History > 2006 > UK > Health (IV-VI)

Row over cancer jab plan

for all schoolgirls

· Mass vaccination 'will save lives'
· Parents fear rise in underage sex

Sunday December 24, 2006
The Observer
Gaby Hinsliff, political editor


Schoolgirls as young as 12 are to be vaccinated against a sexually transmitted disease linked to cervical cancer, under controversial plans being drawn up by the Department of Health.

Millions of girls would be immunised at school against human papilloma virus (HPV) before they become sexually active. Research has shown the virus is one of the key causes of cervical cancer, which kills around 1,000 women a year.

Routine injections against HPV have already been adopted in some US states and a handful of British parents have begun buying the £450 injection for their daughters through private clinics. The vaccine was licensed here earlier this year.

The government's expert advisory body on vaccination, the Joint Committee on Vaccination and Immunisation, is now studying proposals for an NHS-funded mass vaccination scheme which would eventually replace the current screening programme under which women are summoned for smear tests every three years to check for early signs of cancer. Senior Department of Health sources said the best age for immunisation was 12 or 13, before most children become sexually active. Ministers are said to be looking positively at the idea and planning is well advanced.

The move will be controversial with some parents, who fear the jabs will encourage unprotected sex or send confused messages about the right age for girls to lose their virginity. The new jab also adds to the long list of vaccines to which children's immune systems are subjected and which some parents worry put too high a burden on young bodies.

Research among parents conducted by the Department of Health showed that most had not heard of HPV, one strain of which causes genital warts but can be carried without causing symptoms, and they did not know of the cancer link. They were worried, though, about the implications of vaccinating so young, prompting the joint committee to conclude that 'information on impact of vaccination on sexual activity' would be necessary to address parental concerns.

Immunisation is strongly backed within the medical profession. Professor Alex Markham, chief executive of Cancer Research UK, said vaccination could prevent almost three quarters of cases of the cancer, adding: 'The advent of a vaccine is a very exciting development. HPV vaccination holds the potential to prevent the majority of cervical cancer cases in the UK.'

He said the vaccine was 'most effective when given to women prior to any exposure to the virus', meaning before they started having sex.

However Hugh McKinney of the pressure group the National Family Campaign questioned the wisdom of immunising such young girls. 'Vaccination against cervical cancer makes full sense to bring down occurrences of this dreadful disease. The only question is at what age is this most appropriate, and many people will question whether 12 years is too young to be undertaking a vaccination programme that is important for when girls become sexually active,' he said.

'It could be seen as helping to promote or encourage sexual activity in girls before they are physically or mentally mature.'

The vaccine would be given in two to three doses by school nurses, with protection lasting about 10 years. As with all vaccinations, parents could refuse consent. The joint committee has also considered whether boys should be immunised to stop them passing on the virus, with some evidence it could help protect against rarer penile cancers. It concluded that vaccinating boys is 'only cost effective if both coverage and vaccine efficacy is low' among girls.

This summer Hollie Anderson, 13, became the first British girl to get the vaccine privately. Hollie's grandmother died of cervical cancer and her mother, Lisa Anderson, said she believed every mother and daughter should have the jab. She said: 'I've seen how awful the disease can be. I saw it as my role to protect Hollie.'

The main obstacle for the government could be financial - three doses cost the NHS £241.50, although there would be a discount for a universal programme and savings on treating the 2,800 women annually diagnosed with cervical cancer could be significant. Screening would have to continue for at least 15 years post-vaccination, to check it works.

    Row over cancer jab plan for all schoolgirls, O, 24.12.2006, http://observer.guardian.co.uk/uk_news/story/0,,1978538,00.html

This article is from a special (RED)
edition of The Independent to mark World Aids Day

Britain accused

of sending HIV refugees to die

Published: 01 December 2006
The Independent
By Nigel Morris, Home Affairs Correspondent

Ministers have been accused of condemning failed asylum-seekers who are HIV-positive to death by deporting them to Africa.

Campaigners have called for them to be treated as a special case as antiretroviral drugs, which could extend their life expectancy indefinitely, are not yet available in their home countries. They argue that the deportation policy contradicts the Government's commitment to tackling Aids in Africa.

But the Home Office has rejected the pleas, arguing that allowing them to stay could create a "pull factor", attracting other "health tourists" to Britain.

Several hundred HIV-positive refugees are in the UK. The majority are receiving treatment, although hospitals are under no obligation to provide it once an asylum-seeker's claim to remain has been refused. Nearly all are from countries such as the Democratic Republic of Congo, Nigeria or Zimbabwe which have scant or no supplies of antiretrovirals and are unlikely to receive them for another five years.

A Home Office spokeswoman said: "We're not convinced that a special dispensation needs to be made for victims of HIV/ Aids because that would create inconsistencies in how we treat individuals with other serious illnesses."

But Anna Reisenberger, the Refugee Council's acting chief executive, said: "This approach seems to totally contradict the Government's commitment to tackling HIV at a national and global level. "No one should be returned to a situation where their life is in danger. That includes people who are HIV-positive being removed to places where they are unable to access treatment." Lisa Power, head of policy at the Terrence Higgins Trust Aids charity, said ministers seemed more concerned with being tough on immigration than acting humanely in a handful of cases.

She said the trust was helpinga Malawian couple who had discovered they were HIV-positive after arriving in north-east England. Their four-year-old son, who was born in the UK, is free of the virus.

Although all 13 of the man's brothers and sisters have died from Aids, the family have been earmarked for deportation. Immigration officers went as far as to force the woman on to a bus taking her to the airport. She received a last-minute reprieve and the family is now mounting a judicial review of the decision to remove them.

Ms Power said: "The Government is sending people back to their death. There is a great deal of fear among people who have exhausted the appeals process, but haven't yet been deported. What's the difference between fleeing a tyrannical regime or fleeing a virus that is going to kill you?"

Campaigners have repeatedly lobbied the Government on the issue, most recently in a meeting six months ago with Tony McNulty, the former immigration minister. They said they drew some encouragement from his promise to look into the situation. However, the Home Office yesterday confirmed it would not change the treatment of HIV-positive failed asylum-seekers.

In a report today, the Aids charity Crusaid calls for a package of action to enable HIV-positive asylum-seekers to escape poverty. Measures include allowing refugees to work after six months in Britain, an amnesty for those who have been in the country for several years and for subsistence payments to rise in line with income support.

Crusaid is also calling for local councils to give priority to the housing needs of all people living with HIV and for HIV-related hate crime to be addressed.

    Britain accused of sending HIV refugees to die, I, 1.12.2006, http://news.independent.co.uk/uk/this_britain/article2029293.ece
 

Focus: Mental health

My son has schizophrenia. Why can't the system cope?

A litany of failures was revealed last week in the mental care of John Barrett, the man who murdered a stranger in Richmond Park. The failures are not unique. In this brutally honest account, author and father Tim Salmon reveals the frustrations and confusion that have blighted his son's treatment as inadequate care services struggle to manage

Sunday November 19, 2006
The Observer

I do not like to call my son mad. It seems such a final and unforgiving word for a person who for 17 years has struggled with the illness more commonly known as schizophrenia.

Although the underlying condition does not go away, its worst manifestations are cyclical rather than continuous: periods of relative stability interrupted by crises, usually brought on by refusing medication. That is when 'madness' is certainly a much better description of what is happening than 'having issues', the phrase one mental health worker used to describe my son. It is obviously not an easy condition to treat. But once you get involved in this world of 'issues around mental health' - as parent, partner, sister, friend, the mad one himself - you could be forgiven for thinking that confusion reigns.

I am far from alone in my criticism of the care provided by the mental health services. And I know that many parents of sons and daughters with schizophrenia feel as I do - that there is a certain arrogance among the professional caring services, a presumption that they know better than we do what is good for our sick children. Most of us do not have to deal with situations as dramatic as that revealed in last week's damning report on the case of John Barrett, a schizophrenic who killed a stranger in Richmond Park, south west London, after he was released by the secure unit where he was staying. The report showed that many people working in mental health had put the 'rights' of John before the security of the public or even his own safety. It highlights in the starkest manner the possible consequences of focusing on the rights and liberties of the patient turned client.

There is supposed to be a 'seamless network of care'. It is supposed to cover the medical, social, housing and other needs of the mentally ill. But for various reasons it does not. Some of the reasons are financial, some organisational and some, paradoxically, have to do with the culture - to use a horrible jargon word - of the professional caring services and mental health charities whose genuinely held intention is to care for the mentally ill. A further reason - and far from the least important, as it probably behoves people like me who are critical of the system to remind themselves - is the intractable and messy nature of an illness whose distinguishing feature is loss of reason.

Not that you are allowed to say that, because it runs counter to the 'ethos of optimistic realism', probably promotes stigma and generally interferes with our modern desire to pretend that there are no inequalities or other unpalatable differences between people.

This extreme aversion on the part of the caring professions to calling things by their proper names is one of the most vexatious 'issues' I have encountered. The sick are no longer patients, but clients or service users and, by implication, considered capable of evaluating their own needs, entering into contractual relations with doctors and other agencies whose function is to deliver the chosen service or care package. If this seems a surprising way of approaching people who, when ill, are almost by definition 'not in their right minds', what are we to make of the recent 'best value' review of mental health services by Camden council in north London in which it proposes to give patients/clients direct payments from social services with which 'to organise and buy the services you need for yourself'? And this, when one of the most notorious symptoms of schizophrenia is an inability to understand your own situation.

