The Australian Christian Lobby is wrong. Australians don"t support a gag rule | Rebecca Huntley

It’s the photo that launched a thousand memes. The freshly inaugurated Donald Trump, surrounded by a posse of white dudes signing a directive reinstating a “global gag rule” banning US-funded groups around the world from discussing abortion.

I saw the news about it on social media, shuddered, donated to Planned Parenthood and then felt just a little bit more grateful that I live in this country, a place where abortion and reproductive rights aren’t the hysterical hot button issues they are in the United States. I’ve only recently learned that while we might not share their toxic politics around reproductive rights, we have in the past taken America’s lead on the implementation of the global gag rule. It was last removed in Australia in 2009 by Kevin Rudd.

If the Australian Christian Lobby had its way, we’d follow America’s lead yet again. They are currently engaged in a pretty intense letter writing campaign calling for the re-instatement of an Australian global gag rule.

What is the ‘global gag rule’, and why does Trump support it?

Groups like Family Planning NSW are calling for funding to aid programs, specifically in Pacific Island countries, to be maintained in the May budget and with good reason. The Pacific has some of the worst reproductive and sexual health outcomes globally, with high rates of maternal and infant deaths, unintended and teenage pregnancies, sexual violence and unacceptably high rates of cervical cancer deaths.

Women giving birth in the Pacific are dying at 34 times the rate of women in Australia. Women in the Pacific are dying at up to 10 times the rate of women in Australia from cervical cancer. In developing regions, eight in 10 women with curable sexually transmitted infections do not receive treatment. Every two minutes, a woman dies in pregnancy or childbirth – the majority of these deaths are preventable. The main purpose of the global gag rule might be to stop aid agencies providing advice about abortion but the direct consequence is also to stop them providing a whole range of other services associated with sexual and reproductive health.

The people pushing for a gag rule in this country like to think they speak for the silent majority of Australians. Yet there is no evidence they do. Figures from last week’s Essential Report show Australians strongly support the nation’s commitment to providing important health services to women in Pacific Island nations.

In fact, 89% of Australians feel it is important women in Pacific Island countries have access to sexual and reproductive health services like contraception, cervical cancer screening and family planning. A strong majority of men (85%) and an even stronger majority of women (91%) support Pacific Island women having access to these services. There is very little variation in support across generations and party affiliation.

How important is it that women in Pacific Island countries have access to sexual and reproductive health services – like contraception, cervical cancer screening and family planning?

On the issue of whether our foreign aid budget should support the provision of these services in those countries, again there is strong support across gender and generation. This isn’t a women’s issue, it’s a community concern.

How important is it that Australia, through its foreign aid budget, supports Pacific Island countries to provide sexual and reproductive health services including contraception, cervical screening and family planning?

Finally, on the question of the global gag rule, 67% of Australians (64% men and 70% women) would be concerned if Australia also introduced this rule and stopped aid to groups that provide family planning and sexual and reproductive health services in Pacific Island countries. While opposition to the rule is highest among Greens voters, 62% of Coalition voters report being concerned about such a move.

How concerned would you be if Australia introduced a global gag rule and stopped aid to groups that provide family planning and sexual and reproductive health services in Pacific Island countries?

So much for the silent minority. Only 6% of those polled in the Essential Report would be unconcerned about a gag rule being reinstated. It’s clear that bringing vaccines, maternal health care, family planning and cervical cancer screening to the Pacific Island region is the intent of men and women across Australia.

Australians might be fascinated with Donald Trump. They might applaud his recent action in Syria and some of us might even sympathise with the idea of a ban on Muslim immigration. But the research shows there is no widespread support for a Trump-style gag rule that puts a rightwing Christian agenda before the health and wellbeing of Pacific Island women.

The Australian Christian Lobby is wrong. Australians don"t support a gag rule | Rebecca Huntley

The History of Cat Food: Why You’re Probably Feeding Your Cat Wrong

Let’s take a trip through time.

We’ll visit prehistoric African landscapes, ancient Egyptian cities, Victorian streets featuring the sound of cat’s meat men hawking their wares, the unique economic situation of World War II, and the business boom of post-war America.

The unifying thread woven through all of these curious scenes is, as you guessed, cats – and the food they eat.

Their natural dietary needs haven’t changed, either. Nevertheless, humans always have to do things the hard way. Ideas about feline nutrition have transformed quite a bit over the years.

We’ll begin our journey over 12,000 years ago. These are the days of felis silvestris lybica or the African wildcat. This small cat living in Africa, the Near East, and around the Arabian peninsula, is the ancestor of the domesticated cat. This hardy hunter lives primarily off of small rodents, supplementing their diet with small mammals, bugs, birds, reptiles, and amphibians. As obligate carnivores, their diet is comprised of meat – although they’re known to occasionally eat jackalberries.

While dogs were domesticated much earlier (think as much as well over 20,000 years earlier) by hunter-gatherers, the domestication and keeping of cats is always the sign of advanced civilization. Yep, you read that right. You may use this fact in your next argument with a dog person.

Wildcats wandering by a settlement would have noticed the abundance of rodents feasting on the grain stores, twitched their whiskers, and dove in. Thanks to their fantastic value as rodent management tools, these cats quickly earned their place in society. People not advanced enough to harvest and store surplus grain were of little interest to wildcats. Similarly, without grain stores in need of protection, these hunter-gatherers wouldn’t have recognized their practical value.

As is the case with so many things, the story of feline domestication is closely linked to food and diet. Humans need grains and cats need meat. Our different and mutually beneficial dietary needs were the basis for the entire relationship between cats and people.

Continuing onward through the ages of cat-worshipping ancient Egypt and the reverent Romans, cats continued to live on a similar diet – they hunted snakes, rats, mice, and other pests. People may have given them treats to encourage the cats to stick around, but for the most part, these early cats fended for themselves.

This continued for thousands of years. Throughout most of history, cats have been full-time employees in an agrarian society. Although they were valuable companion animals as well, cats were hunters and pest controllers.

The Medieval era was a very turbulent time for cats. Among Muslims, cats were beloved pets. But in Christian Europe, they were seen as devilish creatures – still, of course, profoundly linked to their proclivity to hunt rodents. Medieval printing pioneer William Caxton is credited with this statement that in a sense likens the cat to the devil while addressing its predatory nature:

“The devyl playeth ofte with the synnar, lyke as the catte doth with the mous.”

By the 1700’s, however, European cats were no longer persecuted and again rose to high esteem for their ability to get rid of hated brown rats, which hit Europe in the 18th century.

Through the middle of the 19th century, cats were viewed as independent animals capable of essentially feeding themselves. However, it was around this time that you’ll see evidence that there was a new idea going around.

In 1837, French writer Mauny de Mornay declared that:

“It is… thought wrongly that the cat, ill-fed, hunts better and takes more mice; this too is a grave error. The cat who is not given food is feeble and sickly; as soon as he has bitten into a mouse, he lies down to rest and sleep; while well fed, he is wide awake and satisfies his natural taste in chasing all that belongs to the rat family.”

But what would that well-fed cat eat? Probably a lot of horse meat – cheap meat often sold for pets by street vendors. At the time, “complete and balanced” commercial food didn’t exist even for dogs. The first food made just for dogs hit the market in 1860. James Spratt introduced Patent Meal Fibrine Dog Cakes that year. They were a hit in England and their popularity quickly caught on in America, kicking off the spread of the pet food industry.

It was in the same year that Scottish doctor Gordon Stables stated that:

“…cat ought to be fed at least twice a day. Let her have a dish to herself, put down to her, and removed when the meal is finished. Experience is the best teacher as regards the quantity of a cat’s food, and in quality let it be varied. Oatmeal porridge and milk, or white bread steeped in warm milk, to which a little sugar has been added, are both excellent breakfasts for puss; and for dinner she must have an allowance of flesh. Boiled lights are better for her than horse-meat, and occasionally let her have fish.”

