Tag Archives: Society

Billionaire Bloomberg to fund $5m public health projects in 40 cities worldwide

Exclusive: Melbourne, Accra and Ulaanbaatar among cities to benefit from funding pledged by former New York mayor to tackle issues from air pollution to obesity

Michael Bloomberg, the billionaire bte noire of both the sugar industry and the tobacco industry, famously fought for a ban on the sale of large-sized colas and other sweet drinks when he was mayor of New York and lost. Although that is not how he sees it.

We actually won that battle, he says. I have always thought if we had not been stopped by the court, it would have died as an issue. Nobody would have known about it. But the fact that it kept coming back to the newspapers was a gift in disguise because people started to think, Holy God, maybe full-sugar drinks are bad for me.

So what happened was consumption of full-sugar drinks around the world has gone down dramatically. If we had won the thing, I think it would have been less.

Bloomberg did plenty more for public health while mayor of New York, including imposing one of the first bans on smoking in bars and restaurants in 2003. Since then he has widened his sphere of influence, funding successful campaigns through his philanthropic foundation for sugar taxes in Mexico and Philadelphia and for curbs on smoking all over the world.

Now, appointed last year as the World Health Organisations global ambassador for non-communicable diseases meaning anything that can harm or kill you that is not infectious the eighth richest person in the world, worth an estimated $47.5bn, is taking his philosophy and his cash to 40 cities around the globe.

His offer, taken up by about 40 cities so far and officially launched on Tuesday, is $5m in assistance from Bloomberg Philanthropies as well as technical support for cities that choose to focus on one of 10 healthy lifestyle issues, including curbing sugary drink consumption, air pollution, promoting exercise and and bans on smoking. They range from affluent Melbourne in Australia to Cali and Medellin in Colombia, Accra in Ghana, Ulaanbaatar in Mongolia, Khatmandu in Nepal and Kampala in Uganda.

National and state governments collect taxes, but it is city governments that make things happen. 50% of people currently live in cities and that is projected to rise to 70% in the next decade or so. Cities are where the rubber meets the road, Bloomberg told the Guardian. The problems are in the cities and the solutions are in the cities.

Bloomberg is upbeat, indomitable and an independent thinker. He made his money in global financial services and has been a Democrat, a Republican and an independent at various times. He says he believes the war on sugar and tobacco, of which his foundation must be seen as the main global financial backer, is being won.

In parts of the world, clearly yes, and particularly on smoking, he said. In Europe nobody would have thought people wouldnt insist on smoking in an Irish bar or pub or an Italian restaurant, but the smoking campaign has really worked, reducing consumption in all of western Europe, north and south America and even in China.

But there are places where poor people live and they are still smoking and really damaging their lungs and they are going to die young. It is up to us to keep the battle going. Sugar is a little bit less developed but still working.

His attention is on non-communicable diseases more broadly now that includes air pollution and road traffic accidents as well as cigarettes, alcohol and bad food. Cities in poor countries may argue that they have too many other problems to spend time on sugary drinks, but, says Bloomberg, poverty, ill-health and poor education are all interlinked.

It will be harder to get the public behind you because they less understand the damage being done to their own health. But thats the challenge. The cities where its easy have probably already addressed the issue, he said.

Michael
Michael Bloomberg and WHO director-general Dr Margaret Chan Photograph: Bloomberg Phlilantropies

Bloomberg would not suggest it is easy to make the sort of changes he has pushed for in all these years.

I dont remember anybody objecting to the smoking ban when we put it in, although a lot of people wanted to take my picture and a lot of people gave me one finger waves, he said. If there was an easy solution to a complex problem, we wouldnt have the problem. If you want to make things better, youre going to be doing things that are tough.

The cities that commit to the Partnership for Healthy Cities can choose between curbing sugary drink consumption, passing laws to make public places smoke-free or banning cigarette advertising, cutting salt in food, using cleaner fuels, encouraging cycling and walking, reducing speeding, increasing seatbelt and helmet use, curbing drink driving or carrying out a survey to collect data on the lifestyle risks the city population runs.

Cape Town in South Africa was one of the earliest cities to commit and will focus on reducing the intake of sugary drinks. Its mayor, Patricia de Lille, says they are facing an epidemic of type 2 diabetes, caused by obesity. Diabetes is a silent killer, she said. We dont have the luxury to work by trial and error. Unfortunately we have to get it right first time.

London has also said it wants to be involved, although which issue will be the focus has not yet been revealed. It is a city with which Bloomberg says he has a complex relationship his former wife is British and his daughters hold dual nationality. He has an honorary knighthood from the Queen. He also has an honour from the City of London that he intends one day to cash in.

I do have the right to drive sheep across London Bridge and before I die, I want to do it one day at rush hour, just to see what happens, he said.

Read more: https://www.theguardian.com/society/2017/may/16/billionaire-bloomberg-to-fund-5m-public-health-projects-in-40-cities-worldwide

READ MORE

A journey through a land of extreme poverty: welcome to America

The UNs Philip Alston is an expert on deprivation and he wants to know why 41m Americans are living in poverty. The Guardian joined him on a special two-week mission into the dark heart of the worlds richest nation

Los Angeles, California, 5 December

You got a choice to make, man. You could go straight on to heaven. Or you could turn right, into that.