When I suggested in a discussion about compulsory treatment that perhaps, just as we accept the notion of acting in loco parentis where children are concerned, it might be wise to accept a similar dispensation for people who are 'not in their right minds' - a condition that those of us who have observed schizophrenia at close range are all too familiar with - I was beset by cries of outrage from the spokesmen for civil liberties, advocacy services and pressure groups.

But these are the orthodoxies of the day. Even the National Schizophrenia Fellowship, founded 30 years ago by parents of schizophrenic children to campaign on their behalf, has succumbed. Under the influence of professional charity workers whose training and career prospects depend on their acceptance of these things, the organisation's name was changed to Rethink. Schizophrenia, they argue, is an alarming word: it stigmatises the sufferer and discourages donors to the charity. The group's literature is full of optimistic talk about recovering and positive outcomes, and full of smiling faces on pastel pages. It is not a view of the illness that tallies with my experience or that of the many other parents I have talked to over the years.

The doctors do not seem to have any difficulty in calling the illness by its name, but then it is hard in medicine to develop a treatment for a phenomenon you cannot bring yourself to identify. There was a revealing demonstration of the difference between these approaches at the fateful National Schizophrenia Fellowship annual meeting where the decision to change the name was taken. Professor Robin Murray from the Maudsley Hospital in south London gave an address in which he used the term schizophrenia frequently. He was followed to the podium by the fellowship's chief executive and architect of the name change who did not use the word once. Is the hope that all nastiness and discomfort will disappear if you call it by another name?

As all parents with mentally ill children will know, practical issues are as pressing as ethical debates. The most pressing for us is my son's homelessness. He was admitted to a hospital in north London in May 2005, under 'section' - that is, detained under the Mental Health Act. He is still there. Although his section was lifted in November 2005, he could not be discharged because he was officially homeless. Since he was considered well enough to leave, even though he could not, he no longer had his own bed.

Until he was sectioned again in July, the hospital shuffled him from bed to bed, ward to ward, building to building - including a hotel - in response to the pressures of demand from patients considered to be in more urgent need. It is not a regime calculated to promote the good health of anyone, least of all a person with a history like my son's and was, moreover, in direct contradiction of the doctors' instructions.

And why is my son still homeless after more than 18 months when already, on admission to hospital, everyone knew that accommodation would have to be found for him? The same thing happened in 2003. There does not seem to be a very clear reason, other than bureaucratic inertia and the apparent inability of right hands to know what left hands are doing, a situation compounded by my son's status as 'a client' and 'free agent'. For, when a voluntary agency was finally engaged to help him, he refused them and they withdrew - a decision that I am glad to say has now been reversed, but it was not one that my son should be congratulated for having taken in the first place. Yet, as a client, a customer, who is to say that he does not know best?

I - foolishly, it turned out - had assumed that the local authority, in our case, Camden, would have a stock of accommodation deemed suitable for vulnerable people like my son. But no, that is not how it works: your need is assessed and you are awarded points accordingly. You consult the Camden New Journal week by week, identify the accommodation that your score of points might qualify you for, and bid for it, over the phone, in competition with others in search of a home - ex-offenders, foreign asylum seekers, you name it. Priority, as a 40-year resident of Camden, disabled by schizophrenia? You do not see the property, you do not speak to another human being, you are not interviewed by anyone from the council. It is hard to imagine a less humane way of doing things.

And all the while my son is stuck in hospital, at considerable cost to the public purse. The room he used to occupy, in a hostel run by the charity Mind, to which he does not wish to return and to which he cannot return because Mind does not want him back, remains empty and cannot be given to anyone else until he is rehoused. Where is the logic in that?

And how did he end up in a hostel run by Mind? Because he could not return to his flat following an episode with a neighbour which came about because he had not taken his medication for several weeks. Why? Because, suffering from a kind of agoraphobia, he was afraid to leave the house and walk the 15 or 20 minutes to the surgery to renew his prescription. Why the surgery did not have a way of noticing that such a vulnerable patient had not collected his prescription, I cannot say.

And as for the social services, they had long since given up on him. If you say no often enough, they just stop bothering. You are a free agent, after all, free to act against your best interests until you are found roaring and naked in the street at Mornington Crescent at 3am or shouting abuse at a blank wall in Stoke Newington at lunchtime... or worse. Then you are detained and sectioned.

Last Christmas I was alarmed to discover that there would be no staff at the hostel where my son was staying for four or five days. I spoke to my local paper, which ran an article. I also wrote to my MP, Glenda Jackson, who rang me and told me off for going to the press, repeating Mind's sales pitch about empowerment. When I said I thought this language was hardly appropriate where an illness like schizophrenia was concerned, she accused me of wanting to go back to the days of long-stay asylums.

On one occasion my son was threatened with eviction for being difficult. I intervened and said I thought Mind's position contradictory: on the one hand it accepted residents with a difficult psychiatric history and on the other treated them as if they were normal tenants in breach of their lease. A social worker called a couple of days later to tell me that a meeting was to be convened to review my son's situation. 'That's good,' I said. 'What time?' He refused to tell me, without my son's written permission. I told him that we had seen countless social workers come and go over the years, that the only constant support in my son's life came from his family. He still would not tell me. This is common practice. The Camden and Islington Mental Health Trust would not even reply to my written complaint about my son's current situation at hospital without his written permission.

Shortly after the threatened eviction, encouraged by the social worker to find some kind of occupation, my son signed up for a language course. In Toulouse. And off he went, although he had been more than a month without medication. This, in spite of the fact that his medication had been changed from pill form to fortnightly injection so that people looking after him could keep better track of it. Because, however, my son and all those like him are clients, when he says no, there is nothing anyone can do.

My son is brave and determined, still fighting for his independence and dignity after 17 years. He got to Toulouse, but two days later dad had to set off on a rescue mission - four days of unrelenting and sleepless anxiety. ('Don't say that, dad. We had a really nice holiday together!')

Within a few days of returning home, the police picked him up in the street and took him to hospital. The social worker who had refused to give me any information wrote to say that he was himself going away on a course and would no longer be working with my son. Was he the 31st or the 42nd? I have lost count.

Can anyone explain to me wherein lies the value of the freedom to refuse medication, go round the bend and end up detained in hospital? Yet a coalition of mental health charities, Rethink and Mind among them, are opposing the compulsory treatment laid down in the government's draft mental health bill published on Friday.

I heard Paul Farmer, former Rethink and Mental Health Alliance spokesman on these matters, speaking of 'sections' on Channel 4 news not long ago as if they were routinely used as a tool of repression by a malevolent 'regime'; he made them sound like the old Soviet practice of confining dissidents to psychiatric hospitals. Yet I firmly believe being sectioned has saved my son's life more than once - and the lives of many like him. But then Rethink also apparently looks forward to a time when 'building-based care' will be a thing of the past. Perhaps they have some insider tip on the imminent collapse of the NHS.

During the debate about changing the National Schizophrenia Fellowship's name to Rethink, I received the following explanation from the chairwoman about why she felt the change was necessary: '[It is the fellowship's] wish to move away from the idea that severe illness is the sum total of an individual who has such an illness, to seeing the whole individual who "happens" to have such an illness and, instead of writing him off, considering his abilities, his strengths and weaknesses... All this without losing a sense of realism, that some will not manage much of this, their steps may be very small, recognising that we are concerned with a very real and devastating illness... I am convinced the charity must move to the prevention of the past repeating itself.'

In promoting the case for the three new names proposed - Reason, Thought Works and Rethink - Farmer said: 'We need to develop a strapline, a visual identity and images to ensure that all aspects are addressed. As part of this, it is likely we will develop identities for local activities within the overall image... Rethink has extensive potential for visual identity scheme'. To say nothing of the 'ethos of optimistic realism' and much else in this vein.

In the face of this sort of nonsense and of the confusion that reigns in the mental health 'system' - lack of funds, shortage of beds, absence of suitable accommodation outside hospital, the failure of agencies to co-ordinate activities - it is hard to see who is rooting for people like my son, many of whom end up killing themselves and none of whom, in my experience, ends up with lovely smiles and careers, as Rethink would have us believe.

Tragic history

· Care in the community came under public scrutiny after musician Jonathan Zito, 27, was killed in 1992. His assailant, paranoid schizophrenic Christopher Clunis, stabbed him in the eye on the platform of Finsbury Park tube station in north London, in a motiveless attack. Clunis was 23 when he was diagnosed with paranoid schizophrenia in 1986. He was in and out of various psychiatric hospitals over the following years. In 1992 his condition worsened and he was detained under the Mental Health Act. He was discharged less than a month later to accommodation in Haringey. Eight days before Jonathan Zito's death, Clunis attempted to stab two boys with a screwdriver. No action was taken.