So we see what the cultured Victorian cat might eat: oatmeal and bread with milk and sugar for breakfast, followed by organs, horse meat, and fish for dinner. And perhaps some Spratt’s Patent Cat Food. Note, though, that at this time commercial pet food was still viewed as a luxury item. It didn’t become really common until around the 20’s and 30’s.

It was around that time when the first canned cat food hit the market. Most canned cat foods were fish-based and more popular in coastal areas that produced plenty of seafood byproducts.

Well, dry cat food didn’t exist at all until World War II shook up the world economy and forced major changes in production. For one, pet food was classified as a non-essential good. Secondly, metal rationing took a toll on the can production industry, forcing pet food manufacturers to do something different. Production shifted towards an emphasis on dry food and kibble for cats and dogs. 

After the war, dry food established itself as an essential part of pet care. Commercial pet food, in general, was an essential. Human food manufacturers saw the popularity of pet food as a great opportunity to make use of byproducts. Pet food manufacturers utilized clever marketing to convince consumers that table scraps, raw food, and prey were not enough to keep their pets healthy

Today, dry food is the number one most popular type of cat food in the United States.

We’ve gone from the carnivorous diet of felis silvestris lybica, through the rodent-fueled early days of feline domestication and the thousands of years of meat-eating pest control that followed, onward into times of milk, sugar, and horsemeat, and finally concluding with today’s period: one marked by the prevalence of a grain-based diet for cats.

Grain has always been a critical part of the cat’s relationship with people. Humans use grain as a primary food source, harvesting and storing it for future use. Rodents threaten the stores of that grain, attracting cats, who need the flesh of those rodents to survive. Cats keep the pests in check and, so doing, have earned their place in human society.

Dry cat food has been a staple for only about the last seventy years. That’s just about .5% of the history of domesticated cats. Does it really make sense to believe that this new diet – necessitated by wartime restrictions and popularized by the opportunity to make money off of human food byproducts – is truly appropriate for our cats?

The flaws of dry cat food are numerous and manifest in some of the most common health issues affecting cats today: poor dental health, diabetes, and feline urinary tract disease.

Check out Everything You Need to Know About Dry Cat Food and learn more about why you should probably throw out your cat’s dry food today.

Through Wildernesscat, you can learn even more about your cat’s nutritional and lifestyle needs. Armed with that information, you may begin to make choices to effect positive change in your cat’s world. Visit our site to change your cat’s life through dietary changes, nutritional supplements, and other natural care products – all available through Wildernesscat.

The History of Cat Food: Why You’re Probably Feeding Your Cat Wrong

Talking about death is a part of my work – I worry I say the wrong thing

I am a NHS hospital consultant and work in a healthcare team that specialises in the care of adults with cystic fibrosis (CF). This is a genetic condition that affects various organs, but primarily the lungs. It results in recurrent and severe chest infections that ultimately cause the lungs to fail. There have been considerable advancements in new therapies that we are hopeful will change the natural history of the disease. Nevertheless, it remains a life-shortening illness and coping with the death of young adults brings many challenges to the team that I work in.

Patients move to our CF centre when they are 18 years old. The doctor-patient relationship is a dichotomous and delicate balance of professional distance and empathy. But it does not fully guard against emotion when we see those we look after approach death. Over the years we develop bonds with our patients and their families and witness many life events. We share in their laughter and tears. Occasionally I am the focus, a patient recently said to me: “You’ve lost weight … you need to look after yourself better.” That made me chuckle.

Clinical care satisfies the needs of today, but research brings the hope for tomorrow

Patients strive to lead normal lives and I am frequently in awe of their achievements. Some of their journeys are truly Homeric in stature. But years of infections and damage to the lungs take their toll. The hope of a better tomorrow is a powerful support but the reality of declining health can dismantle the scaffold. Broaching these end-of-life conversations is often difficult as the words uttered can confirm patients’ fears.

It is so important to choose those words carefully as they can linger in the family’s memory. I remember one young 22-year-old woman who was not responding to treatment in hospital; her death was imminent. It was important for her to have some sort of control. I asked her: “You are in the driving seat now, what would you like us to do with your treatment?” She wanted to stop it, and I did. Some months after her death her mum called into the hospital and said: “Thank you for putting my daughter in the driving seat”. I’ve cherished those words.

Many patients now have young families of their own and the death of a parent is a traumatic experience. We arrange for our patients to engage with a specially trained counsellor to express their thoughts in words and pictures. A personalised memory book is produced, which includes advice for the future without them.

I’ll always remember the young girl, after losing a parent, who put her thoughts down in a letter. It was a remarkable achievement for one so young. She said the book helped her and reminded her of the parent she had lost. The presence and tactility of a book is tangible. A father whose son died wrote to me: “It is impossible to balance the awfulness of our heartbreak with the comfort that this book provides, but what is paramount is that it provides amazing comfort to us all.” Their letters are the most powerful I have ever read.

In the liminal transition from life to death a peace descends in the half light. I reflect on what I could have done differently. Should I have changed the treatment plan? Could I have phrased things a little better? Some parents have lost all their children to this disease and they have been made to endure grief that is simply unendurable. So when I go home at night my family are hugged that little bit tighter, as nobody is immune to loss. Death casts light on my own mortality and the impermanence of life comes sharply into focus.

In the following days and weeks we redouble our efforts. Clinical care satisfies the needs of today, but research brings the hope for tomorrow. It is so important to be part of that hope. I walk into the hospital ward to hear new stories and guide as best I can. It is an enormous privilege to do what I do.

If you would like to write a blogpost for Views from the NHS frontline, read our guidelines and get in touch by emailing sarah.johnson@theguardian.com.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

Talking about death is a part of my work – I worry I say the wrong thing

"I was wrong": Pauline Hanson apologises for vaccination claims

Pauline Hanson has apologised for incorrectly claiming on Sunday that parents could conduct their own tests to evaluate vaccination safety.

“Yes, I do apologise,” she said. “As far as having tests done, OK, I admit I was wrong with that.”

Senator Hanson has been criticised by the Australian Medical Association and others for giving the incorrect impression that vaccines were not safe.

“All I’m saying to people that are concerned about it – you go and do your research, go ask questions of your doctor,” she told Channel Seven on Thursday.

Pauline Hanson voiced criticism of the government’s vaccination rules on the ABC’s Insiders program last week, sparking furious condemnation from health and medical groups.

She advised parents to test their children before vaccinations because some parents, she claimed, had reported problems with vaccines.

Hanson also argued that successive governments had “blackmailed” people into having their children vaccinated because of the policy of withholding childcare fee rebates and welfare payments from parents who don’t have their children fully immunised.

“What I don’t like about it is the blackmailing that’s happening with the government,” Hanson said. “Don’t do that to people. That’s a dictatorship. I think people have a right to investigate themselves.”

She later defended her comments saying they were her “personal opinion” and she acknowledged she had vaccinated her own children.

Hanson’s comments were also condemned by the prime minister, Malcolm Turnbull.

“If parents choose not to vaccinate their children, they are putting their children’s health at risk and every other person’s children’s health at risk too,” Turnbull said.

The president of the Australian Medical Association, Michael Gannon, told the ABC that Hanson needed to take responsibility for her position on vaccination.

“She needs to realise that she’s a serious player in Australian politics now,” he said. “You know, with 8, 9, 10% of Australians indicating an intention to vote for One Nation, she can no longer make fringe statements that are dangerous to the health of the whole community.”