We are in Los Angeles, in the heart of one of Americas wealthiest cities, and General Dogon, dressed in black, is our tour guide. Alongside him strolls another tall man, grey-haired and sprucely decked out in jeans and suit jacket. Professor Philip Alston is an Australian academic with a formal title: UN special rapporteur on extreme poverty and human rights.

General Dogon, himself a veteran of these Skid Row streets, strides along, stepping over a dead rat without comment and skirting round a body wrapped in a worn orange blanket lying on the sidewalk.

The two men carry on for block after block after block of tatty tents and improvised tarpaulin shelters. Men and women are gathered outside the structures, squatting or sleeping, some in groups, most alone like extras in a low-budget dystopian movie.

We come to an intersection, which is when General Dogon stops and presents his guest with the choice. He points straight ahead to the end of the street, where the glistening skyscrapers of downtown LA rise up in a promise of divine riches.

Heaven.

Then he turns to the right, revealing the black power tattoo on his neck, and leads our gaze back into Skid Row bang in the center of LAs downtown. That way lies 50 blocks of concentrated human humiliation. A nightmare in plain view, in the city of dreams.

Alston turns right.

Philip
Philip Alston in downtown LA. Photograph: Dan Tuffs for the Guardian

So begins a two-week journey into the dark side of the American Dream. The spotlight of the UN monitor, an independent arbiter of human rights standards across the globe, has fallen on this occasion on the US, culminating on Friday with the release of his initial report in Washington.

His fact-finding mission into the richest nation the world has ever known has led him to investigate the tragedy at its core: the 41 million people who officially live in poverty.

Of those, nine million have zero cash income they do not receive a cent in sustenance.

Alstons epic journey has taken him from coast to coast, deprivation to deprivation. Starting in LA and San Francisco, sweeping through the Deep South, traveling on to the colonial stain of Puerto Rico then back to the stricken coal country of West Virginia, he has explored the collateral damage of Americas reliance on private enterprise to the exclusion of public help.

The Guardian had unprecedented access to the UN envoy, following him as he crossed the country, attending all his main stops and witnessing the extreme poverty he is investigating firsthand.

Think of it as payback time. As the UN special rapporteur himself put it: Washington is very keen for me to point out the poverty and human rights failings in other countries. This time Im in the US.

David
David Busch, who is currently homeless on Venice beach, in Los Angeles. Photograph: Dan Tuffs for the Guardian


The tour comes at a critical moment for America and the world. It began on the day that Republicans in the US Senate voted for sweeping tax cuts that will deliver a bonanza for the super wealthy while in time raising taxes on many lower-income families. The changes will exacerbate wealth inequality that is already the most extreme in any industrialized nation, with three men Bill Gates, Jeff Bezos and Warren Buffet owning as much as half of the entire American people.

A few days into the UN visit, Republican leaders took a giant leap further. They announced plans to slash key social programs in what amounts to an assault on the already threadbare welfare state.

Look up! Look at those banks, the cranes, the luxury condos going up, exclaimed General Dogon, who used to be homeless on Skid Row and now works as a local activist with Lacan. Down here, theres nothing. You see the tents back to back, theres no place for folks to go.

California made a suitable starting point for the UN visit. It epitomizes both the vast wealth generated in the tech boom for the 0.001%, and the resulting surge in housing costs that has sent homelessness soaring. Los Angeles, the city with by far the largest population of street dwellers in the country, is grappling with crisis numbers that increased 25% this past year to 55,000.

Ressy Finley, 41, was busy sterilizing the white bucket she uses to slop out in her tent in which she has lived on and off for more than a decade. She keeps her living area, a mass of worn mattresses and blankets and a few motley possessions, as clean as she can in a losing battle against rats and cockroaches. She also endures waves of bed bugs, and has large welts on her shoulder to prove it.

She receives no formal income, and what she makes on recycling bottles and cans is no way enough to afford the average rents of $1,400 a month for a tiny one-bedroom. A friend brings her food every couple of days, the rest of the time she relies on nearby missions.

She cried twice in the course of our short conversation, once when she recalled how her infant son was taken from her arms by social workers because of her drug habit (he is now 14; she has never seen him again). The second time was when she alluded to the sexual abuse that set her as a child on the path towards drugs and homelessness.

Given all that, its remarkable how positive Finley remains. What does she think of the American Dream, the idea that everyone can make it if they try hard enough? She replies instantly: I know Im going to make it.

A 41-year-old woman living on the sidewalk in Skid Row going to make it?

Sure I will, so long as I keep the faith.

What does making it mean to her?

I want to be a writer, a poet, an entrepreneur, a therapist.

Ressy
Ressy Finley, who lives in a tent on 6th Street in Downtown LA. Photograph: Dan Tuffs for the Guardian

Robert Chambers occupies the next patch of sidewalk along from Finleys. Hes created an area around his tent out of wooden pallets, what passes in Skid Row for a cottage garden.