· Ben Silcock, 27, a schizophrenic from London, was mauled by a lion in 1992. He entered the enclosure at London Zoo to feed chickens to the lions and ended up undergoing eight hours of surgery for his wounds. 'I can't remember much about that time because I was on so much medication I was hallucinating,' Silcock told the Daily Mail years later. Following surgery he was taken to Bethlem Royal Hospital in Kent, where he stayed for three years. 'It was quiet and secluded and helped me think things through,' he said.

· David Howell, a schizophrenic from Birmingham, was shot dead by police marksmen in 1996 as he held a supermarket manager hostage at knifepoint. The 40-year-old, who had been a psychiatric hospital day patient, had missed his medication in the days leading up to his death. Howell had been living in a hostel in the city's Erdington area for 10 years. Hours before the shooting he disappeared, talking about the Mafia and threatening to kill a locum doctor.

· City trader Peter Young, 42, was deemed mentally unfit to face a lengthy fraud trial in 2000. He appeared in court wearing a dress and high heels and had previously tried to castrate himself. Young, now living as a woman and calling himself Beth, told psychiatrists his 'unsympathetic' bosses did not understand him or his investment strategy and were plotting against him.

· One person was killed and two others injured after Simon Pring, 30, a paranoid schizophrenic, deliberately drove his car onto the pavement on Oxford Street, London, in 2005. He had suffered mental illness from the age of 11. He had lashed out repeatedly at his parents, and convinced himself, wrongly, that his father had Aids. At his trial the jury heard that on the day of the Oxford Street incident, Pring had 'flipped' because he thought he was under surveillance like a contestant on Big Brother. He had been in the care of a psychiatrist in the months before the incident. Hours before, his father had contacted his son's psychiatric nurse, begging for better supervision.

Alan Power

    My son has schizophrenia. Why can't the system cope?, O, 19.11.2006, http://observer.guardian.co.uk/focus/story/0,,1951739,00.html

Cocaine: An IoS Special Investigation

Revealed: UK's 'staggering' £57m-a-week drugs habit spirals out of control
Number of young people using drug doubles in seven years

Published: 19 November 2006
The Independent on Sunday
By Sophie Goodchild and Francis Elliott

A shocking picture of cocaine addiction in Britain will be revealed this week in a new international report on drug abuse.

Britons consume more cocaine than people in almost every other country in Europe, the report on drug use in 29 countries released this Thursday will show.

Evidence from UK officials, which has been given to European Union experts compiling the report, shows that use of cocaine has risen more than any other drug.

The most recent statistics in the report show its use has more than doubled among 16- to 24- year-olds over seven years.

Over the same period, ecstasy use has fallen. And although many more people smoke cannabis, use has stabilised compared with cocaine.

UK experts warn that the increase in cocaine use shows no sign of slowing, with the most dramatic rise among 15- to 34- year-olds.

There has also been a worrying increase in crack cocaine use, with seizures going up by 74 per cent between 2000 and 2004. The number of people involved in cocaine offences has also risen, with more than 8,000 arrests or cautions in 2004.

The findings from the annual report by the European Monitoring Centre on Drugs and Drugs Addiction, which monitors drug use, is based on evidence from health and drug authorities across mainland Europe. New figures obtained by this newspaper also show that the proportion of cocaine-related drug deaths has risen year on year since records began in 1999.

The drug now accounts for more than 13 per cent of all drug-related deaths in Britain. In 2005, 171 people died after using cocaine, compared with 147 in 2004.

In an interview with this newspaper, the United Nations' most senior drugs officer warned of a "staggering" rise in the number of Britons using the drug.

Antonio Maria Costa, executive director of the United Nations Office on Drugs and Crime, said: "A steadily growing number of Britons ... are being seduced by the 'white lady'. Either Europe snaps out of its state of denial or it should brace itself for the consequences."

Now widely affordable, cocaine has soared in popularity among clubbers, with more than three-quarters saying they have taken the drug, compared with only half in 2005.

In contrast, there has only been a small percentage rise in the number of users of ecstasy, which once dominated the club scene.

Clubs, keen to avoid getting labelled as magnets for drug users, have introduced special amnesty bins in an attempt to encourage people to hand over their drugs, without fear of police action, before a night out.

Growing concern about the rise of cocaine use will be among the drug issues discussed at the annual conference of the Association of Chief Police Officers (ACPO) being held in London on Tuesday.

Scotland Yard last year took the unprecedented step of using undercover officers to pose as dealers in a bid to target recreational users.

Anti-addiction charities are warning that people who take cocaine and binge drink risk liver failure in future years, because of the highly damaging effects of the mixture. People under 25 are particularly vulnerable.

They are also concerned that people will progress to crack cocaine. Harry Shapiro, from the charity Drugscope, said: "It would appear that cocaine is increasingly the class A drug of choice but there is a danger that some of these cocaine users will become crack users."

Additional reporting by Jonathan Owen

    Cocaine: An IoS Special Investigation, IoS, 19.11.2006, http://news.independent.co.uk/uk/this_britain/article1996310.ece

A nation addicted: Cocaine - Britain's deadly habit

A major new report shows that 1.75 million young adults use a drug that most think is harmless.
But 171 people have died from its use last year, an increase of 300 per cent in five years. Jonathan Owen and Sophie Goodchild report

Published: 19 November 2006
The Independent on Sunday

'I was snorting cocaine like a pig," says Tim Burgess. "Everyone was worried and thought I had a month to live." Coke was easy to get hold of. After all Burgess was the lead singer of the Charlatans, at the time one of Britain's biggest bands. He was so in thrall to "charlie" that he was snorting huge amounts of the drug "morning, noon and late into the night".

What had started as recreational use when he was 22 years old became a 17-year-habit that escalated into a serious addiction. The singer, now 39, was so paranoid and withdrawn that he was barely able to function.

Burgess, who has lived in Los Angeles for the past few years, has been clean for seven months since coming to London for treatment in April. He is the latest of a slew of celebrities baring their souls about bitter struggles with cocaine, but aspects of his story will resonate with thousands of Britons.

Figures to be released this Thursday by the European Monitoring Centre on Drugs and Drugs Addiction (EMCDDA), which reports on drug use, will show that the UK is in the top three for the number of cocaine users in Europe. The figures are based on evidence from 29 countries including Spain and France.

And findings submitted to the EMCDDA by UK government officials and drug experts paint a frightening picture of soaring cocaine abuse in the UK. They warn that although use of most class A drugs increases by relatively small amounts, the number of people taking cocaine has soared.

The last decade has seen use of the drug almost triple among UK adults. Over the same period, ecstasy use, for example, has fallen and although cannabis use is much more widespread in society, its use hasn't increased by anything like as much as cocaine.

Crack cocaine seizures have increased by 74 per cent since 2000 and the number of people arrested or cautioned for cocaine offences rose to 8,165 in 2003. Between April 2002 and December 2003 customs seized more than 26,000kg of cocaine.

The UK report, obtained by this newspaper, shows that use of cocaine has risen more than any other drug.

In a statement to The Independent on Sunday yesterday, Antonio Maria Costa, executive director of the United Nations Office on Drugs and Crime, warned of a "staggering" rise in the number of Britons using the drug. He said there was "a steadily growing number of Britons... are being seduced by the 'white lady'. Either Europe snaps out of its state of denial," he warns, "or it should brace itself for the consequences".

Despite a constant stream of such dire warnings, coke has maintained its image as a drug associated with a celebrity lifestyle and does not have the stigma that surrounds other class A drugs such as heroin. The drug's image has been given a boost by Kate Moss's apparent transformation from shamed coke snorter to style icon in the space of less than 12 months.

She was temporarily ditched from several high-profile modelling contracts after a national newspaper published pictures apparently showing her using the class A drug in a west London recording studio last year. But her earnings this year were her highest ever, with a whole range of new contracts and endorsements.

A potent combination of image and lower prices has helped fuel cocaine's soaring popularity not just at home but also abroad. In the case of the Ibiza set, more than three-quarters say they have taken the drug, compared with only half last year. In contrast, there has only been a small percentage rise in the number of users of ecstasy, which once dominated the club scene.

The cost of cocaine has nearly halved over the past decade, which has given rise to an alarming trend in bingeing on the drug because people are getting more cocaine for their money. Professor Mark Bellis, Director for the Centre for Public Health at Liverpool John Moores University, argues, "Cocaine used to be regarded as a high-class drug but it is far more available and affordable now."

Cocaine is fast replacing ecstasy as the drug of choice on the club scene for the first time, with record numbers of young people snorting the powder for as little as £30 a gram.

Nearly one in 10 people in their twenties who go to clubs admits to taking two grams in a session - the equivalent of 40 lines.

These figures are based on a survey of more than 2,000 regular club-goers across the country, ranging from students to civil servants, carried out by the magazine Mixmag, seen as the clubbers' Bible.

Clubs, keen to avoid getting labelled as magnets for drug users, have introduced special amnesty bins in a bid to encourage people to hand over their drugs, without fear of police action, before a night out.

Health ministers and educationalists continually sound alarms about teenagers becoming hooked on the drug. Cocaine has been in schools for many years but is becoming so common that a number of schools are seriously considering bringing in drug testing of pupils.

In one case, four teenage girls were expelled from a school in West Sussex after snorting the drug in the toilets before lessons. Police gave two pupils a warning after being alerted by staff at Holy Trinity School in Gossops Green, Crawley.