“We know in medical science that we’re never going to reach that 1 or 2% of rusted-on flat-earthers who don’t accept the science of vaccination.

“But what we worry about a lot about is that about 8% of the population are so-called vaccine-hesitant, and they’re looking for any information that might lead them away from what is, with the exception of clean water, probably the most significant health measure we’ve got.

“It is absolutely essential that we have accurate information, and this fatuous idea that parents can spend half an hour on Wikipedia and come to a greater understanding of the issues than their doctor and the accumulated wisdom of all the world’s medical scientists is ludicrous.”

"I was wrong": Pauline Hanson apologises for vaccination claims

Babies born in London hospital "could leave with wrong mother"

The biggest hospital in Europe has been ordered to improve security on its maternity ward after inspectors found that mothers “might leave the unit with the wrong baby”. Some babies born at the Royal London hospital had no name tags – which could lead to them going home with the wrong families or even being given medication meant for another baby, according to the Care Quality Commission (CQC).

Inspectors said there was a “lax” approach to checking babies’ name bands. Even the head of midwifery at the hospital, in Whitechapel, east London, was unaware of a baby abduction policy, the regulator said. Inspectors found there were not enough midwives on the delivery suite to provide safe cover, and midwives said they had been ordered by managers not to raise concerns about low staff numbers.

There was a “mixed” view about how caring staff were: one mother told inspectors she was treated as “childish” because she was upset that her baby had been taken into special care.

Inspectors who visited the hospital in July this year said they also observed some “intracultural issues and some bullying behaviour” between groups of midwives, and between midwives and patients. Doctors and midwives on the postnatal ward referred to patients by their bed numbers rather than by name, according to the CQC.

Last year 4,645 babies were born at the Royal London, which is the largest stand-alone acute hospital in Europe.

The CQC has ordered the Barts health NHS trust, which runs the hospital, to improve security in maternity “urgently” after rating the service inadequate. The trust said it had already taken steps to address baby safety concerns, including the introduction of new baby ID tags. Overall the hospital was rated “requires improvement”.

Some of the other issues highlighted in the report include:

• A two-week backlog of outpatient appointments waiting to be booked and some patients waiting for over a year for follow-up appointments.
  


• The nutrition and hydration needs of patients were met, though in some busy departments this was enabled by patients’ relatives.
  


• Nine “never” events were reported at the hospital between August 2015 and July 2016 – wholly preventable errors. These blunders included a surgeon leaving an object inside a patient after finishing an operation, the extraction of a wrong tooth, “wrong-site implants” and incorrect medication being given to a patient.
  


• During the inspection, some patients in A&E had to wait an hour and 20 minutes for an initial assessment from a medic, though national guidance suggests the majority of people should be assessed by a clinician within 15 minutes.
  


• Some medics had to complete mandatory training in their own time or during their holiday leave.
  

Professor Sir Mike Richards, chief inspector of hospitals at the CQC, said: “We were most concerned about the standard of care around maternity and gynaecology services. Staffing on maternity wards was sometimes inadequately covered. But most worrying of all was the lack of a safe and secure environment for newborn babies. At the time of our inspection we raised this with the Royal London hospital as a matter for their urgent attention.”

A spokeswoman for the trust said: “We acted immediately to improve the security of babies at the Royal London hospital. It’s important to stress that these reports are based on observations from five months ago. Since then we have subjected our processes and procedures to forensic scrutiny.

“As a result, we’ve introduced new baby ID tags, we’ve reviewed our procedure for locking down the hospital, and refreshed our policy. We have recirculated our policy to all staff and now test it every single month. Women should be assured our services are safe and we will review our processes regularly to ensure they remain safe.”

Babies born in London hospital "could leave with wrong mother"

The NHS cannot afford to get another workforce initiative wrong

Ultimately, saving money in the NHS means cutting staff costs. The NHS in England spends roughly 40% of its £121bn budget on staff, and as local health economies try to stabilise their finances, options such as slashing agency spending and creating cheaper full-time roles are inevitably part of the mix.

Although clinical staff shortages are a global problem, the NHS exacerbates the difficulties of workforce planning by constant changes in policy. Nursing posts – currently numbering around 300,000 – have borne the brunt of this.

Having been recruited in record numbers since the 2013 publication of the Francis report into the Mid Staffordshire scandal, nursing costs face being cut again as hospitals fight to contain deficits.

Once upskilling was in vogue; now the latest convulsion in the nursing profession is downskilling, with the introduction of the post of nursing associate as trusts across the country struggle to fill thousands of vacancies.

Health Education England is ramming this through with ill-considered haste. In January, around a thousand trainees will begin at pilot sites which were only announced in October, leaving far too little time to prepare adequately for a new discipline. A similar number of trainees follows in April, long before any meaningful evaluation of the first wave will be possible.

With just weeks to go, there have been alarming swerves in specifying what nurse associates will do. Crucially, a draft of the curriculum leaked to the Health Service Journal indicated they would be administering controlled drugs independently – a highly-controversial proposal that was dropped from the final version published on Thursday.

The key issue is whether this new role will support or replace nurses. As a study published this week in the journal BMJ Quality and Safety highlighted, replacing qualified nurses with assistants increases the risk of patients dying.

The Department of Health insists nursing associates will complement rather than replace nurses. That does not tally with the Buckinghamshire, Oxfordshire and Berkshire West sustainability and transformation plan to cut staff costs by £34m, which requires a “reduction of nursing grade input” coupled with greater use of various forms of support workers across health and social care services. The plan says that if they “do nothing”, by 2020-21 the area will have a financial gap of almost £500m.

There is nothing inherently wrong with introducing new posts with less training than traditional doctors and nurses. There are some outstanding examples – notably in countries such as India – where new approaches can cut costs and improve quality. On the other hand, in different circumstances replacing low-skilled staff with high-skilled staff has the same effect. The way to find the right solution is to test changes before rolling them out; rushing major changes through in the midst of a financial panic risks serious mistakes.

As well as the obvious dangers around patient safety, the NHS does not have the luxury of getting another workforce initiative wrong; it has too little money and too many nursing vacancies.

For example, this new post seems to have been created primarily to help hospital wards and budgets. It is far from clear how it will support the expansion of community-based nursing and the integration of care services, which is supposed to be at the heart of a transformed care service.

The Council of Deans of Health has raised concerns, such as how nursing associates will improve care quality, whether they are the right way to encourage service integration and whether their function could be met better through existing roles.

Since Health Education England was established four years ago it has pushed the need for “values-based recruitment” – in other words, appointing people who have the right temperament to care for people, not just the technical ability. In the rush to fill trainee positions and nursing vacancies, it must ensure that this progress is not undermined.

Constant changes in resources, technology and patient need coupled with training schemes that take years mean that maintaining the right workforce for the NHS is a near impossible task. But rushing through changes aimed primarily at cutting costs with a poor grasp of the implications for care will not help.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views.

The NHS cannot afford to get another workforce initiative wrong

Unsick days: a day off when there’s nothing wrong with you ... but there’s a catch

Name: Unsick days.

Age: Brand new.

Appearance: Confusingly altruistic.

I like the sound of this, provided that an unsick day means I can take time off work when I’m not sick. That’s right! That’s exactly what an unsick day is!

Amazing! I already know how I’m going to spend mine. Does it involve going for routine medical and dental appointments?

Well, I’d been planning to spend a lot of it eating takeaways and watching Judge Rinder. Then you’ve fundamentally misjudged the notion of an unsick day. It’s specifically a day on which workers can preventatively go and get themselves seen to.