He has a sign up saying Homeless Writers Coalition, the name of a group he runs to give homeless people dignity against what he calls the animalistic aspects of their lives. Hes referring not least to the lack of public bathrooms that forces people to relieve themselves on the streets.

LA authorities have promised to provide more access to toilets, a critical issue given the deadly outbreak of Hepatitis A that began in San Diego and is spreading on the west coast claiming 21 lives mainly through lack of sanitation in homeless encampments. At night local parks and amenities are closed specifically to keep homeless people out.

Skid Row has had the use of nine toilets at night for 1,800 street-faring people. Thats a ratio well below that mandated by the UN in its camps for Syrian refugees.

Its inhuman actually, and eventually in the end you will acquire animalistic psychology, Chambers said.

He has been living on the streets for almost a year, having violated his parole terms for drug possession and in turn being turfed out of his low-cost apartment. Theres no help for him now, he said, no question of making it.

The safety net? It has too many holes in it for me.

Of all the people who crossed paths with the UN monitor, Chambers was the most dismissive of the American Dream. People dont realize its never getting better, theres no recovery for people like us. Im 67, I have a heart condition, I shouldnt be out here. I might not be too much longer.

That was a lot of bad karma to absorb on day one, and it rattled even as seasoned a student of hardship as Alston. As UN special rapporteur, hes reported on dire poverty and its impact on human rights in Saudi Arabia and China among other places. But Skid Row?

I was feeling pretty depressed, he told the Guardian later. The endless drumbeat of horror stories. At a certain point you do wonder what can anyone do about this, let alone me.

And then he took a flight up to San Francisco, to the Tenderloin district where homeless people congregate, and walked into St Boniface church.

What he saw there was an analgesic for his soul.

San Francisco, California, 6 December

The
The Gubbio project at St Boniface in San Francisco. The church opens its doors every weekday at 6am to allow homeless people to rest until 3pm. Photograph: David Levene for the Guardian


About 70 homeless people were quietly sleeping in pews at the back of the church, as they are allowed to do every weekday morning, with worshippers praying harmoniously in front of them. The church welcomes them in as part of the Catholic concept of extending the helping hand.

I found the church surprisingly uplifting, Alston said. It was such a simple scene and such an obvious idea. It struck me Christianity, what the hell is it about if its not this?

It was a rare drop of altruism on the west coast, competing against a sea of hostility. More than 500 anti-homeless laws have been passed in Californian cities in recent years. At a federal level, Ben Carson, the neurosurgeon who Donald Trump appointed US housing secretary, is decimating government spending on affordable housing.

Perhaps the most telling detail: apart from St Boniface and its sister church, no other place of worship in San Francisco welcomes homeless people. In fact, many have begun, even at this season of goodwill, to lock their doors to all comers simply so as to exclude homeless people.

As Tiny Gray-Garcia, herself on the streets, described it to Alston, there is a prevailing attitude that she and her peers have to contend with every day. She called it the violence of looking away.

Coy
Coy Catley, 63, in her homeless box made of cardboard sheets on a sidewalk of Tenderloin, San Francisco. Photograph: Ed Pilkington for the Guardian


That cruel streak the violence of looking away has been a feature of American life since the nations founding. The casting off the yoke of overweening government (the British monarchy) came to be equated in the minds of many Americans with states rights and the individualistic idea of making it on your own a view that is fine for those fortunate enough to do so, less happy if youre born on the wrong side of the tracks.

Countering that has been the conviction that society must protect its own against the vagaries of hunger or unemployment that informed Franklin Roosevelts New Deal and the Great Society of Lyndon Johnson. But in recent times the prevailing winds have blown strongly in the youre on your own, buddy direction. Ronald Reagan set the trend with his 1980s tax cuts, followed by Bill Clinton, whose 1996 decision to scrap welfare payments for low-income families is still punishing millions of Americans.

The cumulative attack has left struggling families, including the 15 million children who are officially in poverty, with dramatically less support than in any other industrialized economy. Now they face perhaps the greatest threat of all.

As Alston himself has written in an essay on Trumps populism and the aggressive challenge it poses to human rights: These are extraordinarily dangerous times. Almost anything seems possible.

Lowndes County, Alabama, 9 December

Aaron
Aaron Thigpen discusses the poor sewage conditions in Butler County. Improper treatment has put the population at risk of diseases long believed to be extinct in the US. Photograph: Bob Miller for the Guardian


Trumps undermining of human rights, combined with the Republican threat to pare back welfare programs next year in order to pay for some of the tax cuts for the rich they are rushing through Congress, will hurt African Americans disproportionately.

Black people are 13% of the US population, but 23% of those officially in poverty and 39% of the homeless.

The racial element of Americas poverty crisis is seen nowhere more clearly than in the Deep South, where the open wounds of slavery continue to bleed. The UN special rapporteur chose as his next stop the Black Belt, the term that originally referred to the rich dark soil that exists in a band across Alabama but over time came to describe its majority African American population.

