£3,300,000,000 = The amount we got last year for arms exports to Saudi Arabia.
Wikileaks: Saudi Arabia’s rulers threatened to make it easier for terrorists to attack London unless corruption investigations into their arms deals were halted… told they faced “another 7/7” and the loss of “British lives on British Streets” if they pressed on with their enquiries.
Wahhabism (as part of the Salafi movement) = The ideological concept of destruction and terrorism (suicide bombings, indiscriminate attacks) which is the root of current home-grown terrorism. From Saudi Arabia. We have now sponsored it for years and years to come.
This is a very important argument, and it is essential for healthcare professionals, journalists and politicians alike to make a concerted and aggressive effort to kick these sugar-peddling companies out of the sphere of academic influence.
The more overt “More Doctors smoke…” advertisements of yesteryear are thankfully a thing of the past, but the covert influence of sugar-saturated food companies is no less a threat to our health. Aaron and Siegel (1) report that from 2011 to 2015, the Coca-Cola Company and PepsiCo were found to sponsor 95 national health organizations, many medical and public health institutions amongst them. They also lobbied against 29 public health bills intended to reduce soda consumption or improve nutrition.
The British Nutrition Foundation, for example, lists amongst “Sustaining Members” Coca-Cola, PepsiCo, Kellogg, Nestle, Tate & Lyle and has “Corporate Members” British Sugar plc, Mars UK, KP Snacks, McDonalds, United Biscuits, Weetabix, Ocean Spray and many more. Although it is open to companies and corporations from a variety of backgrounds including healthcare and fitness, the actual members who have provided support read as a Who’s Who of Sugar Salesmen (2), making their promise of a “a focus on objective nutrition science interpretation and delivery” open to scrutiny. The American Society for Nutrition is no different, with an almost-identical list of names cropping up (3) for this group, which publishes the Journal of Nutrition.
Indeed, the editorial boards of top nutrition journals are littered by corporate affiliations with sweetie companies – The American Journal of Clinical Nutrition, for example, lists the likes of Mars, Coca-Cola, PepsiCo, Nestle, McDonald’s and Ferrero amongst companies who have a relationship with members of their board (4). The ambassador’s reception may also be overflowing with hazelnut-and-wafer spherical treats at many other nutrition journals, who often home of the Journal of Nutrition Education and Behavior, who have eight “corporate patron friends” and four “corporate sustaining friends. (5)
It would be interesting to note how these journals consider submissions which report a detriment to health from these companies’ products, but when some of the largest nutrition journals display such a conflict of interest it must become clear to all that the Honey Pot relationship between “Big Food” and academia is poisonous and needs to be dealt with.
(1) Sponsorship of National Health Organizations by Two Major Soda Companies. Aaron, Daniel G. et al. American Journal of Preventive Medicine , Volume 52 , Issue 1 , 20 – 30
Published on: https://iranwire.com/en/blogs/693/4344
In this guest blog, Dr Nima Ghadiri describes the harrowing experience of the end-of-life care his grandmother received in an Iranian hospital, and the betrayal of the principles of bioethics, which were first identified many centuries ago by Iranian polymaths, including Avicenna and Razi.
Avicenna (left) and Razi (right), Persian physicians and polymaths who helped define the principles of bioethics, used by healthcare professionals to this day
My beloved grandmother and closest friend Batool Sepassi died in an Iranian Hospital ICU (Intensive Care Unit) following a short illness.
During the course of a viral illness, she became increasingly short of breath and had to be admitted to a local private hospital. She had a chest infection and was taken to the intensive care unit accompanied by close family. At this point the family had separated to go to the payment desk, and my grandmother was taken to ICU, though no medical history was taken nor treatment started until payment was organized (the privilege of private healthcare).
There were some major flaws in treatment. Having been admitted with a chest problem, it took 30 hours for a chest consultant to see my grandmother, though not without a battle — we were told “this patient is not on my list” — and a serviceable X-ray was only taken the following day.
My family was only allowed an hour a day to visit my grandmother, which was extremely hard given that she thrived on closeness to family and friends. My close relatives stayed outside all day the ICU to be able to glance at my grandmother from a distance and hear her calling out for them. This was a traumatic experience, particularly when they heard the expressions “Saaket” or “Khafeh Sho” (“Shut up”) from my grandmother when she was undergoing procedures. My grandmother loved to communicate and form bonds with people, and appreciated having her close ones hold her hand during medical procedures. During all of her stay, her arm was outstretched to hold someone’s hand, but there was no one there and her hands were eventually fastened to the bed.