Really? I haven’t seen a dentist in 13 years because my boss would kick off if I took an afternoon off work. That’s exactly what an unsick day is for. It’s a day when you’re encouraged to see a dentist, so you don’t have to take six months off when your jaw starts rotting two years from now, which it definitely will.

How thoughtful. I know. It’s the brainchild of American healthcare scheduling service Zocdoc, who …

Oh, I get it, this is a publicity stunt. Apparently not. Apparently companies such as Virgin Hotels and Foursquare have agreed to sign up to the scheme from next year.

What are the benefits? Better health, obviously, and the overwhelming morale boost that comes from knowing that your boss isn’t a cackling Victorian workhouse supervisor determined to wring every last ounce of productivity from you before watching you drop dead from exhaustion.

Sounds great! When do we get unsick days over here? Well, don’t hold your breath.

Why? Have you tried getting a doctor’s appointment for a non-emergency lately? My local surgery is rammed until the middle of 2023.

Surely, we could still benefit from some sort of unsick day? I mean, perhaps there could be a day where you get to stay at home and Google the symptoms of that rash on your arm until you become convinced that you’ve contracted a rare form of penis cancer.

Well, sure, if it gets me a day off work. You’re right. I demand an unsick day!

Do say: “Hi, doc! There’s nothing wrong with me, but here I am.”

Don’t say: “This won’t put any more undue strain on the NHS, will it?”

Unsick days: a day off when there’s nothing wrong with you ... but there’s a catch

I had heard clean eating made you feel better – but for me it went wrong

I got into clean eating with a friend around my AS levels, when I was 16. My friends only followed the diet for about two weeks but when they all stopped I continued. I got addicted to it and I lost loads of weight.

We all started the diet because we were really stressed and tired and had heard eating better made you feel better, but for me it went wrong.

I cut out snacking, I had smaller portions, and everything was a health food. I prepared all my meals myself from scratch.

I cut out dairy and any drinks that weren’t water. I was eating fruit and vegetables and no carbohydrates and no snacking. I was eating no processed food – I would have a handful of dried fruit if I had a snack. An average dinner would be just meat or fish and a small side of vegetables.

I obsessively watched Lean in 15 – a YouTube channel on healthy eating by Joe Wicks. I used to watch a lot of his videos and also followed loads of “transformation” accounts where people ate healthily to lose weight.

At first I did this all to feel better in myself and then it became about losing weight. I liked how it felt and people saying: “Oh you’ve lost weight and you look great.” I used to limit food groups and obsessively weighed my food. I had foods I was afraid to eat and would avoid, such as carbohydrates. This went on for two years, from 16 to 18, and eventually I was diagnosed with anorexia with orthorexic tendencies.

As well as losing weight, orthorexia made me feel exhausted. I couldn’t sleep because I was really hungry the whole time. I had depression and anxiety and I couldn’t focus on anything at all.

My parents noticed that something was wrong. I actually didn’t know what was happening – they took me to the doctor. I went to the Priory for diagnoses and was referred to Camhs (child and adolescent mental health services). I then got sent there on an outpatient basis and got cognitive behavioural therapy. That helped a lot.

Because of my eating disorder I have body dysmorphic disorder and have always feel more overweight than I am. CBT helped me realise that this was not logical. Medication also helped with my depression and gradually everything got better.

I feel more normal about food now. I am a student at Leeds and cook for myself. I eat out with friends. I still suffer guilt when I eat unhealthily but I can cope.

I think health food bloggers have a big influence on young people and they should make it clear that everything should be eaten in moderation. For example, it’s OK to have a biscuit every now and then – it’s not going to kill you. The expression clean eating makes it sound like other foods are dirty; it’s like making an enemy out of everyday food, making it something negative in people’s heads.

Healthy eating is supposed to make you feel better, but not if you develop orthorexia. Although some people need to be careful about what they eat, others can take this lifestyle to the extreme.

I had heard clean eating made you feel better – but for me it went wrong

Hillary Clinton was wrong to keep working: presenteeism is damaging | Peter Cheese

Is coming into work when you’re so sick that you’re on the verge of collapse really something we should be praising, or encouraging? When Hillary Clinton announced last week that she was trying to work through a pneumonia diagnosis and continue her campaign schedule, her supporters were quick to use this as an opportunity to praise her strength of character. She was described as tough, determined, strong, gritty and other adjectives that suggest working through serious illness is to be admired.

It may well be viewed as heroic by some, but in reality it’s a sign of an increasingly pervasive culture that sets up work as more important than our wellbeing.

Clinton certainly isn’t the only person who has turned up sick for work recently. I suspect at one time or another we’ve all uttered the words “don’t worry, it’s nothing serious”, or struggled in only to be greeted by a concerned colleague who politely asked us to go home and stop sneezing on them.

Whether it’s guilt about letting down the team, concern your tasks won’t get covered or more likely some fear that it might be counted against you, the trend for employees to come into work or to work longer hours when they should be taking time off has been growing.

Research by Simplyhealth and the Chartered Institute of Personnel and Development (CIPD), where I work as chief executive, shows “presenteeism” is on the rise. Our 2015 survey showed that in the preceding 12 months, a third of firms reported a rise in employees working when they’re sick, and this has some pretty clear negative effects on employee wellbeing. Organisations that have noticed an increase in presenteeism are nearly twice as likely to report an increase in stress-related absence and more than twice as likely to report an increase in mental health problems among their staff too.

Hillary Clinton, back on the campaign trail: ‘I’m doing great’ – video

Greater uncertainty in the economy and regarding jobs in recent years, together with an increasingly “always on” working environment and the pressure to perform are all factors driving this trend. Many of the companies and employees we talk to cite job insecurity as a reason for increased presenteeism, with employees fearing that a competitive job market, and the growth of automation, will make them more replaceable.

But leaders and managers set the tone, and have a responsibility not just to their organisation but also to the wellbeing of their employees. As our research shows, increasing presenteeism leads to increased prevalence of stress, and there is a wealth of evidence, such as the Towers Watson 2014 Global Benefits Attitudes survey, which clearly shows that workplace stress leads to less productive employees.

So why, then, do more than half of all organisations admit that they aren’t doing anything to combat this growing problem? It may well be that they believe that promoting long-term employee wellbeing might come at the expense of the short-term success of an organisation, but it can also be a lack of awareness of the growth of a corporate culture that accepts or even encourages presenteeism.

To perform at our best, people need to be well both physically and mentally. If businesses want employees who are engaged and motivated, then employees need to feel that their organisation, their managers and bosses are supporting them, and not pressuring them to work when they are not properly fit.

How do we change this culture? It has to come from the top down. Employees won’t feel empowered to take time off when they’re sick if their manager’s behaviour runs counter to that. The second action businesses can take is to build a culture that emphasises healthy living.

Health should be promoted in the workplace, with people given the opportunity to learn more about their own health, to exercise and eat well within the workplace and beyond. At the CIPD, we host discounted zumba and yoga classes each week. TransferWise takes all its staff on annual company holidays, while the law firm Allen & Overy has GPs and dentists on site. Those are at the more expensive end of the scale, but even simple things like free fruit for staff, a perk offered by just 15% of employers, can help instil a healthier work culture.

Mental health and particularly the understanding of stress is equally important and is perhaps even more challenging. Much more needs to be done to educate managers in how to show understanding and ask the right questions, and how and where to find the right support. Leaders in this field, such as Google, have built good mental health into their culture by offering mindfulness classes to staff, while many large employers in the City, such as KPMG and Deloitte, have launched the City Mental Health Alliance, working with charities to end the stigma attached to mental health problems.

The message to business is clear; a workforce that is well, works well. Clinton may have wanted to preserve her image of strength, but she wasn’t being honest with herself. We need our leaders – in the workplace and beyond – to take responsibility for their own health and wellbeing first, to set the right example.