Rebecca Smith (not her real name), a former pupil at Fortismere School in London, is now 20 and has already seen how cocaine use has increased since she left school, "Coke was everywhere... and since I've left people say that it's got even worse. There are always trends with drugs and at the moment cocaine is seen at the coolest."

Even more worryingly, the drug has graduated from weekend recreational to a daily staple for increasing numbers. The IoS revealed in September an increase of 3,000 per cent in the number of workers caught with cocaine in their system over the past decade.

This is particularly significant because drugs like cocaine are swiftly flushed out of the system and can be hard to detect, indicating that users are high during the working week, not just at weekends.

Anti-addiction charities now fear that in the hunt for a harder high, users will progress to crack cocaine. Harry Shapiro from the charity Drugscope said, "It would appear that cocaine is increasingly the class A drug of choice but there is a danger that some of these cocaine users will become crack users."

London is now the cocaine capital of the world, according to a UN report published earlier this year which revealed that one in 50 people have used cocaine in Britain - a higher figure than anywhere else in the world, including countries such as the United States. Sir Ian Blair, the Metropolitan Police commissioner, earlier this year announced a clampdown on middle-class cocaine users.

In response to the explosion in cocaine use, Scotland Yard has taken the unprecedented step of using undercover officers to pose as drug suppliers in a bid to target recreational users.

Increasingly, cocaine is taking a toll on users' health. Latest figures from the National Programme on Substance Abuse Deaths show that the proportion of cocaine-related drug deaths has risen year on year since they began collecting records of drug deaths in 1999.

The drug now accounts for more than 13 per cent of deaths, with 171 cocaine-related deaths in 2005.

This week, the Association of Chief Police Officers will be holding its annual conference on drugs at which Britain's cocaine crisis will be discussed.

Experts are also worried about a new trend among addicts of injecting cocaine, a technique used by heroin users, to increase the hit from the drug.

There has been a huge rise in deaths and the Government needs to do more to educate people about the dangers, including recreational users, according to Professor John Henry, a leading expert on drugs at St Mary's Hospital in London.

"People need to know that not only can you die from first use but that you are also going to end up with arteries like a 60 year old and with brain damage," he said. "There should be primary prevention like there is in preventing cancer."

Combined alcohol and cocaine use is becoming a major concern to health services and drug and alcohol treatment agencies. Addaction, a drug and alcohol treatment charity, believes the cocaethylene issue will emerge as a major health problem, namely liver failure, in the future if "recreational" coke users who go out binge drinking are not fully aware of the trouble they are storing up for their bodies. Although there have been awareness campaigns about drink spiking and personal safety, the charity warns that young recreational drug and alcohol users need to be made aware of the dangers of combining different drugs, such as cocaine and alcohol.

Tim Burgess needs no such warnings. His body is paying the price for years of cocaine abuse. He is on medication for problems with his kidneys and a swollen liver and reflects, "My white powder dreams turned into a nightmare. I was just toying with myself, dancing with the devil ... dancing with death ... I just lost control."

1. Paul Bettany

"It was slowly destroying me. I had this need to punish myself. I stopped doing drugs when I realised I couldn't function without them."

2. Rod Stewart

"I don't know why anyone would want to take coke now. It was different in my day, because it was all so much purer."

3. Mike Skinner (The Streets)

"I know I could buy two grand's worth of cocaine and do it all tonight. And then get four more grand's worth and there would be absolutely nothing to stop me."

4. Naomi Campbell

"What is very scary about cocaine is that you start to feel too confident and indispensable, although none of us is indispensable."

5. Tracy Shaw

"I did coke because Darren did it - and that was it really. I would never go back and it isn't a nice experience."

6. Jay Kay

"It's amazing how your friends aren't such friends when you're not coming in and buying their supply."

7. Patsy Kensit

"I'm not proud of it. Sometimes I hang my head in shame. Drugs, they ravage you."

8. Richard Bacon

"It was a drug that I found to be a huge anti-climax. After 25 minutes I needed to stave off the depression. It went on for 12 hours."

9. Darren Day

"Cocaine will take everything away from you. I still wake up in a cold sweat at night, thinking of the money that I've blown on it."

10. Justin Hawkins

"I regularly used to stay up for four days at a time on coke and alcohol binges. I became secretive, volatile and verbally abusive, a really unpleasant person to be around."

11. Frank Bruno

"Taking [coke] was the worst thing I could have done in my mental condition. It was like a black hole with no ending."

12. Sophie Anderton

"I was using alcohol to get numb, then cocaine to numb the alcohol, and then Valium to numb the cocaine."

13. Shaun Ryder

"I was fucked, I was falling back into that trap - doing cocaine, drinking too much. The first year on tour it was fun. After two I was shaky and by the third I knew it had to stop."

14. Liam Gallagher

"The devil can be in cocaine ... The devil is everywhere but it depends how strong you are. In 1996 I was doing as much cocaine as anyone you've heard of, but I'm not addicted."

15. Robbie Williams

"I'd have about five grams of cocaine and as much booze as I could get down my gullet. I don't have to do that any more. I'll just go back to the hotel, have a cup of tea and play cards."

16. Kate Moss

Although "Cocaine Kate" has been careful not to talk about cocaine herself, Pete Doherty has said about her: "With the amount of coke Kate was taking, it's amazing she got through rehab."

17. Tara Palmer-Tompkinson

"For me what started off as a little naughtiness turned into a full-blown habit. I became completely powerless under its spell."

18. Daniella Westbrook

"Whenever you sort of wake up from this haze that you are in, and the first thing you do is reach ... for a line - that's when you know you've hit a really bad point"

19. Pete Doherty

"I sparked up like a Christmas tree. Sticking a line of cocaine up your nose is normal in the music industry ... it's rife. Drugs and music are one and the same to me."

20. Elton John

"Coke is the worst. It's more rampant now than ever. Cocaine is more a danger to me than drink. So I don't put myself in situations where it might be."

Jonathan Owen

    A nation addicted: Cocaine - Britain's deadly habit, IoS, 19.11.2006, http://news.independent.co.uk/uk/this_britain/article1996313.ece

10.45am

Total ban for junk food ads around kids' shows

Friday November 17, 2006
Mark Sweney
MediaGuardian.co.uk

Junk food ads: Ofcom has set a deadline of March next year for advertisers to alter their campaigns. Photograph: PA

Ofcom has announced a total ban on junk food advertising around all children's programming, on all children's channels and around all programmes that have a "particular appeal" to under 16-year-olds.
The restrictions are much harsher than the TV and advertising industry had been hoping for but fell short of a complete pre-watershed ban that health campaigners were seeking.

The surprise is that Ofcom has chosen to extend the restrictions to any programme any time of the day that has an "above-average" audience of under 16-year-olds.

It had previously been focusing on a range of options for restrictions on advertising to under 9-year-olds and during particular time periods.

This brings into the ban a range of programmes previously considered to be unaffected by the likely proposals such as music channels and shows, many awards ceremonies and early evening general entertainment programmes.

The age bracket concerned is defined as any programme that has a 20% higher proportion of under 16-year-old viewers than the UK average.

Ofcom has estimated that the restrictions will cost £39m in TV ad revenue.

The media watchdog has based its definition of "junk food" on the Food Standards Authority's nutrient profiling system.

As a result of Ofcom's decision to target regulation to ensure the protection of the under 16-year-old group - the original proposals looked only at the under 9-year-old group - there will be a "short and focussed" consultation to seek views on extending the restrictions.

This will close before Christmas with an announcement planned in January.

Ofcom has set a deadline of March next year for advertisers to alter their marketing campaigns in line with the new restrictions on junk food advertising to children under-16s.

However, advertising restrictions will be phased in over 24 months up until the end of 2008 for dedicated children's channels where the "ability to substitute revenues from food and drink advertising would be more difficult to achieve quickly".

The media regulator is introducing the measures with the goal of reducing the amount of advertising of foods high in fat, salt and sugar to children by 50%.

It claims that the new regulations will reduce the number junk food ads seen by under-16s by 41% and the key group of under-9s 51%.

Ofcom estimates that the restrictions will affect only 0.7% of the ad revenues of terrestrial broadcasters such as ITV, GMTV, Channel 4 and Channel Five.

Cable and satellite channels will see a loss of around 8.8% of total ad revenues.

However, the hardest hit will be dedicated children's channels, such as Cartoon Network and Nickelodeon, which will see an estimated 15% hit in ad revenues.

Ofcom believes that the total impact on TV advertising will be a loss of £39m.

However, if broadcasters introduce "mitigating" strategies - such as running more repeats or using more cheaper, imported shows, the drop in advertising revenue could be just £23m.

The chancellor, Gordon Brown, has welcomed Ofcom's ban on junk food ads around children's shows, saying he would host a seminar with broadcasters and other groups to see what more could be done.

"The chancellor welcomes Ofcom's report and their proposals to tighten the restrictions on the advertising of unhealthy foods during programmes that children watch," a spokesman said.

The National Consumer Council said it was "very disappointed" by the junk food ad ban proposals as they didn't go far enough in covering shows such as Coronation Street.

The chief executive, Philip Cullum, said: "This doesn't really get to the heart of the issue. They say they have taken a focus on children, but the proposals actually don't deliver that."