The course of the disease was unpredictable, and ultimately a poor prognosis was given, i.e. the chances of my grandmother’s survival diminished. During this period, interactions with nurses and doctors were punctuated by disregard and dismissal. For example, when one relative noticed that the nebulisers were inserted in my grandmother’s eyes rather than her nostrils (where they belong), this fact was dismissed with a “oh, her oxygen was high”. There were a few good doctors and nurses, but they were conspicuously outnumbered by the poor ones. When my cousin objected against intubation (insertion of a tube into the lungs) for the last few hours of life, instead of explaining the rationale, the doctor shouted at her “Do you want to kill your grandmother?” It took a lot of pressure to prevent the ICU team from doing a completely needless invasive procedure (kidney dialysis) with just a few hours of life remaining and kidney test results that had been unchanged for years.
Nevertheless, simple measures such as giving my grandmother something to drink were considered a luxury. When my grandmother was deteriorating, no provision was made to allow her to be close to loved ones. She and her family did not want her to be in an intensive care unit, and not only was she kept there against her will during the treatment phase, but she was kept there when she was about to die.
I asked my cousin to connect her to me by video call before her death during the one-hour visiting period. Her eyes were initially closed, but as soon as she heard my voice, they opened wide. Her mouth was entirely bandaged apart from a tube coming out of it, but I could see the outline of her lips moving briskly underneath all the bandages. She wanted to say something, and had never been stopped from talking to me before. She started vigorously shaking her tied arms in an attempt to communicate with me, but then realized her efforts were fruitless and her eyes started welling up with tears. In all my years of knowing her, I don’t remember her crying. She died just over an hour later, curtains drawn and no loved ones around her.
Nothing could have prepared me for this image, which remains traumatically imprinted in my mind. It will be a memory I will never forget. I keep wondering what she wanted to say – was she saying goodbye to me, or asking me to convey a message: to look after my mother, my brother, or help someone desperately in need? Finding the answer to this is a futile quest, but it is a rumination that will, sadly, remain.
Dying alone, with family not allowed to be with her is one thing, but my family were also denied the chance to see her after death. Only after begging were they able to get a brief glimpse of her in the corridor prior to entering the mortuary after challenging the comment, “She’s gone, why don’t you just go now”.
Passing away is an inevitable part of people’s existence, but the environment for this chapter of life is so important. As a doctor who works in the United Kingdom’s National Health Service, I have been well-versed in the importance of dignity in death. But in Iran, a country whose polymaths helped define the early principles of bioethics, it is unfathomable that core bioethical values were denied for such a sweet soul as my grandmother, and potentially for others. These principles include Non-Maleficence — not performing unnecessary procedures that serve just to prolong the patient’s life and often cause distress and pain to the patient — and Autonomy – respect for the desires and values of the patient, including how they want to be treated and how they want to die.
In my grandmother’s case this was with her family around her and without fruitless procedures. Denying someone’s spirit and character so manifestly in their final days and hours is criminal. These sentiments were shared by my family, and indeed being able to spend time with a loved one before and after their death to say goodbye should be a basic right, rather than just being able to observe this sorrowful moment from a distance. It should not be such as Sisyphean effort to spend time with a loved one and find out what happened during a hospital stay, hampered at all stages by a lack of sympathy and empathy alongside a degree of ageism against someone who is perceived as just a bed number rather than a human being.
A photo of Nima Ghadiri’s grandmother holding a pomegranate on Shab-e Yalda (An ancient Persian festival commemorating the Winter Solstice), three weeks before she died
I remain always indebted to my grandmother for looking after me as a child in the United Kingdom and being someone I could talk to and share my life with for so much of my existence. Even at her age, she had the spirit of someone many decades younger, was full of life and brought joy to so many. She shared all she had with charity and those less fortunate than herself. Strangers often commented on how sweet and bright she was and I used to talk to her about films, technology and current affairs. She remained a fountain of wisdom and I could not have dreamt of a better grandmother. Her grandchildren remain traumatized by the manner in which she has gone, and the suffering and abuse that she endured. Because she was such a positive and life-loving soul, I do not want the final page of her life to be negative. I am not sure how yet, but I know that I would be happy if the discussion arises for Iran, the country of Avicenna, Razi and numerous others, to re-discover what care, particularly at the end of life, means. Perhaps in the future, I will open a palliative care institute in her name.
Dr Kermode’s Top 10 films are a highlight of the year for many Wittertainment fans. As usual, there is the odd smattering of unjust criticism, with some saying there should be a separate “top 10 arthouse” and a “top 10 multiplex” list. No, no there shouldn’t.
People have watched and listened to Mark Kermode for different reasons over the years, and they are all equally valid.
Some people just listen for the infectious banter between him and Simon Mayo, and are perhaps less interested in going to the cinema, that is fine.
Others want to know which of the week’s big releases is worth seeing from people whose opinion they can generally trust, that is also fine.