Only then does this damaging culture of presenteeism have any chance of changing.

Hillary Clinton was wrong to keep working: presenteeism is damaging | Peter Cheese

I cough at all the wrong times. Thank God I"m not Hillary Clinton | David Ferguson

If you are a character in a Victorian novel – which, much to my occasional dismay I am not – you know you’re going to die if, at an otherwise slow plot point, you begin to cough. Within two chapters, your cough will be spraying drops of dark red blood on to your linen kerchief and before long, you’ll be carried off by consumption.

These days we don’t live with the constant threat of tuberculosis and yet, from the way a certain segment of the right wing fever swamp is treating Democratic presidential nominee Hillary Clinton, you’d think she was Fantine from Hugo’s Les Miserables.

Matt Drudge, Sean Hannity, Rush Limbaugh, some ghoul named Steve Malzberg – who probably can’t help it that he’s a dead ringer for 90s make-believe car salesman Joe Isuzu – and even Republican nominee Donald Trump have seized upon Clinton’s seasonal allergies and resulting cough as a sign that she is trembling at death’s door, barely able to function.

“People don’t cough like that,” Malzberg insisted on his Newsmax.com podcast last week. People don’t have coughing fits ‘all the time,’ in public that go on and on and on and on and on and on. Not unless there’s something going on that’s not right.”

Please allow me to disabuse you of that notion, sir. Plenty of people “cough like that,” myself included. According to the Centers for Disease Control and Prevention, an estimated 19.1 adults over 18 were diagnosed with seasonal allergic rhinitis – also known as “hay fever” – in 2014 and 6.1 million children.

I’ve got big sinuses. It’s part of what makes my singing voice able to cut through layers of drums and guitars – a network of large, resonant holes in my skull. My late mother sang opera and had a glorious lyric soprano voice that could fill a whole theater and shake the chandeliers.

Twice a year, for 2 to 4 weeks in the spring and fall, those holes in my head fill up with gunk and it makes my face and forehead feel like a huge throbbing, aching, seriously clogged bottle of rubber cement.

If I don’t get enough sleep, drink quarts of water, eat right and keep my stress levels down, that respiratory distress will move straight down into my chest and I will develop a booming, persistent cough.

For some reason, the fall of 2009 was particularly nasty. I’d quit smoking the year before and thought that would make my seasonal battles with pollen and mold less miserable, but that first year, it seemed to have the opposite effect.

That was when I was a late night classical music DJ. My show went out live to the whole state of Georgia four nights per week. I remember it was Thursday, Sep. 10 because I was queuing up John Adams’ solemn, exquisite symphonic remembrance of the 9/11 victims, On the Transmigration of Souls.

“Our next selection,” I began, “is John Ad–” and I was seized with a violent coughing fit. Most radio consoles have what’s known as a “cough button” for just such an emergency. It mutes your microphone until the cough or sneeze or period of hoarseness passes.

But this coughing fit didn’t pass, it just kept going on and on. I killed my mic and started the music because I wasn’t sure what else to do. I was mortally embarrassed and for an awful moment felt sure I was disgracing the memory of all those people who were killed in the terror attacks of September 11, 2001.

The control room phone rang. I gulped down two swallows of tepid coffee and answered, still weak-voiced and froggy.

“You okay in there?” it was my boss calling from home.

“I’m fine,” I sputtered. “Just fighting for breath.”

He asked if I needed someone to come take over. I said no, I’m fine, it’s already passing. I hung up the phone and it immediately rang again. I picked it up and it was my twin brother calling from his car.

“Boy, that sounded terrible,” he said, laughing. “You’ve really got to quit smoking crack rocks at work.”

“It went out live to the whole state,” I said. “Our listeners probably think I’m dying.”

I wasn’t, though, any more than Hillary Clinton is. The fact is, even an able-bodied, healthy, athletic person like myself can get a cough that sounds like the end of the world. A week later I was back to running four miles a day and breathing like normal.

Sometimes, oh ye right-wing vultures, a cough is just a cough and the woman candidate whose health you’ve never cared one iota about before now is probably just fine, suffering from – as her personal physician disclosed in detail – a round of seasonal allergies.

So, if you’re expecting Hillary Clinton to keel over dead like Mimi, the consumptive heroine of Puccini’s La Boheme, or Hugo’s Fantine, I wouldn’t get my hopes up. I think she’s got a couple of arias to sing first.

I cough at all the wrong times. Thank God I"m not Hillary Clinton | David Ferguson

Jeremy Hunt has got it wrong: junior doctors are not the enemy within | Diane Abbott

The first ever all-out strike in the NHS took place under David Cameron’s Tory government. The very first five-day strike in the NHS is now set to take place under Theresa May, unless the government sees sense. This is the Tory record on the NHS.

Jeremy Hunt says there is always tension between health secretaries and NHS staff. Tension is one thing, strike action is unprecedented. The government is attempting to portray this entirely as a result of unreasonable, militant or even out-of-touch and overpaid junior doctors flexing their muscles. Nothing could be further from the truth.

In psychology, this is known as projection. The government is blaming NHS workers for its own failings. It is flexing its own muscles. It’s possible that junior doctors are just the first group of workers who will be targeted for the unreasonable imposition of contracts without negotiation. The Conservative government is also out of touch with public opinion. Of course the public dislikes the disruption, and may even be fearful of its consequences. But people are clear that the blame for this lies with the government itself.

The government’s anti-doctor propaganda campaign should not be allowed to obscure a central truth about the crisis. Far from being able to deliver a seven-day NHS it is clear the existing procedures of the NHS are not sustainable because of government underfunding. On virtually all measures NHS performance is deteriorating, and waiting lists are growing across the board. Hospital trusts are racking up enormous debts because they are being asked to do more with less, and the waste of PFI. Targets for ambulance waiting times, A&E consultations, GP access and cancer referral times are all being missed.

Jeremy Hunt: junior doctor strike will be ‘worst in NHS history’

The target for elective surgeries is that they should be performed within 18 weeks. According to the Patients Association the target was missed for 92,739 people in 2015, a rise of more than 40,000 in a single year. This should be borne in mind when Hunt points the finger at junior doctors and blames them for postponed operations. Patients are already waiting inordinate periods of time for operations, often suffering painful or debilitating conditions.

This throws into sharp relief the central cause of the dispute, the attempt to impose seven-day working without the resources to fund it. Current resources are insufficient to adequately fund the so-called five-day NHS. The mantra that the NHS must do more with less has become “the NHS must do much, much more with less”. It is infeasible.

As the junior doctors point out, most NHS services are available at the weekend and most doctors work weekends as part of their rotas. The government is not introducing something wholly new, just something wholly unworkable without resources. The danger is that the changes to the rotas will increase risk to patients. Doctors might end up working even longer hours.

All of this is avoidable. The BMA junior doctors committee is willing to enter talks about the contract. The government could approach the aim of creating a seven-day NHS in a collaborative way.

Our health service relies above all on the skill and professionalism of its staff. They are the key asset in preserving and improving the NHS to meet new needs. Nothing useful can be achieved by this government treating hard-working junior doctors like “the enemy within”.

Jeremy Hunt has got it wrong: junior doctors are not the enemy within | Diane Abbott

Feel You Cannot Stand To Do Some thing? Demonstrate By yourself Wrong

No matter whether you feel you can not stand one far more day at the office, or you are convinced you can not stand one more minute of a dull seminar, really do not give into people ideas proper away. In reality, the much more you believe you cannot stand anything, the much more crucial it is to show oneself wrong.