The link between soil type and demographics was not coincidental. Cotton was found to thrive in this fertile land, and that in turn spawned a trade in slaves to pick the crop. Their descendants still live in the Black Belt, still mired in poverty among the worst in the union.

You can trace the history of Americas shame, from slave times to the present day, in a set of simple graphs. The first shows the cotton-friendly soil of the Black Belt, then the slave population, followed by modern black residence and todays extreme poverty they all occupy the exact same half-moon across Alabama.

There are numerous ways you could parse the present parlous state of Alabamas black community. Perhaps the starkest is the fact that in the Black Belt so many families still have no access to sanitation. Thousands of people continue to live among open sewers of the sort normally associated with the developing world.

The crisis was revealed by the Guardian earlier this year to have led to an ongoing endemic of hookworm, an intestinal parasite that is transmitted through human waste. It is found in Africa and South Asia, but had been assumed eradicated in the US years ago.

Yet here the worm still is, sucking the blood of poor people, in the home state of Trumps US attorney general Jeff Sessions.

A disease of the developing world thriving in the worlds richest country.

The open sewerage problem is especially acute in Lowndes County, a majority black community that was an epicenter of the civil rights movement having been the setting of Martin Luther Kings Selma to Montgomery voting rights march in 1965.

Philp
Philp Alston talks to a resident. Many families in Butler and Lowndes counties choose to live with open sewer systems made from PVC pipe. Photograph: Bob Miller for the Guardian

Despite its proud history, Catherine Flowers estimates that 70% of households in the area either straight pipe their waste directly onto open ground, or have defective septic tanks incapable of dealing with heavy rains.

When her group, Alabama Center for Rural Enterprise (Acre), pressed local authorities to do something about it, officials invested $6m in extending waste treatment systems to primarily white-owned businesses while bypassing overwhelmingly black households.

Thats a glaring example of injustice, Flowers said. People who cannot afford their own systems are left to their own devices while businesses who do have the money are given public services.

Walter, a Lowndes County resident who asked not to give his last name for fear that his water supply would be cut off as a reprisal for speaking out, lives with the daily consequences of such public neglect. You get a good hard rain and it backs up into the house.

Thats a polite way of saying that sewage gurgles up into his kitchen sink, hand basin and bath, filling the house with a sickly-sweet stench.

Given these circumstances, what does he think of the ideology that anyone can make it if they try?

I suppose they could if they had the chance, Walter said. He paused, then added: Folks arent given the chance.

Had he been born white, would his sewerage problems have been fixed by now?

After another pause, he said: Not being racist, but yeah, they would.

Round the back of Walters house the true iniquity of the situation reveals itself. The yard is laced with small channels running from neighboring houses along which dark liquid flows. It congregates in viscous pools directly underneath the mobile home in which Walters son, daughter-in-law and 16-year-old granddaughter live.

It is the ultimate image of the lot of Alabamas impoverished rural black community. As American citizens they are as fully entitled to life, liberty and the pursuit of happiness. Its just that they are surrounded by pools of excrement.

This week, the Black Belt bit back. On Tuesday a new line was added to that simple graphic, showing exactly the same half-moon across Alabama except this time it was not black but blue.

blue belt south

It depicted the army of African American voters who turned out against the odds to send Doug Jones to the US Senate, the first Democrat from Alabama to do so in a generation. It delivered a bloody nose to his opponent, the alleged child molester Roy Moore, and his puppetmasters Steve Bannon and Donald Trump.

It was arguably the most important expression of black political muscle in the region since Kings 1965 march. If the previous entries in the graphic could be labeled soil, slavery and poverty, this one should be captioned empowerment.

Guayama, Puerto Rico, 10 December

So how does Alston view the role of UN rapporteur and his visit? His full report on the US will be released next May before being presented to the UN human rights council in Geneva.

Nobody expects much to come of that: the world body has no teeth with which to enforce good behavior on recalcitrant governments. But Alston hopes that his visit will have an impact by shaming the US into reflecting on its values.

My role is to hold governments to account, he said. If the US administration doesnt want to talk about the right to housing, healthcare or food, then there are still basic human rights standards that have to be met. Its my job to point that out.

Alstons previous investigations into extreme poverty in places like Mauritania pulled no punches. We can expect the same tough love when it comes to his analysis of Puerto Rico, the next stop on his journey into Americas dark side.

Three months after Maria, the devastation wrought by the hurricane has been well documented. It tore 70,000 homes to shreds, brought industry to a standstill and caused a total blackout of the island that continues to cause havoc.

READ MORE

why do men suffer depression in silence?

When Kevin Braddock hit rockbottom, he had every intention of killing himself. He recounts what happened next and reveals why so few men ask for help

It was a Monday when Robin Williams killed himself three years ago Monday 11 August 2014. His death was shocking even if in hindsight it shouldnt have been a surprise that the worlds funniest man might also be the most sorrowful, too a person despairing to the point of ending it all.

Its a date I remember well, because Id spent the previous day trying to do the same thing. I was in the psychiatric ward of the Berlin hospital which Id been manhandled into by friends the day before, and I was waiting to see the doctor whod asked me to promise that I wouldnt kill myself.