TV shows such as The Simpsons, Hollyoaks, The X Factor, Lost and Friends will be affected by new restrictions that aim to block junk food ads from shows that have a "particular appeal" to under-16s.

Other shows that are likely to fall within Ofcom's new junk food ad ban, based on historical viewing data, include early evening mass-entertainment shows, especially those involving musical elements.

According to media agency Carat, based on viewing figures for October, other shows that would be affected include Make Me a Supermodel, Two and a Half Men, Pimp My Ride and Ant & Dec's Saturday Night Takeaway.

Beyond a ban on advertising of junk food on children's channels and programmes, Ofcom intends to introduce a mechanism, called "Index 120", to assess which shows have an "above average" appeal to under-16s and therefore cannot run any junk food ads.

Broadcasters are familiar with this type of system because variations of it have been used for assessing where alcohol advertising can run, for example, but it has not been used on such a wide scale before.

The definition that Ofcom is using is for shows with a "particular appeal" to under-16s is any show that has a 20% higher proportion of viewers below 16 years old the UK average.

Ofcom's predecessor, the Broadcasting Standards Commission, revealed in 2003 that children spent more time watching "grown up" programmes such as EastEnders, Only Fools and Horses and Pop Idol than shows aimed specifically at young people.

Channel Five and Turner Broadcasting criticised Ofcom's decision on junk food advertising, calling it "draconian" and a "missed opportunity".

However, Channel 4 has called Ofcom's decision a "proportionate response to a complex social issue" but warned it will cause the channel "financial difficulties".

The future of UK children's programmes on commercial television now looks "bleak", according to the Five chief executive, Jane Lighting.

Ms Lighting re-iterated her channel's commitment to well-regarded pre-school brand Milkshake! but said the future looks difficult for Five.

She said: "This is a tough decision and we are disappointed it is even more draconian than the stringent measures that Ofcom originally proposed.

"Five has a continuing commitment to broadcasting children's programmes both for our Milkshake! pre-school audience and for older children."

She added: "However, these restrictions will deny us substantial revenue and make the economics of producing children's programmes a lot more difficult in the future.

"The long-term future of UK-produced children's programming outside the BBC is bleak."

Five's children's output includes such favourites as Make Way for Noddy and Thomas & Friends.

Its non-children's shows that may be affected include Australian soap Home and Away and Make Me a Supermodel.

Turner Broadcasting, which owns kids channels Cartoon Network, Toonami and Boomerang, has also criticised Ofcom's proposals, saying its plan to use characters like Scooby-Doo to promote healthy eating would now be barred.

The company described the junk food ban as a "missed opportunity for a creative and considered solution" to the problem of childhood obesity and said it had been looking at ways it could use its cartoon characters.

"Turner, like other media companies, had been looking at ways in which we could harness our characters, such as Scooby-Doo and Dexter, for the power of good, aligning them with the promotion of healthier food products, such as water, fruit and vegetables," the Turner senior vice-president, Dee Forbes, said.

"Sadly, the new restrictions will deny us this potentially exciting route to complement other forms of health promotion."

However, Channel 4 has called Ofcom's decision a "proportionate response to a complex social issue".

    Total ban for junk food ads around kids' shows, G, 17.11.2006, http://media.guardian.co.uk/site/story/0,,1950542,00.html

Safe sex advertising campaign offers the bare facts

Saturday November 11, 2006
Guardian
Sarah Boseley, health editor

A hard-hitting government advertising campaign on sexual diseases, featuring raunchy scenes of young people grappling in pubs, clubs and on deserted footpaths, launches today in an attempt to make 18- to 24-year-olds think of condoms as "essential wear" when they go out for a night.

The TV and magazine adverts are intended to shock by showing attractive and apparently healthy ordinary young people "on the pull" whose rapidly discarded clothing bears logos and slogans reading "gonorrhoea" and "chlamydia". Sexual diseases are spreading, says the whispered voiceover. If it was as easy to tell who was infected as it is to tell the designer of a pair of jeans, you would wear a condom.

The £4m campaign was widely welcomed by sexual health organisations such as Brooks, the Family Planning Association and the Terrence Higgins Trust, but there are fears that NHS cuts may stop the government spending the rest of the £50m it promised for raising awareness of sexual infections among young adults.

Deborah Jack, chief executive of the National Aids Trust, said: "Changing attitudes requires long-term and sustained efforts. It is vitally important that the government keeps its promise to spend the additional £46m over the remaining two years. Even in a time of budgetary constraint, to cut back on a sexual health campaign is the worst kind of false economy."

Anne Weymann, chief executive of the Family Planning Association, welcomed the campaign but said a long-term sustained effort was needed.

But health minister Caroline Flint, launching the advertising campaign, declined to rule out a reduction in spending. The £50m was for three years, she said. The campaign and additional spending this year would amount to £7m in total across departments - the education department was involved in the campaign to reduce teenage pregnancies. Her department was spending on the new campaign double the money that it spent on the last one, two years ago. That campaign was known as the "sex lottery" and was also designed to raise awareness of sexually transmitted infections.

The department later said it had afterwards tracked 1,000 young people in the target audience. It found that three-quarters were aware of the safe sex messages. That was an improvement of 17% from the start of the campaign.

Ms Flint said the aim of the new campaign was "to make carrying and using a condom among this age group as familiar as carrying a mobile phone or putting on a seat belt".

    Safe sex advertising campaign offers the bare facts, G, 11.11.2006, http://society.guardian.co.uk/health/story/0,,1945217,00.html

Dying to be thin: a special IoS investigation

* Revealed: 1 in 100 young women suffer from anorexia or bulimia
* GPs told: examine all underweight girls for signs of eating disorders

Published: 29 October 2006
The Independent on Sunday
By Sophie Goodchild and Marie Woolf

The Government last night called on GPs to screen all underweight women for signs of anorexia and bulimia following an investigation by The Independent on Sunday into the growing problem of eating disorders.

In the first major survey of its kind, this newspaper can reveal that more than one in 100 young women is affected by clinical eating disorders and up to six women in every 10 have "psychological issues" with food as a result of low self-esteem.

Doctors and government experts also called for a ban on the growing number of websites that promote the deadly illnesses as a "lifestyle choice" and encourage them to starve themselves to achieve "perfection".

Rosie Winterton, the health minister, said: "It is crucial that people with anorexia and bulimia receive the treatment they need and medical professionals need to be vigilant for the symptoms."

The IoS can also reveal that doctors are facing a disturbing new type of "multi-impulsive" bulimia that affects a third of patients. It is thought to be linked to an obsession with body size and image.

Women with this form of the illness, unheard of 10 years ago, not only purge themselves of food, but also cut their bodies, overdose and abuse alcohol. Experts believe the current obsession with obesity is confusing young women about their relationship with food.

The extent of the problem has prompted calls for greater emphasis on treatment for all. Psychiatrists have condemned the massive variation in services for eating disorders and the lack of specialist teams available to provide therapy for sufferers. The lack of services are particularly acute in Scotland, Wales and north-west England.

Many vulnerable patients are having to travel for treatment, putting an added strain on them and their families. One London clinic said it was receiving referrals from Yorkshire.

Professor Hubert Lacey, director of the UK's largest eating disorder clinic at St George's Hospital in London, warned that long-term anorexics were being left lonely and isolated because of the treatment gap.

The Government last night called on GPs to screen all underweight women for signs of anorexia and bulimia following an investigation by The Independent on Sunday into the growing problem of eating disorders.

In the first major survey of its kind, this newspaper can reveal that more than one in 100 young women is affected by clinical eating disorders and up to six women in every 10 have "psychological issues" with food as a result of low self-esteem.

Doctors and government experts also called for a ban on the growing number of websites that promote the deadly illnesses as a "lifestyle choice" and encourage them to starve themselves to achieve "perfection".

Rosie Winterton, the health minister, said: "It is crucial that people with anorexia and bulimia receive the treatment they need and medical professionals need to be vigilant for the symptoms."

The IoS can also reveal that doctors are facing a disturbing new type of "multi-impulsive" bulimia that affects a third of patients. It is thought to be linked to an obsession with body size and image.
Women with this form of the illness, unheard of 10 years ago, not only purge themselves of food, but also cut their bodies, overdose and abuse alcohol. Experts believe the current obsession with obesity is confusing young women about their relationship with food.

The extent of the problem has prompted calls for greater emphasis on treatment for all. Psychiatrists have condemned the massive variation in services for eating disorders and the lack of specialist teams available to provide therapy for sufferers. The lack of services are particularly acute in Scotland, Wales and north-west England.

Many vulnerable patients are having to travel for treatment, putting an added strain on them and their families. One London clinic said it was receiving referrals from Yorkshire.

Professor Hubert Lacey, director of the UK's largest eating disorder clinic at St George's Hospital in London, warned that long-term anorexics were being left lonely and isolated because of the treatment gap.

    Dying to be thin: a special IoS investigation, IoS, 29.10.2006, http://news.independent.co.uk/uk/health_medical/article1938365.ece

Time to speak up

It's 39 years since abortion was legalised in this country, yet these days it's rarely discussed without mention of 'shame', 'mental trauma' or 'viability'. With pro-lifers dominating the debate, and even leftwingers describing abortion as a 'necessary evil', women's hard-won rights could soon be under threat. In an introduction to an eight-page special, Zoe Williams asks: are we just going to roll over?

