilead–that the greater value of the drug will essentially eliminate prospective downstream costs related with hepatitis C- specially liver transplants and ongoing and finish of existence care- is in the end flawed in many respects.

Bitter Pill to Swallow: Can The US Industry Bear The Value Of Sovaldi?

A bitter pill: Syrian refugee medical doctors share their stories

A medic requires care of a newborn Syrian refugee child in the Lebanese town of Arsal. Photograph: Joseph Eid/Getty Photos

Dr Muhammed Selim, 41, Kawergosk camp

Muhammed, a common surgeon from Qamishli, had worked in the Al-Safira district, in the Aleppo governorate, since 2006. He worked at a government hospital in the morning and at his private clinic in the evening.

“Prior to 2011, daily life was happy and function was good,” he says. “I would function hard and after function I would get pleasure from visiting friends all around Aleppo.”

But when conflict started out in rural Aleppo, Muhammed found himself and his clinic in the midst of battle. “My clinic was situated in the vicinity of 3 strategic positions which have been currently being fought more than by numerous groups. I was stuck for eight months, unable to leave my clinic for Aleppo or anyplace else, and there were snipers all close to.

With fighting continuing each and every day, there was an exodus of people leaving Al-Safira. Muhammed managed to escape with his lifestyle, underneath fire, in January 2014. He recalls a extended and perilous journey via Ar-Raqqah and Al-Hasakah, passing many checkpoints at which he had to hide his Kurdish identity, right up until he reached Qamishli. From there, he tried to cross the border to Iraq 3 instances, but it was closed. He then endured an eleven-hour journey on foot by means of mountains and valleys from Qamishli to another portion of the border, in which he was lastly able to leave Syria.

Soon after settling in the Darashakran refugee camp, Muhammed worked as a painter for two weeks. But a likelihood encounter with Médecins Sans Frontières expat staff would be a turning point for him.

Following a written check and interview, Muhammed began operate as a basic physician in the close by Kawergosk camp. “Function is very good,” he says. “I am really happy to be functioning in my area, with all my energy. The men and women here are satisfied with our support, specifically that I share their language and dialect. I know about their struggling and their way of contemplating. Often the only treatment they need to have is through phrases, not drugs.”

Muhammed nonetheless lives in the Darashakran camp, commuting every single day to Kawergosk, 10km away. Regardless of escaping with his life and continuing to offer health care care to his fellow Syrian refugees, Muhammed nonetheless struggles with his conscience. “Even to this moment I have feelings of guilt that I left Syria. Continuing to function here is some consolation, but sometimes I tell myself that I need to have served my individuals better and stayed even if I was killed. Perhaps I could have fulfilled my duty far better.”

Dr Media Rasheed, 28, Darashakran camp

Possessing graduated from Damascus University in 2009, Media was in her fourth 12 months of specialisation in haematology when she had to end and leave the country.

Media’s family had currently fled Damascus, although she had stayed behind, determined to comprehensive her training. But her household convinced her that there was significant danger to her daily life and safety if she stayed, and so she left for Erbil in June 2013.

Right after hunting for work for six months, Media commenced functioning for Médecins Sans Frontières as a standard physician, very first in Kawergosk camp and then in Darashakran, the place she sees all around 50 patients a day.

“As a Syrian medical doctor operating in a Syrian refugee camp my connection with the individuals is not restricted to being a doctor. Some sufferers just want to speak. I pay attention to their stories of struggling and truly feel their soreness, particularly individuals escaping the conflict in rural Damascus and Aleppo. 1 of the stories that affected me the most was of a Syrian lady who lost her husband following hefty shelling in Aleppo, and did not have the chance to say goodbye or bury him ahead of fleeing.

“I often come to feel guilty for leaving my country, as we physicians have pledged not to depart in times of war, but the security circumstance left us no decision. The day the war ends I will return to Syria.”

Read more stories like this:

• Globe in a week: much more refugees today than at the finish of World War II

• Five issues they inform you about refugees that are not correct

• ‘We urgently need a lot more information on internal migration’

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A bitter pill: Syrian refugee medical doctors share their stories