In her consultation room Id thought about it for a while; Id already told her all I could about what led me to try to die. Id described the methods looping ceaselessly through my mind as I was slumped on the pavement near Berlins TV Tower: the gun, the noose, the blade, the pills, the bottle. The gun, the noose the mantra that would not stop. Since the only thing to hand was the nearby sptkauf (off-licence), Id resolved to drink my way to unreality.

Id told the doctor my history of depression, anxiety, panic attacks, drink, drugs, meds, love and fear, my crises of faith and existential dread, and all the other things that seem to go with being human in the 21st century. I had few words left in me, but mumbling through endless tears with my hands in my lap, Id mouthed the words to her: I promise.

I hadnt gone through with the act, but God knows Id wanted to wanted to end it all and wanted it all to end. I was outpatiented for a while, and friends and loved ones looked after for me. Three years later, they still do.

How had things got so bad? In 2009, fed up with London, I bought a one-way ticket to Tegel with vague plans to hang out for a couple of months and run the Berlin marathon. Two months turned into six, then a year and eventually half a decade in that beautifully confused city. In the teeth of this current crisis, Id been struggling to hold things and myself together at the magazine where I was working. Id begun, falteringly, to deal with the dependencies that had got a grip on me (Id long been a heavy, problematic drinker, and Berlin is an easy city in which to hedonise, although by the standards of Berghain regulars, I was a total lightweight).

Meanwhile, depression and anxiety, old adversaries which Id suffered incapacitating episodes with at 21 and 30, had begun ranging back on to my neurological horizons. Id also caught glandular fever, fallen in love, and turned 42 which, as readers of Douglas Adams know, is the meaning of life. I was perpetually stressed, exhausted and despairing at work and it didnt take much for the cascade to begin: yet another work problem, a row, some piece of bad news.

Looking back, Im surprised at how fast I unravelled, how the energyless fog of depression condensed into an electric psychosis, how despair became madness. One day, one of my editors had asked if I was all right. I said: No, Im not, and started listing conflicts and confusions. (I was also surprised that she asked: I mean, its generally not the way that bosses look out for their employees.) A few days later I was in hospital.

Madness comes at you fast, to paraphrase the social media clich.

None of this is to equate my life or story with Robin Williamss in any way, apart from to say that I made it through what the doctor wrote down as a schwere (major) depressive episode, whereas Williams didnt, and Im thankful that one of us is around to talk about this stuff. Above all, Im grateful I found the courage to ask for help.

Facebook gets a lot of stick these days, but in one sense it kept me alive, because Facebook was where I asked for help in a status update that Sunday afternoon which read: Im at the bottom now, can a German speaker come to St Hedwigs with me, I need help, along with my phone number.

I dont know how long Id been there, or how many bottles of Augustiner beer to the worse I was. But I do remember an alternative thought forming from the cognitive murk: I could ask for help. Sure, everyone would see what a pitiful, drunken, helpless, tearful state I was the opposite of what Id prefer to project, yet also the truth. But the thought came: theres another way. I couldnt speak, I seemed to have been silenced, but there was my phone I could test the limits of this thing which helps people (and I quote) connect with friends, family and other people you know.

Keep
Keep talking: Tom Chapmans Lions Barber Collective is turning a network of barber shops into safe spaces for men to open up in.

After a few minutes the phone went red hot, bleeping, flashing and ringing. I was hardly in a suitable frame of mind to process these messages, but looking at them a few days later, they said things like: Youll get through this; Stay positive; You are loved; and simply Love you. Some friends offered places in which to recuperate, others offered to come over. Not only was I ashamed at the alarm Id caused, I was also shocked at the volume of support that came through. There turned out to be more in the world than blank nothingness after all.

Help came, and rapidly. Friends took me to the hospital, and my life began to change.

Whether its an effect of social media or not, recently theres been a wave of men admitting to anxiety, depression or addiction, or of having attempted to kill themselves, or knowing someone whos seen the act through, problems which respect neither class, race, age or status and which, statistically and anecdotally, seem to be on the rise.

When Stormzy or Prince Harry admit that they, too, have feelings, struggles and doubts, these confessions challenge the Strength Myth which men have long laboured under. They also represent a tacit plea for help, a kind of Save me from what Im supposed to be, which usually means autonomous, successful, potent, dominant, along with all the other clichs of whats been termed hegemonic masculinity.

And when another male celebrity Ant McPartlin being the latest checks into rehab, you sense that the work being done by organisations such as the Campaign Against Living Miserably (which aims to raise awareness of mental illness and prevent suicide in men) or Tom Chapmans Lions Barber Collective (which is turning a worldwide network of barber shops into safe spaces for men to open up in) is vital.

People are opening up more instead of hiding; things are getting better, says Chapman from his salon in Torquay. Men are starting to feel comfortable talking to one another about their worries, problems and self-doubts, or going to see a GP or a health professional. Chapman decided to set up the Lions Barber Collective as a charity engaged with mens mental health awareness after a friend killed himself. Theres something about the relationship between a barber and their client where theres complete trust, he says.