Just since you consider you cannot stand it, does not indicate it is correct. (See my preceding report on The 10 Pondering Errors that Will Hold You Back in Existence). You’re very likely in a position to tolerate much more than you give yourself credit for. Nonetheless, the much more you consider you cannot perhaps tolerate another 2nd, the worse you’re most likely to come to feel and the much more these ideas will influence your conduct.

Believe 1st (Photo credit: jDevaun)

Examples of “I Cannot Stand It” 

Picking to steer clear of unpleasant feelings gives some fast quick-term relief, but avoidance can lead to extended-term consequences. Right here are some techniques that thinking, “I cannot stand this,” leads to difficulties for folks:

•  If you consider, “I cannot stand getting hungry,” you may eat frequently to avoid any likelihood that you’ll experience hunger. You might commence consuming an further snack just before you head into a meeting or you might stop to pick up an added bite to eat prior to your commute residence. Even when you really do not come to feel hungry, you may decide not to consider any chances and consume as a preventative measure. Sooner or later, your waistline could suffer the consequences.

•  Thinking, “I can not stand my job any longer,” will probably result in you to only target on all the unfavorable facets of your perform. You could ignore something optimistic about your job and persuade oneself that you need to quit right away.

•  When you feel, “I cannot stand going to people boring department meetings,” you are not very likely to appear for answers that could make the meeting much more productive. Alternatively, you could get started to stay away from the meetings altogether or waste time complaining to other folks about how much you dislike the meetings.

Why Beliving Your Self-Doubt is a Negative Notion

Just since you come to feel unpleasant, doesn’t mean you require to give up appropriate away. Here are the causes why you must prove to oneself that you really don’t need to have to end carrying out one thing just simply because you consider you cannot stand it:

•  Thinking you can not stand anything influences how you truly feel. You are very likely to really feel a sense of dread, anxiety, or even anger as you approach some thing that you think you can’t tolerate. As you knowledge much more negative feelings about one thing, your thoughts are likely to turn into exaggeratedly unfavorable.

•  If you give up every time you can not stand something, you aren’t probably to attain your goals. It is likely that you tremendously underestimate your capabilities. You may possibly sell yourself quick if you give up each and every time you believe you can not stand something.

•  Giving up when the going will get tough can turn out to be a negative habit and it can alter how you see by yourself. You may begin to believe you’re weak or that you are a failure simply because you can not appear to stick with items long sufficient to see optimistic final results.

Demonstrate to By yourself You Can Stand It

When you consider you can’t stand one thing any longer, prove yourself wrong. If you feel you cannot stand anything for yet another minute, stick close to for two minutes just to show to yourself that you can do it. If you think you cannot stand 1 a lot more week at the workplace, resolve to perform at least two far more weeks. 

That does not indicate you require to perform at a job you dislike for 30 many years just for the sake of it, but by doing work 1 day longer than you thought you could, you can prove to oneself that you are stronger than you give your self credit score for. If you pick to quit your occupation, it’s crucial to recognize you quit by choice, not due to the fact you couldn’t stand the discomfort any longer.

When you conduct behavioral experiments that demonstrate your contemplating wrong, sooner or later, it will modify the way you feel. You’ll start to see that you have far more potential than you ever even imagined. You’ll be much less probably to think, “I can not do that.” Instead, you’ll recognize all the issues that you can pick to do.

Feel You Cannot Stand To Do Some thing? Demonstrate By yourself Wrong

Is Arkansas" "Personal Option" A Block Grant? Insurance Skilled Bob Laszewski Thinks So, But He Is Wrong

Throughout the previous couple of months, insurance coverage industry insider Bob Laszewski has chronicled a lot of of the failures of ObamaCare’s launch. He has raised some very critical questions and concerns from the insurance business about future policy and premium bumps that lay ahead below the ACA. Sadly, his recent assault on Republican governors and state lawmakers who have rejected ObamaCare’s misguided Medicaid expansion totally misses the mark. He contends that Arkansas’ “Private Option” is genuinely just a block grant for Medicaid. But the truth lies in the fine print, and even though there is no question the Private Option puts state taxpayers at risk, it also produces a new entitlement and ceded most of the manage for the plan to the federal government. It’s like putting the fox in charge of the hen property.

Laszewski praises the Obama administration for getting “very cooperative and flexible” on Medicaid expansion, by permitting states to improve Medicaid eligibility via applications this kind of Arkansas’ “Private Choice.” There’s just one dilemma: the promised “flexibility” in no way materialized.

We not too long ago talked to Arkansas State Senator Bryan King, chairman of the Legislative Joint Auditing Committee, who has been monitoring Private Option implementation. Here’s what he had to say about that promised versatility:

Arkansas’ negotiations with the Obama Administration manufactured 1 factor clear: the bureaucrats in Washington hold all the cards and their primary concern is implementing ObamaCare, not providing states with any true flexibility. They could relent on tweaks that quantity to nothing at all more than window dressing, but their intent is for states to expand Medicaid and enroll much more Americans into government-run well being care. Arkansas produced a grave error in trusting the Obama Administration’s false promise of flexibility and our state’s sense of buyer’s remorse grows worse by the month. I only hope that leaders in other states are not fooled by these empty guarantees.

Senator King is correct: Arkansas was given no meaningful flexibility at all.

The Federal Government Did not Grant Arkansas A Medicaid Block Grant

The Private Alternative Medicaid growth produces a new entitlement for in a position-bodied, operating-age grownups.  It is not a Medicaid block grant. By definition, a block grant calls for a state to acquire a fixed amount of funding in exchange for meeting particular policy goals. Although the federal government positioned a per-individual cap on Private Option spending—though kept an open-ended funding scheme for an unlimited amount of eligible individuals—it did not accompany that cap with accurate versatility. It’s the worst of each worlds for Arkansas: capped per-individual funding from the federal government and no meaningful flexibility to manage charges.

The Federal Government Did not Grant Arkansas Versatility On Who To Cover

The Personal Choice Medicaid growth covers all of the ready-bodied grownups that ObamaCare envisioned. The vast bulk of these ready-bodied grownups are operating age, have no dependent young children and are ineligible for most other sorts of welfare, such as money support and extended-term foods stamps.

In order to safe its waiver, Arkansas was forced to guarantee to cover men and women who have been already purchasing private insurance coverage – either via an employer or in the personal industry – as well as people who would otherwise qualify for federal subsidies on the ObamaCare exchange.

Other states that have explored partial expansions or various prepare types, like South Dakota and Indiana, have been smacked down by the Centers for Medicare and Medicaid Services—the choice-making arm of the U.S. Division of Well being and Human Services when it comes to Medicaid-associated negotiations with the states.

Is this the cooperation and flexibility that Mr. Laszewski praised the Obama Administration for?

The Federal Government Didn’t Grant Arkansas Flexibility On What To Cover

Personal Alternative enrollees are assured the same Medicaid rewards they would acquire below a conventional growth. All positive aspects not typically covered by private insurance coverage, like non-emergency medical transportation (NEMT) and early and periodic screening, diagnosis and treatment (EPSDT) benefits, are merely delivered through the traditional fee-for-support Medicaid program.

The Federal Government Did not Grant Arkansas Flexibility On What To Charge

Beneath the terms of the waiver, the vast bulk of enrollees in Arkansas’ Private Option have no cost-sharing whatsoever. Even between these who have to shell out nominal copays, cost-sharing is reduced than what existing Medicaid principles allow.

The Federal Government Didn’t Grant Arkansas Versatility To End The Expansion Whenever It Wishes

Practically nothing in the Personal Alternative waiver provides the state new authority to roll back its ObamaCare Medicaid growth. Federal law and regulation nonetheless classifies the growth population as a new “mandatory population” for states that opt into the expansion, which authorizes the federal government to consider away all federal Medicaid money if a state were to roll back eligibility for that group.