Friday October 27, 2006
Guardian
Zoe Williams

Today marks the 39th anniversary of abortion becoming legal in Britain. Yes, yes, there would have been an argument for waiting for the 40th, but I really think, in the current climate, that it needs to be celebrated as often as possible. On Halloween, mindful or not of this anniversary, the Conservative MP Nadine Dorries will be introducing her 10-minute-rule bill, proposing a reduction in the time limit on abortion in this country to 21 weeks (down from 24 weeks at present), and a "cooling-off period after the first point of contact with a medical practitioner about a termination" - so far as I can make out, she wishes to slow the abortion process down still further, and then penalise women who have left it too late. Her rationale? She just "has a feeling it's right". Honestly.

I remember the first time that I wrote about having had an abortion; it was in the mid-90s (the abortion, I mean. And the article, too). A survey had come out saying that one in four women had had availed themselves of termination services; I was surprised by how low that figure was, but it also made me think: if 25% of women have had abortions, then surely every one of us, male and female, has a friend or partner or family member, someone very close anyhow, who has had an abortion. Seriously, unless you are very cloistered or you are incredibly judgmental and uptight and nobody ever tells you anything, you will have been aware of an abortion at very close quarters, even if it was not your own.

So why does nobody talk about it, I pondered then, and do again now. Why are there never any abortion jokes? Why is it unthinkable to discuss it without prefacing everything with "of course, it's terribly traumatic, no woman enters into this lightly"? I found it no more traumatic than any other operation I have ever had, no more psychologically scarring, way less painful than anything involving my teeth and considerably less annoying than anything I have had done on the NHS (whose "resources" in this area - which I will complain about later - meant I had to go private, which is entirely against my principles, but did make it very convenient).

Even writing that, I am furious - it is considered a given, an unarguable tenet of modern society, that you would feel ashamed of having a termination, that you would, in some cutesy, feminine, inarticulate way, feel "bad" about it. You are not allowed to talk about this operation unless it is to say how dirty it made you feel. We are all expected to have these moral objections and yet suffer the business anyway, in the name of pragmatism. Ethically, this is a far dodgier and more repugnant position than mine, which is that I am entirely pro-abortion because I do not consider it murder; if you do not consider this foetus human, then it becomes no more of an issue than getting a tumour removed. If I have any shame at all, it is because, when my health was at stake, I immediately opted out and went private, and I would have hoped before that happened that it would have taken more than an unwanted pregnancy. Never mind. The NHS doctor made me feel that if I had stayed in the system, I would be wasting resources that rightfully belonged to poorer, younger mothers. I was 25; if I had been the age I am now, I would not have taken any notice of her.

This is worth revisiting. The prevailing attitude these days seems to be that abortion is state-sanctioned murder and we put up with it because if we didn't, women would have them in back alleys anyway. It is the lesser of two evils, therefore, and as such, must be cloaked in silence, since whichever way you look at it, it still has an evil at its core. This line has taken hold because it is the least controversial way of supporting the right: so an MP standing up and saying "Women need this right, because otherwise they will put their health at risk having illegal terminations" will not find the pro-life lobby instantly rearing up against them, petitioning their constituents with what a murderer he or she is. If, however, an MP were to stand up and say "I am pro-choice because I do not consider this to be murder. I do not consider it to be evil. I do not consider a foetus which a woman has a one in three chance of involuntarily rejecting anyway to be a viable life unless she deems it so. I do not buy this craven sentimentality about the unborn, this pseudo-spiritual cleanliness we ascribe to it. In fact, it makes me sick", then votes will be lost. In other words, there are no votes to be won supporting abortion in an ideologically honest way, and lots to be lost. The taboo started in Westminster, I believe; not everything starts in the Daily Mail.

Back to this article. I got a lot of weirdos sending me pictures of tiny bloodied babies' fingers, Photoshopped on to a pair of abortionist's rubber gloves, with captions along the lines of "Just a collection of cells? Tell that to the baby". Those were pretty lurid, but also amusingly put together. What irked me more, though, was all the traffic from the "voices of reason" saying words to the effect of "Why do you have to push everything? We all value the right to abortion, we're all glad it exists. Why on earth would you want to fight for the right to be able to joke about it? When it's not even funny?" But I was not saying abortions are, in and of themselves, hilarious. I was asking why they never crop up in jokes. Cancer does, cheese does, shagging and gonorrhoea and disabilities and dogs and flowers and terrible, terrible diseases, and all other foodstuffs, and all other genres of people ... There are taboos in political rhetoric, yes, tonnes of them, but in comedy, even in very mainstream comedy, there are almost no taboos. You could make a joke about September 11 before you could make a joke about abortion. And this is not irrelevant, it is not as if the right is inviolable, and the joking is a side issue. If you allow a taboo to hold, you leave all the cultural space open to anti-abortionists.

Ten years on, we can see the results of this. Culturally, there is an even greater silence around abortion, and an even greater refusal to discuss it except in terms of its terrible psychological toll on women. Research in both Britain and America repeatedly shows this not to be the case - that abortion, unlike bringing to term an unwanted pregnancy, does not increase the risk of depression; and furthermore, that the uptake on the compulsorily offered post-abortion counselling is staggeringly low (in some areas it is just 1%). And even she is probably just being polite.

Meanwhile there is an increasing foetus fetishisation in mainstream media - all this "miracle of life" stuff, with six-day-old embryos bouncing around, looking deliciously as if they are playing football with the placenta. It is hard to take this any more seriously than you would those pictures of baby bats in socks (non-readers of the Daily Mail will at this stage start to wonder what on earth I am on about) but, operating in this chamber of cultural silence where mature commentary about women's rights, health and beliefs vis-a-vis abortion simply is not happening, it is not a huge leap of the imagination to think that these dancing-foetus babies are jeopardising the gynaecological freedoms of the next generation.

Noises from parliament are ineffectual but nevertheless damaging. It has become de rigueur not to criticise the right to abortion, but rather to attack the time limit. During the tedious Tory leadership election, there was briefly some ham-fisted tub-thumping by Liam Fox (who wanted the time limit reduced to 12 weeks), but since then there have been cross-party rumblings, with early-day motions and other unhelpful motions made by Labour MPs Geraldine Smith and Claire Curtis-Thomas, as well as Liberals (notably Evan Harris).

There is a huge amount of evidence for the disingenuousness of this strategy. Firstly, anyone with a serious interest in reducing the (already terribly small) number of late-term abortions would make it their priority to improve provision of pre-12 week terminations on the NHS. They would roll out the pre-nine-week abortion pill as something nurses could administer without doctors; they would, of course, overturn the ludicrously old-fashioned system of having two doctors on hand to ratify every abortion; they would lobby against the tacit but anecdotally widespread NHS policy of not even bothering providing pre-12-week abortions, on the basis that anyone who is in that much of a rush could go private.

Sufficient interest in late-term abortions to actually research them would, furthermore, show that the functional NHS time limit is not 24 weeks but 19, after which public health services become so foot-draggingly obstructive that women have to go private. Since the second scan during a pregnancy occurs at 20 weeks, sometimes later, and it is generally only at this point that many birth defects become clear, there would seem to be an active, perverse, unlegislated barrier to late-term abortions.

Furthermore, late-term abortions constitute the truly pitifully small proportion of 1.6%; that was in 2003, since when the trend has been downwards. The late-term argument always rests upon so-called "scientific advances", which have made foetuses marvellously hardy, so that the laws of 1967 are blatantly out of date. We are like a crowd of Victorian idiots marvelling at some fairground quack who claims to cure constipation. The truth is that no significant scientific development in foetal viability has occurred since the late-term law was brought down from 28 to 24 weeks in 1990. In all respects, you are better off dealing with those politicians who openly admit their anti-abortion stance: such as the Tory MP Laurence Robertson, who, in May last year, used his windfall in the private member's ballot to propose a blanket ban on all abortion. Robertson is not only a lot more honest than your Harrises and your Foxes, he also provides the useful service of reminding us that this right is still something we must be ready to fight for.

The other thing to remember, of course, is that the one thing we have in common with America (where, of course, the situation is much direr - see Suzanne Goldenberg's report on page 12) is that this boils down to a class issue. In the US, while the Christian right campaigns feverishly against late-term abortions, there are women leaving it to 18 or 20 weeks because they literally cannot afford the operation or even the transport to get to it. In the US, abortion laws are effectively working only for middle-class women already. In Britain, while some care trusts offer a good abortion service pre-12 weeks, it is by no means nationwide, so a very large proportion of women are having to wait till after their three-month scan unless they can afford to go private. And yet, many women who count as late-term abortions, at 18 weeks or more, report that the reason their pregnancy got so advanced was because that at any point from 15 weeks, their GPs became obstructive and unhelpful. So really, the window for an abortion on the NHS can be as narrow as three weeks, and all it takes is some garden-variety inefficiency for that window to be shut altogether.