The Campaign Against living Miserably cites figures from the Office for National Statistics that suicide currently stands as the biggest single killer of men aged under 45 in the UK. In 2014, there were 6,109 suicides in the UK, of which 76% were male. The ratio of male to female suicide has shown a sustained rise over the past 30 years. In 1981, men accounted for 62% of suicides, with the figure rising to 70% in 1988, 75% in 1995 and 78% in 2013.

All of which is why its heartening that in recent years the conversation on the meaning of masculinity has been growing in volume, running parallel to a wider openness on mental illness and health in society today.

The Royal Foundations Heads Together charity harnesses Princes William and Harry and the Duchess of Cambridge to a mission encouraging people to open up about these problems. At a speech given on World Mental Health Day in October 2016, Prince Harry said: Too often we think mental health problems are things that happen to other people, not us. But we will all experience pressure on our mental health at some point during our lives. The more we accept that, the better we can help each other. Catching it and recognising it early saves lives. Its time we ended the shame around mental health the fear of judgment that stops people talking or getting help.

When
When Stormzy admits he, too, has struggles, it challenges the Strength Myth which men have long laboured under. Photograph: Shirlaine Forrest/WireImage

A few months after my breakdown I returned to the UK and spent a deep, grey winter with my tirelessly patient parents, in the room where I grew up. News arrived one day of a family friend whod taken an overdose thankfully she survived. And on a train one evening I fell into an initially sheepish conversation with a woman in her 50s, each of us cryptically tiptoeing around what we both guessed was going on in each of us.

Well, Ive been ill, I told her, rather euphemistically.

Me, too, she said. Er mind if I ask what kind of ill?

It took some gentle work to overcome a barrier of shame between us, but once we had, the talk became extraordinarily candid and affirming. Shed been visiting her support group. She recounted details of her own psychotic episodes and an attempt to kill herself, then handed me an A4 pamphlet simply entitled My Story, which was heartbreaking along with being one of the bravest, most honest stories Id ever read. We made friends and resolved to stay in touch.

My own story developed, too. I spent a year living monastically in a friends boxroom in Bristol, discovering that recovery is a process rather than a destination, a project of constant modifications and setbacks with modestly miraculous breakthroughs that convince you that life is worth living. Things that have helped me include: learning, sobriety, therapy, meds, volunteering, tai chi, vitamin B, walking, talking, working and much more.

Something else helped. A few days after being taken to hospital, someone I hadnt seen for a decade read my Facebook message and wrote to say: From now on, Kev, be completely honest and open about this stuff. Confront it all head on. And seeing as youre a writer, write it all down. I was consoled by his concern, but also perplexed as to why he was so adamant about this tactic. It turns out his sister had taken her own life.

Recently I was back in Berlin to share the story I wrote down with the people who picked me up and kept me going. It turned into a book I made with my friend Enver, called Torchlight: a Publication About Asking for Help, which details my experiences of breakdown and recovery.

If that sounds like a rather crass sales pitch at the end of a story of common human dysfunction, Id counter that by saying that while we are overwhelmed by digital technologies these days, theres a striking lack of social technologies to assist people in asking for help, talking about their experiences, or sharing the methods they use to deal with the darkness. Facebook offered me the chance to ask for help, but any recovering Ive been fortunate enough to do has been social in the original sense of the word: person-to-person, with friends, family, therapists, study groups, recovery fellowships, sympathetic employers and colleagues, with people I met randomly on trains or in rooms, always in collaboration with others. Recovery is a social exercise that can be assisted but never replaced by digital technologies.

Something else I know now is that we fall apart, alone and in private, but we heal together, with others, the ones who arent shocked or scared by what they see when the mask of shame is removed.

At torchlightsystem.com you can buy Kevins book Torchlight, watch his short film and purchase Practice Cards which offer hints for daily living when suffering from depression and anxiety. The Samaritans can be contacted on 116 123, and Mind on 0300 123 3393

Read more: https://www.theguardian.com/society/2017/aug/13/why-do-men-suffer-depression-in-silence

READ MORE

Why do stars like Adele keep losing their voice?

The long read: More and more singers are cancelling big shows and turning to surgery to fix their damaged vocal cords. But is the problem actually down to the way they sing?

I dont even know how to start this, Adele wrote in an online letter to fans on 30 June. The previous night, she had played the second show of a sold-out, four-night residency at Wembley Stadium. These dates, in front of audiences of 98,000, were supposed to be the triumphant conclusion of her record-setting, 123-date world tour. But on stage, something had just felt wrong.

Ive struggled vocally both nights, she wrote. I had to push a lot harder than I normally do. I felt like I constantly had to clear my throat. After the second show, Adele went to see her doctor, who told her she had damaged her vocal cords and had no option but to cancel her remaining shows. The most powerful young voice in the music business had fallen silent. To say Im heart broken would be a complete understatement, she wrote.