Others want to hear a good old Kermodian rant, also absolutely fine.
But some people have always tuned in to hear his opinions about films which are less well-marketed but no less good than action-packed multiplex offerings. He has been doing this for decades. I personally think there are enough places which review and advertise big releases and I know enough about them from reading a magazine or a paper.
I go to Mark to get his thoughts on films which I would not have otherwise heard of, but can be more enjoyable and impacting than Return of the Nostalgia Fest VIII. I don’t think there should be two separate lists. He is a film critic, and it is right that this is his top 10 list.
Earlier this year, former prime minister David Cameron pledged a mental health revolution of almost a billion pounds. Whilst this proposed outlay is welcome, it must be matched by a proactive change to the stigma attached to mental health in media, the workplace, and at home.
Mental health and doctors
Professor Debbie Cohen of Cardiff surveyed almost 2000 doctors this year and found that 60% had experienced mental illness in the UK (82% in England alone). In the general population, the rate is 28%. Doctors experience the same range of problems as everyone else, but the cocktail of work, exams, academia, family and relationships lowers the threshold for illness. Many have perfectionist traits which lead to doubt and self-criticism when things go wrong, leading to a self-perpetuating cycle.
Worryingly, more young doctors are being diagnosed with mental health problems. There may not be a pre-existing illness: After 25-year old junior doctor Rose Polge tragically committed suicide in February 2016, her family described a young lady with an infectious enthusiasm for life and no previous mental health problems, but long hours and work-related anxiety contributed to her decision to end her life.
Extreme stress early on
Doctors are as susceptible to mental problems as the general population. However, particularly early on in their careers, they face a unique combination of challenges. These include the need to develop countless skills within a short period (for which university education can never fully prepare) and service burdens in a chronically under-resourced environment, only more challenging for those with family or caring roles. Early junior doctors shifts are usually incompatible with outside interests, and losing day-to-day balance can unearth mental health struggles.
Doctors face a societal and professional weight compelling them to ignore difficulties. A cultural idiosyncracy of willing martyrdom exists, in which doctors feel it their role to attend work regardless of fitness. This is less prevalent in other countries, for example Australia and New Zealand, where attitudes towards sickness are more rational.
Fewer professions stigmatise mental health disorders more prominently than medicine. In the Cardiff study, 41% of doctors with mental illness said that they would not disclose it. Doctors are not supposed to get ill, and seeking help is weakness which imperils trust in the practitioner’s ability to do his/her job. This featured in the heartbreaking suicide of GP Wendy Potts in November 2015 after a patient read her blog on living with Bipolar Disorder and complained to the surgery.
Some doctors find changing roles from helper to patient unnatural, others find treatment from a colleague embarrassing. Often the prevailing fear is of a career-threatening “black mark” on a permanent record: Doctors must labour through appraisals and assessments, and competition for jobs and training posts can be ferocious.
A culture of fear
A 2008 Department of Health report said:
“Doctors may fear that acknowledging the need for help will damage their career prospects or lead to scrutiny of their fitness to practise”
This happened in the case of Dr Dakhsha Emson, who killed herself and her baby during a relapse of bipolar disorder in 2000. A stirring tribute from her husband reflected a talented doctor and a successful medical career. However, worry of colleagues and patients finding out when she was applying for consultant posts led to a lack of treatment. The report highlighted a:
“Widespread stigma against mental illness in the NHS”
This stigma can arise as early as medical school, fostered by a triad of competitiveness, fear and uncertainty. Students sometimes receive conflicting information about mental health, and may fear disclosing illness. Pastoral care can be arbitrary, often with little demarcation between disciplinary roles and support roles. Some universities have introduced “fitness to practice” hearings to monitor student behaviour, fostering a culture of castigation.
For some doctors, this culture is epitomised by the General Medical Council (GMC), whose role is to protect the health and safety of the public. All doctors with mental health issues are required to notify regarding their problems, which are investigated under the same procedures as misconduct and poor performance. Subsequent fitness to practise processes are required to be declared on application forms for jobs. These can sometimes be beneficial, for example recommending support. However, often they are described as harrowing experiences, and the duress of investigation affects doctors personally and professionally.
The toll can sometimes be too much, between 2005 and 2013 there were 28 reported cases of suicides following investigation. One of those was GP Belinda Brewe, describing the process:
“threatening and isolating”, eroding “self-confidence and self-belief”.
The NHS needs continued active campaigns to encourage openness, tackle stigma and promote healthy working practice.
Medical schools should be proactive in support and awareness: counselling services, pastoral care positions and peer support.
The insight that doctors with mental health problems have when treating their patients should be valued.
A doctor who has a mental health disorder might put his patient at risk, but a doctor hiding or in denial because of a culture of fear will put his patient at risk.