So it boils down to this: for those of us with the cash, abortion is still an inviolable right, and for those of us without it, things are a lot more sticky. Let's not forget, this is exactly what the situation was before 1967. Not since the dawn of medical capability has it been impossible for a rich woman to get a termination. This battle was fought for all women; if, as middle-class women, we stand by and watch while the right is clawed away from the bottom up, and then if, in 50 years' time, it has been rescinded altogether, it will be no more than we deserve. Anyone interested in findiing our more on abortion rights should contact Abortion Rights (Abortionrights.org.uk).

Abortion

The facts

· The 1967 Abortion Act made abortion legal in the UK up to 28 weeks gestation. In 1990, the law was amended: abortion is now legal only up to 24 weeks except in cases where it's necessary to save the life of the woman, there's evidence of extreme foetal abnormality or there is grave risk of physical or mental injury to the woman.

· Abortions after 24 weeks are extremely rare, accounting for 0.1% of all abortions (fewer than 200 a year).

· The act does not extend to Northern Ireland. Abortion is only legal there if the life or the mental or physical health of the woman is at "serious risk". There are no clear guidelines, however, and provision depends on the moral outlook of individual doctors.

· In 2004/05, 64 women had an abortion in Northern Ireland, according to the Family Planning Association.

· In 2005, 1,164 women from Northern Ireland travelled to England for an abortion. Women travelling from Northern Ireland for an abortion cannot have them on the NHS.

· According to the Department of Health, the total number of abortions in England and Wales last year was 186,400 (compared with 185,700 in 2004 - a rise of 0.4%).

· The abortion rate was highest, at 32 per 1,000, for women in the 20-24 age group.

· The rate for under-16s was just 3.7 per 1,000 women and the under-18 rate 17.8 per 1,000 women, both the same as in 2004.

· 89% of abortions were carried out when the foetus was less than 13 weeks old; 67% at under 10 weeks.

· 1,900 abortions (1%) were classified as having been carried out because of a risk that the child would be born with disabilities.

· According to pro-choice campaign groups, 1.6% of abortions fit the classification "late-term", being performed at 20 weeks or more.

· Scotland keeps its own statistics and in 2005 there were 12,603 abortions performed, compared to 12,461 in 2004.

Kira Cochrane

    Time to speak up, G, 27.10.2006, http://society.guardian.co.uk/health/story/0,,1932834,00.html

Drunk & disorderly: Women in UK are worst binge drinkers in world

Published: 22 October 2006
The Independent
By Roger Dobson, Sophie Goodchild and Marie Woolf

Women in England and Ireland are officially the world's biggest binge drinkers, according to a unique study of global alcohol consumption.

One in three 17- to 30-year-olds is now classed as a heavy drinker, bingeing on four or more drinks in one session at least once a fortnight.

These disturbing figures are 11 times higher than those of Germany and Italy, prompting warnings that record numbers of women face liver damage and premature death unless they curb their alcohol consumption.

The findings are based on a survey of more than 17,000 women and men from 21 countries, including Belgium, France and the United States, in the largest study ever carried out into worldwide drinking habits.

The disclosure will alarm policy-makers struggling to combat Britain's growing drink problem, which has led to an escalation in anti-social behaviour, lost working hours and long-term health problems, including cancer and heart problems.

A new government advertising campaign will this week highlight how drunkenness puts women at risk of sexual assault. Studies show that more than three-quarters - 81 per cent - of sex attack victims have been drinking before being attacked.

A review by the Association of Chief Police Officers of drug-rape attacks has found that in many cases women had been drinking heavily rather than been targeted by men using date-rape drugs. The Government is considering tighter laws so that even when a woman has consented to sex, men can be prosecuted for rape, if she was drunk at the time.

New Department of Health figures for England and Wales show that more than one in six women aged between 16 and 64 are either addicted to alcohol or suffer health problems as a result of drinking. Nine per cent of women are now classified as binge drinkers, consuming four units or more per session.

The study reveals that excessive drinking has soared in England, but has declined in Germany and France. In Ireland, nearly two-thirds of young women are rated as heavy drinkers. But even though some 26 per cent of British men binge drink, England does not feature at the top of the male heavy drinkers league table. This is dominated by Belgium, Colombia, Ireland and Poland.

Dr Andrew Steptoe, co-author of the report, said heavy drinking was a worldwide problem, but that England and Ireland had high figures compared with mainland Europe.

"Although not all young heavy drinkers end up being heavy drinkers in later life, they are at higher risk later for health problems," said Dr Steptoe, of the department of epidemiology and public health at University College London.

Doctors also blame the drinks industry for deliberately targeting women with female-friendly drinks and décor. They want ministers to exercise more control instead of allowing the industry to self-regulate. England, Scotland and Ireland are the only countries in western Europe, apart from Denmark, where alcohol consumption is rising.

Additional reporting by Jonathan Owen

    Drunk & disorderly: Women in UK are worst binge drinkers in world, IoS, 22.10.2006, http://news.independent.co.uk/uk/health_medical/article1919105.ece

The $1bn trade that is beyond the eyes of the law

October 20, 2006
The Times
By Nigel Hawkes, Health Editor

THE body parts market is lucrative and lightly regulated in the US. Estimates of its value range from $500 million to $1 billion (£530 million) a year.

The use of tissue goes far beyond the familiar world of organ transplants, and involves a host of different materials including bone, skin, muscle, tendons and ligaments.

Bones can be used in fracture repair, skin can aid wound healing, and heart valves can be used as replacements in ailing patients.

Tendons and ligaments may be used to treat sports injuries, long bones to replace those damaged by cancer, shaped-bone products in spinal surgery, and ground bone in dental surgery. Collagen can be used to plump up lips, while bodies or body parts can be used in crash tests or in demonstrations of new techniques for surgeons.

In Britain the number of body parts that are taken in is unknown, because there is no requirement to keep a tally. Premises that store tissues, however, have to have a licence from the Human Tissue Authority (HTA), and of these 41 are either importing or exporting tissues.

The quantity of such imports and exports is not known, because the HTA does not gather figures.

There are moves to change the law so that such data would in future be collected. Up to 77 patients in Britain may have had grafts from bones imported from the New Jersey company involved in the Alistair Cooke case, the Medicines and Healthcare products Regulatory Agency said last month.

Patients were offered screening and counselling to detect any problems.

Every year it is estimated that 25,000 US bodies are used as source material for as many as 750,000 operations and procedures.

Heart valves can fetch up to $7,000 each, and skin $1,000 per square foot. A body could be worth about $150,000 if broken down into its component parts, according to Art Caplan, Professor of Bioethics at the University of Pennsylvania.

There are two legitimate sources of body parts in the US. The vast majority of bodies donated to science go to medical schools, where they are used to teach anatomy.

Surplus parts can be sent to not-for-proft biomedical corporations, and it is illegal to charge for them. But medical schools can charge fees to cover administrative costs, and these can be high.

A second source is the tissue and organ banks, non-profit organisations to whom individuals can leave their bodies. They are often linked to trading companies to whom they pass on the parts.

There is no real ethical reason why the trade should not continue, so long as proper consents are obtained.

But some orthopaedic surgeons, such as Professor Angus Wallace, of Nottingham University, believe that officials are discouraging the harvesting of parts because of fears of an Alder Hey-style public backlash.

He believes that it is unethical to treat British patients with imported body parts and could be dangerous because of uncertainties over quality.

    The $1bn trade that is beyond the eyes of the law, Ts, 20.10.2006, http://www.timesonline.co.uk/article/0,,3-2413169,00.html

Health inspectors demand tough action to cure 'weak' NHS trusts

· Half of England's hospitals graded in lowest category
· Only two organisations get top marks in review

Thursday October 12, 2006
Guardian
John Carvel, social affairs editor

Health inspectors demanded urgent action last night to remedy failings at 50 NHS trusts across England that scored the worst marks in a new tougher system of measuring the quality of patient care. The Healthcare Commission confirmed a report in the Guardian yesterday that it has graded nearly half the country's hospitals and other healthcare organisations as "weak" in the NHS's first annual health check published today.

It placed 236 of the 570 trusts in the lowest category, rating some as weak for poor stewardship of resources and others for inadequate control of the quality of patient care. Eight hospitals, four ambulance services, one mental health trust and 11 primary care trusts (PCTs) achieved the unenviable distinction of being weak on both counts.

Anna Walker, the commission's chief executive, said urgent steps were needed to improve performance in 50 trusts with the lowest quality of patient care. Their defects included failure to ensure proper decontamination of medical equipment, lack of staff training and poor management of patient records.

She said strategic health authorities would ask the trusts to produce action plans within 30 days on how to come up to minimum standards. They would also look into the performance of 290 trusts whose quality was deemed to be no better than "fair".

Ms Walker said: "Poorer performance is in areas that really matter to patients. A significant number of PCTs are failing to provide out-of-hours crisis care. MRSA [the hospital superbug] targets still need vigorous action. And trusts report not meeting standards on compulsory training and use of medical equipment."

Sir Ian Kennedy, the commission chairman, said the new system was largely based on trusts owning up to poor performance, although the commission ran checks to ensure honesty. About 43% of trusts should be praised for admitting shortcomings and starting on "a journey of improvement".

He added: "Patients will want the NHS to raise its game still further. They need a universal guarantee that trusts are meeting general standards ... We expect these standards will be met next year."