Though only 29, Adele had been here before. Six years earlier, she had suffered a haemorrhage to her vocal cords after singing live on a French radio program. In order to repair the injury, she underwent an incredibly delicate, high-risk medical intervention: vocal cord microsurgery. In this operation, the surgeon wields miniature scalpels and forceps attached to foot-long poles that are guided down the throat to excise whatever damaged tissue is robbing the vocal cords of their elasticity, and depriving the voice of its natural timbre, range and clarity.

Adeles surgeon, Dr Steven Zeitels, was after a nasty polyp that had formed under her epithelium, the thin outer layer of the vocal cord. Zeitels carefully snipped the layer with a scalpel, and then, with a forcep, pulled back the tissue like a flap, exposing the polyp below. With a second forcep he pulled out the gooey, infected mass, and zapped the remaining haemorrhaged surface with a laser to stop the bleeding and prevent scarring.

The margin for error in such surgeries is measured in fractions of a millimetre. You cant let the instruments touch any healthy tissue. Dig too deep, Zeitels knew, and he would risk damaging the superficial lamina propria, the soft, pliable underlayer of Adeles vocal cords. If he pierced that, he told me, there would be no way to preserve the power and suppleness of her voice.

On 12 February 2012, three months after her surgery, Adele swept up six awards at the Grammys, including album of the year and song of the year. In her acceptance speech for best pop solo performance, she thanked Zeitels for restoring her voice. To most observers, it was a cheering comeback story, but for a handful of medical specialists it was a watershed moment. For years, vocal cord microsurgery had been considered risky. (In 1997, an unsuccessful surgical procedure left Julie Andrews already damaged voice beyond repair.) More than the physical risk, though, singers feared the damage to their careers that could follow if word got out. In the world of showbusiness, it was safer to be seen as a singer with a healthy young voice than as a one-time great with surgically repaired cords.

Now, Adele had suddenly swept away the stigma. In the years since, Zeitels business has boomed, along with those of many of his peers. They have no shortage of patients: there is an epidemic of serious vocal cord injuries in the performing arts. In addition to his work on Adele, Zeitels, who directs the Massachusetts General Hospital Center for Laryngeal Surgery and Voice Rehabilitation, has repaired the cords of more than 700 performing artists, including Sam Smith, Lionel Richie, Bono and Cher. Michael Bubl, Keith Urban, Meghan Trainor and Celine Dion have also had to quit touring to get their cords surgically repaired. In a mark of how attitudes to surgery have changed, both Smith and Bubl broke the news of their surgeries to their fans via Instagram.

There is no precise data on the number of performers who have gone under the knife over the years. But several surgeons told me they estimate that vocal cord surgery has been performed on thousands of pop, rock and classical singers, as well as on theatre and stage musical stars. Cancelled shows reverberate across social media and hit a struggling music industry hard. When Adele pulled out of her remaining two Wembley shows this summer, nearly 200,000 tickets had to be refunded. Its unclear if she will ever tour again.

After Adeles 2011 surgery, Zeitels became something of a celebrity. Occasionally, a reporter asked him if Adele was cured for good. He made no assurances, but told Channel 4s Jon Snow that her surgically repaired voice sounds smoother now than before.

While the media was celebrating this miracle surgery, one woman in the music industry raised a dissenting voice. According to Lisa Paglin, a former opera singer turned voice coach, Zeitels had simply found a temporary fix; in the not too distant future, Adele would once again be forced off the stage and back into the operating theatre. It was a prediction that Paglin and Marianna Brilla, her coaching partner, were willing to stake their reputations on. The rash of vocal injuries silencing our most promising young talents, they argued, is too big a problem to be solved by microsurgery.

How many surgeries would Dr Zeitels consider performing on Adele? Or on anyone? After surgery, unless a singer makes major changes, return to performing means a return to the vocal abuse that put her/him on the operating table in the first place, Paglin wrote, in the small trade publication Intermezzo. Concerts injury surgery rest concerts injury surgery. Is this the life of a professional singer?

When Adele cancelled the final nights of her recent tour, Brilla and Paglin felt saddened but vindicated. For more than a decade, they have been pushing for a revolution in the way that almost every modern performer has been taught to use their voice. After years of painstaking research in musical archives, early scientific journals and the classroom, Brilla and Paglin say they can deliver what medical science has failed to: a permanent fix for vocal burnout.

Their solution requires the revival of an all-but-vanished singing method that is not just beautiful to the ear, but also easy on the throat. Some of their ageing and beleaguered clients described it to me as a kind of fountain of youth. But their cure is not without controversy. It is based on a provocative theory that has been gaining ground among a small cadre of international talents: that we have all been singing completely wrong even Adele.


Singing is a rough business. Every vocal performance involves hundreds of thousands of micro-collisions in the throat. The vocal cords also known as vocal folds are a pair of thin, reed-like, muscular strips located inside the larynx, or voice box, in the throat. They are shaped like a wishbone, and contain the densest concentration of nerve tissue in the body.

When we are silent, the cords remain apart to facilitate breathing. When we sing or speak, air is pushed up from the lungs, and the edges of the cords come together in a rapid chopping motion. The air causes the cords to vibrate, creating sound. The greater the vibration, the higher the pitch. By the time a soprano hits those lush high notes, her vocal cords are thwacking together 1,000 times per second, transforming a burst of air from her lungs into music powerful enough to shatter glass.