Is Arkansas" "Personal Option" A Block Grant? Insurance Skilled Bob Laszewski Thinks So, But He Is Wrong

Whose NHS is ideal? It truly is the wrong question | Andy McKeon

‘The English NHS seems to be very likely to hit the fiscal buffers soon the Welsh reduce in overall health spending may be a lesson in what can happen’ Photograph: Alamy

Criticism of the Welsh NHS is a common sport for English ministers. David Cameron will take typical pot shots at longer waiting occasions and a failure to hit A&ampE targets. To the politically cynical it seems like a straightforward try to brand Labour, which governs in Wales, as a celebration that cannot handle the NHS.

It may possibly also be an attempt to present that the “English” technique to managing the NHS, with the development of a market, competitors and a selection of personal, voluntary and other suppliers, is making much better final results than that in Wales, which abolished the “inner” marketplace in 2009 and can make little use of personal suppliers.

Not remarkably, Welsh ministers react in variety. In February the wellness minister, Mark Drakeford, referred to as the English NHS “a shambles”. Cameron threw the identical phrase back final week, only to be accused by Wales’s very first minister, Carwyn Jones, of turning into obsessed.

But beneath the yah-boo froth of politics, what is the reality of comparisons across the Uk, and what does it indicate for the potential of the NHS?

The Nuffield Believe in and the Health Foundation these days published the final results of an independent investigation into overall performance of the four Uk countries over the past 15 years since devolution started. On the indicators accessible, three key factors emerge.

First, devolution has brought different selections about funding ranges, priorities and targets. Yes, patients wait longer in Wales, and in Northern Ireland, partly simply because the targets set had been significantly less demanding than those for England. Waiting times substantially lengthened in Wales after 2010 (they also have in England, but only a small) as austerity set in and the Welsh government, alone amongst the 4 nations, made a decision not to shield NHS spending but to reduce it by roughly one% a 12 months in money terms.

2nd, more standard measures of performance in regions this kind of as the number of preventable deaths and stroke care display Wales moving in line with England but not closing the historical gap. Certainly, this is also true of Northern Ireland. On other indicators in the report the longer-term trend across the 4 countries is 1 of improvement and convergence, even if historical differences stay. But then inequality gaps have proved notoriously difficult to shut in England.

Third, Scotland’s functionality on waiting times, and other areas, matches that of England, possessing been significantly worse in the early 2000s. It abolished the purchaser-supplier split in 2004 and tends to make minor use of the personal sector, but it crucially introduced much more exacting targets backed up by tougher functionality management.

The message from this examine is that targets and overall performance management, which all four nations use, function. But outside this, what ever the selected approach to construction and governance the total rate of improvement in healthcare seems to be broadly related.

Making use of these comparators it is clear that the effect so far of competition in England has been overhyped – both approaches. It has neither been as good or as unfavorable as individuals on either side of the argument portray. Maybe it will in the potential, but the jury is out.

There are deeper troubles at work to which politicians in all 4 countries would do properly to pay out interest.

The top quality, amount and stability of employees at a neighborhood level is critical. The report demonstrates that the north-east has created important progress on enhancing healthcare. It has had much more funds over the previous decade than several other English locations and so has much more medical doctors and nurses. But it also has a much more secure, substantial-high quality workforce than, say, London and the south-east, assisted by nationwide pay charges. Troubles of recruitment and retention, such as relative pay, numbers and capabilities, all demand much more interest nationally than they at the moment receive.

Supporting the workforce is also critical. Politicians like to have battles to battle to demonstrate their reforming zeal. But most progress for patients will be achieved by spreading studying of what performs, generating sure every person from ministers and professionals are functioning to the identical objectives, and measuring the outcomes that matter most to patients. This is how care for the growing number of frail elderly men and women and these with continual illnesses will be improved. Fiscal wheezes, incentives and reorganising management structures will largely be at the margins.

Last but not least, money issues. The English NHS seems likely to hit the financial buffers soon the Welsh lower in overall health spending over the past three years may be a lesson in what can occur. Continued zero real-terms growth in wellness investing for the following five many years will surely see a deteriorating and crisis-ridden NHS.

Whose NHS is ideal? It truly is the wrong question | Andy McKeon

It truly is wrong to suggest poverty is a cause not to assistance action against smoking | Kevin Barron

‘The claim that we need to not act to stop a single bad issue, simply because there are other poor factors that we are not preventing at the same time is a fallacy usually perpetrated by reactionaries.’ Photograph: Martin Rickett/PA

Zoe Williams appears to be arguing that we ought to not legislate to avert smoking in vehicles with children present due to the fact “it stamps into public lore an image that fixates conservative view – that of the negligent parent” and “who makes the greatest mother or father? The middle class, of course” (The hidden agenda behind the ban on in-auto smoking, twelve February).

Initial, it must be remembered that ending smoking in cars with children was only part of the bundle of tobacco control measures agreed by parliament as part of the young children and families bill. The other people included the introduction of standardised packaging for cigarettes and other tobacco products – a measure aimed squarely at the tobacco firms, their advertising and marketing method and the huge income they make from pushing addiction and ailment. Williams does not mention that – it would spoil her narrative.

Second, she looks to propose both that due to the fact “the smoking figures are virtually usually in constellation with other aspects … from bad housing to reduced birth weight”, we either are not able to know for certain that smoking is a issue in kid illness, such as sudden infant death syndrome, or that we should not act on it even if it is – due to the fact we are not concurrently tackling other variables, typically a consequence of poverty in the household.

I profoundly disagree with her 1st proposition: the connection between smoking in front of young children and sudden infant death syndrome is effectively established in scientific literature and has been confirmed by the US surgeon common, the UK’s scientific committee on tobacco and health, and numerous other people.

Yes, there are other elements – and, like smoking, a lot of are associated to poverty and inequality – but this does not make government action to decrease smoking in front of young children a bad idea. The 2nd proposition is a fallacy generally perpetrated by reactionaries: the claim that we need to not act to avoid 1 negative point due to the fact there are other bad issues that we are not avoiding at the very same time. As even Williams looks to accept, smoking in cars is notably risky to youngsters simply because “smoking is more extreme in a modest enclosed area”.

Third, she forgets that smoking is the most significant single trigger of wellness inequalities in our country. Simply because smoking costs are higher in poorer communities, it accounts for about half the distinction in lifestyle expectancy in between the richest and poorest social class.

Smoking is an addiction deliberately promoted to some of the poorest folks in our society by some of the biggest, greediest and most irresponsible multinational companies in the world. If that is not some thing that must animate men and women on the left to action, I do not know what is.

I was brought up in a local community the place funds was tight and smoking was commonplace. Many great guys and women died younger as a outcome. I will not require to be lectured by a Guardian journalist about the realities of poverty, or to have it advised that poverty is a explanation not to assistance legislation to reduce smoking rates. I think I have a very good grasp on what poverty means, why we need to have to fight it, and why we must reduce the toll of death and ailment triggered by smoking.

It truly is wrong to suggest poverty is a cause not to assistance action against smoking | Kevin Barron

AOL"s Tim Armstrong couldn"t be more wrong about "distressed babies" | Janet Sheaffer Pickel

Cade, son of Janet Pickel when he was born (left) and now (right). Photograph: The Guardian.

On the day my twins were born, they racked up health-related expenses of $ 29,000 apiece.

They were delivered by way of emergency caesarean segment at 24 weeks’ gestation, meaning I was approximately five months along. Our daughter, Jaina, weighed just below a pound her brother, Cade, weighed 1 pound, five ounces.