The report gave top marks to only two trusts, both foundation hospitals with independence from Whitehall control.

Harrogate and the Royal Marsden, a specialist cancer hospital in London, got an "excellent/excellent" rating in recognition of their high performance on finance and quality.

Sue Slipman, director of the foundation trust network, said the results showed its members were "way ahead of the game", with 87% graded as good or excellent on use of resources. However, Moorfields foundation hospital, the country's premier ophthalmic centre, was ranked as weak on quality of care.

Among all types of trusts, 36% scored good on quality of services and 4% were excellent. Just 12% were found to be good at managing their finances and 3% were excellent.

Sources at the Department of Health said the commission may have been unduly harsh in its interpretation of financial data provided by the Audit Commission. It was understood that ministers asked the commission to explain why the scores of 50 PCTs were improved a few hours before publication. Without this late adjustment, more than 30 trusts would have got a weak/weak rating.

But in public, Patricia Hewitt, the health secretary, supported the commission for "the toughest and most comprehensive assessment of the NHS ever made". She said: "There is no doubt the NHS has made big improvements ... but, as these results show, there needs to be more improvement. I can reassure patients that staff in all NHS hospitals will continue to give good, safe care."

Andrew Lansley, the Tory health spokesman, said: "It is a pretty sorry state of affairs when nine out of 10 PCTs have been rated only weak or fair. Even with an increase in resources, the government's policy of using PCTs to manage NHS resources is failing. The healthcheck is at least a dramatic improvement on the discredited star ratings used by ministers over previous years. These results serve to show the weakness of the management by ministers themselves."

Niall Dickson, chief executive of the King's Fund health research institute, questioned the reliability of trusts' self-assessments. "We are concerned that many across the country overestimated their levels and had their standards revised by the commission," he said.

Gordon Lishman, director general of Age Concern England, said: "The performance assessment ratings largely bypass patients' views and are the equivalent of asking students to mark their own exam papers."
 

    Health inspectors demand tough action to cure 'weak' NHS trusts, G, 12.10.2006, http://society.guardian.co.uk/health/news/0,,1920171,00.html

NHS debts topped £540m last year despite cash injection

· Hewitt hopes for small surplus in future
· Cameron pledges to end 'political meddling'

Tuesday October 10, 2006
Guardian
Tania Branigan and Will Woodward

The NHS ran up debts of more than half a billion pounds by the end of the last financial year, the health secretary, Patricia Hewitt, revealed yesterday. The figure of £547m is significantly higher than the £512m which NHS trusts initially reported in June and way above the government's target of £200m. However, Ms Hewitt stressed in her written statement to MPs that figures for the current year suggested the NHS would have a small surplus.

The Liberal Democrat health spokesman, Steve Webb, joined other opposition parties in condemning the government for mismanaging health services. "These figures make it even more unlikely that the NHS will break even. This is further evidence that ministers haven't got health funding under control," he said.

The NHS has regularly veered between surpluses and deficits. Last year's deficit is almost half that seen in the last year of John Major's administration, if calculated as a proportion of the total budget. But critics argue that a huge injection of cash into the service should have enabled trusts to balance their books more easily.

A minority of organisations account for most of the deficit, with one, the Mid Essex Hospital Services NHS trust, producing almost a third of the extra debt yesterday after its audited figures took it from a £1m surplus to an £11m deficit.

The Conservatives capitalised on the government's struggle to control deficits as they launched plans for a new NHS independence bill, alongside their high-profile campaign against cuts to local NHS services. "A lot of the cuts can be laid at the door of government mismanagement," David Cameron said. But he ducked a question on whether the Tories would reverse the closures of some wards and departments. Mr Cameron promised to end "political meddling" in health, to get rid of "centrally imposed and politically motivated targets" and to give GPs and primary care trusts greater independence. But he also pledged that the Conservatives in government "will not mess around with existing local and regional structures; we will allow the current structures to settle down and bed in".

Under the Tories' plans, the Department of Health would focus on improving public health. A new, independent NHS board would allocate money and be charged with delivering improved care. The service would have an "economic regulator", to promote competition and safeguard finances, and a healthcare commission to ensure standards of care were being met. An enhanced independent voice for patients would be able to intervene through the commission to raise the alarm on failing standards.

Stephen Dorrell, the former health secretary who co-chairs the party's public service improvement policy group, welcomed Mr Cameron's "unambiguous commitment" to increasing spending on health as the economy grows, describing it as "a fundamental and key shift in Conservative attitudes to the national health service". Mr Dorrell said: "In the past we have too often sounded as if the national health service was a burden and that increased resources committed to it were a regrettable necessity. Politicians are often accused of being out of touch and that attitude so far as we transmitted it was clearly out of touch with the vast majority of the British people."

Andy Burnham, the health minister, said: "David Cameron's new health campaign is muddled and confused. It faces both ways yet does not focus on the interests of patients or NHS staff."

    NHS debts topped £540m last year despite cash injection, G, 10.10.2006, http://society.guardian.co.uk/publicfinances/story/0,,1891673,00.html

Superbug claims 49 lives in top hospitals

· Death toll to rise as infection strikes
· NHS hit by crisis over ward hygiene

Sunday October 1, 2006
The Observer
Jo Revill, health editor

The true scale of Britain's hospital superbug problems emerged today as a leading hospital trust admitted that a 'hypervirulent' infection had claimed the lives of at least 49 patients - and possibly as many as 78 people - in the space of nine months.

The superbug Clostridium difficile (C. difficile), which can cause severe illness and death in patients who have undergone surgery, appears to be at unprecedented levels. It has turned into a more virulent strain, ironically as a result of antibiotics commonly prescribed to fight other infections. The increase in cases is partly due to dirty wards, but also to a shortage of beds. The bacterium has also become more deadly because it has mutated genetically, becoming resistant to other treatments.

Three hospitals in Leicester admitted yesterday that the bug is likely to have caused 28 patients' deaths and contributed to another 21 since the beginning of this year. A further 29 suspicious cases have been referred to the coroner. One of the affected hospitals lies in the constituency of the Health Secretary, Patricia Hewitt, who has tried to prioritise infection control within the NHS.

It emerged last week that at least 20 patients are thought to have died during an outbreak in Kent earlier this year as a resilient strain of C. difficile spread across the country. The Healthcare Commission, the NHS's independent inspection body, is to hold an inquiry into the outbreak at Maidstone Hospital, when 136 patients were diagnosed with the infection over a three-month period.

According to the commission, C. difficile is the major infectious cause of diarrhoea acquired in UK hospitals. It can also lead to fevers, severe inflammation and death in around 5 per cent of cases. More than 51,000 patients in England were found to be carrying the infection last year, with experts warning that it is now more of a danger than MRSA.

The use of detergents may also unwittingly have spread the infection. It is thought the chemicals used on floors and equipment may encourage the creation of bacterial spores that are much more resistant to attack. The only answer appears to be steam-cleaning wards and immediate isolation of infected patients, which will make it harder for hospitals to meet waiting list targets.

Officials at the University Hospitals of Leicester NHS trust, which runs the Leicester Royal Infirmary, the Glenfield and the General hospitals, have ordered wards to be steam-cleaned while staff, patients and visitors must wash their hands before touching anyone.

But there is still concern that not enough is being done, particularly as the hospitals have high bed occupancy rates. Bed numbers have fallen in recent years, but hospitals are carrying out an increasing number of operations and it is extremely hard for a chief executive to close a ward because of infections, because the other targets on waiting lists would be missed.

Concerns about C. difficile first arose in 2003 after 41 pensioners were killed by the deadly bacterium in dirty wards at Stoke Mandeville hospital. According to a Healthcare Commission report, senior executives ignored the dangers and concentrated on delivering the government's waiting time targets.

Even after a public outcry prompted an investigation, the renowned hospital in Aylesbury failed to introduce basic measures of infection control. This year, when the NHS trust had supposedly corrected its mistakes, inspectors witnessed 'dirty wards, dirty toilets and commodes, bedding and equipment lying on floors, faeces on bed rails, pubic hair in baths, mould and cobwebs in showers'.

Experts at University Hospitals of Leicester trust were warning about levels of the bug this year after they discovered that 1 per cent of all their patients were carrying it. David Jenkins, the trust's director of infection control said: 'C. difficile is a very, very nasty diarrhoea bug which is increasingly a problem in the UK, Europe and the States. It has gone through various mutations, meaning it is a genetic moving target which is hard to kill. We are analysing this as part of the battle against the new, hypervirulent strain. The full analysis will take some weeks, and when we have the accurate data, we will let people know. We take this very seriously.'

But he warned: 'We are in this for the long haul and it will take a long time to turn it round.'

Sylvia Greaves died in Leicester Royal Infirmary in May after being admitted with leg ulcers. Her children discovered that she had caught the superbug only after it was given as a cause of death on the death certificate.

Her son, Barry Calow, told a local newspaper that the family was horrified to find their mother had been treated on an open ward and no special precautions had been taken. 'We just want to know why this happened,' he said. 'Every time we ask a question, the door slams shut.'

    Superbug claims 49 lives in top hospitals, O, 1.10.2006, http://observer.guardian.co.uk/uk_news/story/0,,1885022,00.html