They could not breathe on their personal. Their skin was so thin, their bodies so little, we could watch their hearts beat. They hadn’t developed cartilage yet their ears and noses have been flaps of skin. We didn’t inquire how a lot it was going to expense to deal with them we just wanted our infants to live.

Our several physicians talked about day-to-day survival, not lengthy-term payment strategies.

My employer – a newspaper not far previous a round of buyouts and price-cuts – did not inquire me how significantly it was going to cost to deal with them. My co-workers pooled money and bought us present cards so we didn’t have to cook as we drove back and forth to the hospital for months.

When I study AOL chief Tim Armstrong’s remarks blaming his company’s improved well being-care expenses on two “distressed” infants with million-dollar healthcare expenses, I wondered if that’s what every person imagined about our twins. Did we invest as well considerably of an individual else’s money to consider to conserve them?

I know my unplanned initial pregnancy (at 41) value a total great deal of money, a lot of which did not come out of my pocket. Insurance coverage and Medicaid picked up all but a handful of thousand bucks of the $ 2m we “invested” at the Harrisburg Hospital neonatal intensive care unit in four months.

Our Jaina lived only 49 hrs. In that time, she had x-rays, blood transfusions, IVs, a ventilator, an incubator, a devoted nurse. I never even know what else. All I know is she was quite sick and she died, and I would’ve paid $ 10m – any amount – to save her if I could have.

Cade appeared healthier at 1st, but had his initial (of 10) surgeries when he was two weeks previous. When he was 3 weeks outdated, struggling through his umpteenth infection, a doctor asked us if we needed hold making an attempt to hold him alive.

We did, no matter the cost.

Thanks to talented doctors and nurses who found the supply of the infection and fixed it, Cade turned the corner following that day. He was not out of the woods, however. He could not breathe on his personal right up until he was two months previous. He had sight-conserving eye surgical procedure at 3 months.

At one stage, we have been advised he likely had cerebral palsy and would be disabled in some way, perhaps mentally, maybe physically, possibly the two. Was a disabled youngster also expensive to maintain? No 1 asked that query. My husband and I in no way deemed it.

Cade was launched from the NICU when he was four months outdated. His very first week home, he had 7 physician appointments. He did not have cerebral palsy soon after all, but received government-paid early intervention companies to help him find out to stroll and talk and catch up with his non-preemie peers.

Today, Cade is a content, wholesome two-yr-outdated. He has mild asthma, but has not been hospitalized unexpectedly for a lot more than 18 months, which is trigger for celebration. He still sees a good deal of medical professionals, but not really frequently. His final surgery was only a month in the past, but his scars on his back, his belly and his arm never seem to bother him. Largely, he giggles and skips and asks to watch “Hi Elmo” (Sesame Street) all the time.

I wonder if AOL’s Tim Armstrong, who has apologized for his statements, understands how dehumanizing they were. Some have even advised his remarks violated America’s healthcare privacy laws. Remember when Obamacare opponents were speaking about grandma being subjected to death panels as an alternative of expensive care? It is the very same thing. It’s as if he wished price-benefit analyses to be done just before our daughter’s IV was place in or our son’s cardiac surgeon referred to as.

Thankfully, in our situation, my husband and I were capable to determine what was very best for our child with no worrying about the price. We have usually paid our insurance coverage premiums and taxes without complaint, believing that the frequent very good is well worth sharing the ache. We have tried to give back what we’ve been provided by means of perform and volunteerism.

Must I really feel guilty for possessing medically fragile babies? Was it worth it? Was it fair for other people to aid pay out for them? Must my son truly feel pressured to have a much better-than-common existence due to the fact his start price a lot far more than every person else’s?

Unanswerable concerns. I cannot put a cost on a priceless existence, and neither can any individual else.

AOL"s Tim Armstrong couldn"t be more wrong about "distressed babies" | Janet Sheaffer Pickel

Michael Sam"s Announcement Is A Non-Concern -- Not That There"s Anything at all Wrong With That

Michael Sam"s Announcement Is A Non-Concern -- Not That There"s Anything at all Wrong With That

If you want to know how to help an alcoholic, you are asking the wrong question | Patrick Strudwick

‘How do you reply to hearing a thud, and it is them on the stairs? Or when they burst into our bedroom raging?’ Photograph: Stephen Barnes/Urban Exploration/Alamy

Making an attempt to assist an alcoholic is, at greatest, like making an attempt to water a dead plant. It is not a situation of diminishing returns – there are none. Only two solutions surface, as a result, to the question of how any of us with loved ones who descend into dipsomania can assist. Very first, you cannot. Pleading, screaming, reasoning, removing their stash, calling their GP, frantically Googling AA meetings, phoning the police, the ambulance, their mothers and fathers, or young children, or anyone – no, it is all useless.

2nd, it is the incorrect question, and 1 that cloaks the query we can not attain (since a carer’s perform is in no way accomplished): how do we support ourselves? And then, exactly where is the aid for us?

I ask simply because these concerns by no means occurred to me for the duration of the two intervals I lived with alcoholics, nevertheless have been triggered by studying of another’s predicament. Nobel prize-winning biologist Sir John Gurdon, 80, and his wife Jean, 77, were, a court heard this week, attacked by their alcoholic son. John confronted William, forty, in their kitchen over his drinking – he had attempted the Priory. William lashed out.

“You got drunk and pushed your mom above so she hit her head on the floor leading to injury,” said Ken Sheraton, the judge who gave William Gurdon a suspended prison sentence. “You then pushed your father on to the floor and grabbed him by the throat and attempted to strangle him.”

It was not this that winded me it was one more crushing detail. When his mom smelled booze on his breath at 8.30 that morning she cooked him a fry-up. Of course she did. He is her son and it is what we do. Give them meals. Make them a coffee. Pay attention to their looped anecdotes. Mop up their self-hatred. Reassure them. Support them.

The unkind phone this enabling. I get in touch with it caring. Simply because what else are we to do? What is the very best response to stepping in urine due to the fact you made it to the toilet in the quiet of night but they had not? How are we to respond when we hear a thud and it is them on the stairs? Or when they burst into our bedroom raging?

I did not know what to do when one of the alcoholics I lived with left the front and back doors open (a billboard advertisement for burglary in north-east London). I did not know what to do when all the reasoning ran out and the investigation ran, rather inaptly, dry. Try out to locate an NHS rehab bed for an individual. Attempt to find totally free counselling. Try out even to get them sectioned. It is virtually extremely hard. At this stage there is not even water for the dead plant.

Some recommend Al-Anon, the organisation for those affected by alcoholics, and no doubt they are superb, but what I needed was a working, capable NHS and social care method that requires addicts off our incapable hands.

Alcoholics talk of “rock bottom”: theirs, not ours. I reached mine in October 2007, not since I couldn’t cope any much more, but due to the fact he was drunk on a Sunday morning and my then 4-yr-outdated niece was due to come round. No little one ought to see that. But, in accordance to Alcohol Concern, two.six million young children are living with mothers and fathers who drink “hazardously”. How are we to respond to that gutting, jeroboam statistic other than to conclude: we do not care about these kids.

The privileged – by which I imply not just the John and Jean Gurdons but any grownup who, unlike youngsters, has options – can at rock bottom go nuclear: kick them out or telephone the police. I did the former, grabbing his keys, bagging up his belongings and dumping them on the street. But what are you left with?

Guilt for sure. More fear – will they die? And, in my case, a bedroom reeking of the dozens of vodka bottles stashed inexpertly. There wasn’t even anyone to support me clean it up.

If you want to know how to help an alcoholic, you are asking the wrong question | Patrick Strudwick