Beautiful singing requires lithe cords, but all that slapping together can wear down their fine, spongy surface and lead to tiny contusions. Over years of heavy use, nodules, polyps or cysts form on the vocal folds, distorting the sound they create. For a singer, the first sign of trouble is often the wobble. His pitch fluctuates on and off key because his ragged cords have lost their natural vibrato their ability to resonate properly. Then theres the hole, a point on the scale where a singers vibrating vocal cords fail to produce the proper tone. Try as he might, those notes will exit his mouth flat or, worse, as a barely audible gasp.

An
A vintage engraving of a view inside the throat. Photograph: Alamy Stock Vector

It was once unheard-of for a singer to perform with a faulty voice, but the opera world has recently been shaken by a trio of incidents in which the stars Rolando Villazn, Aleksandrs Antonenko and Robert Alagno walked off stage mid-performance, unable to go on. Some opera singers complain of year-round cold symptoms, and legal steroid injections and other drugs are often used to get a struggling singer through a performance. But singing through the wear and tear can cause the lesions to burst and bleed, creating voice-ruining scars, which is what happened to Adele in 2011.

Voice specialists liken the physical toll on singers and stage performers to what athletes endure. Surgery to the professional singers vocal cords is what ligament reconstruction has become to the football players knee. Dusty theatres, stuffy airplane cabins, erratic eating and sleeping patterns, the stress of living off stingy contracts all affect the vocal cords. Add to it the occupational hazard, at least in opera and classical music, of taking on roles that require you to sing above your natural range, and the cords become extremely susceptible to injury.

In 1986, the conductor, vocal coach and New York Times music critic Will Crutchfield lamented that vocal burnout was cutting short careers and diminishing the power of opera, as audiences, by necessity, accustom themselves to hearing voices in poor condition. Back then, Crutchfield saw that singers peaked in their 30s and then began to decline. But Adele, Trainor and Smith all underwent career-saving surgery in their 20s. Vocal burnout is afflicting amateurs, too. One veteran teacher in Italy told me that female students in their early 20s who want to sing like Adele or a young Whitney Houston are the ones who come down with vocal nodules. Another music teacher told me she recently had to instruct one of her 10-year-old students to stop singing and get his damaged cords checked by a specialist.

The rise in vocal injuries is linked to a change in what we consider good singing. Across all genres, it has become normal to believe that louder is better. (One reason that Adele is such a big star is because her voice is so big.) As a result, singers are pushing their cords like never before, which leads to vocal breakdown.

New waves of medical research into the causes of dysphonia, or the inability to properly produce voice, bear this out. In the west, vocal abuse is surprisingly common in all professions that rely on the voice , from schoolteachers to opera singers. Awareness of the problem is growing, but as Adeles case demonstrated, and separate studies conclude, surgery is not necessarily a lasting fix.

Brilla and Paglin have been saying this for years. You cannot solve the problem by simply relieving the symptom, Brilla said. Its a motor problem. The singer has to understand its the way youre running your engine the techniques theyre using to sing. If you dont fix the engine, its going to happen again.


Teatro La Nuova Fenice, a 19th-century opera house built in the neoclassical style, sits at the top of the small hill town of Osimo in central Italy, just inland of the Adriatic Sea. In the grand lobby of the building is a marble plaque commemorating the night in 1927 when the Italian tenor Beniamino Gigli, one of the greatest talents of his era, performed here. Gigli packed concert halls across Europe and the Americas in a career that spanned five decades.

Gigli is an icon of the purer, more natural singing style that characterised a period when vocal injuries were almost unheard of, say Brilla and Paglin. They have a small teaching studio in a cul-de-sac below La Nuova Fenice. Brilla, a dramatic soprano with a fearless air, first became obsessed with the fragility of the human voice more than 50 years ago, as a teenage opera singer growing up in Pennsylvania coal country. A doctor there diagnosed her with a problem common among young singers with big voices: her vocal cords werent coming together properly. She had a hole. Over the next few decades, she cycled through nearly 30 teachers, including legends such as Antonio Tonini and Ellen Faull, trying to learn to sing in a style like Giglis at once powerful, clear and sustainable over the course of many years.

Brilla met Paglin, a lyric soprano who appears small next to Brilla, while studying voice at Indiana Universitys school of music. The two bonded over their love for Italian opera and their frustration with the way singing was taught, even by their legendary teacher Margaret Harshaw. Feeling that the giants of music instruction didnt have the key to vocal longevity, Brilla and Paglin determined that they would be the ones to unlock the secret.

In 1977, Brilla won a prestigious Fulbright scholarship to travel to Italy to search for a way to sing beautifully without risking injury. There, she heard glimpses of perfect arias from older, mostly Italian opera singers who learned their craft in the early 20th century. These singers seemed to effortlessly produce clear, powerful musical tones, and so many of them were still performing with vigour well into their 60s, 70s and 80s. To Brilla, they held a clue to the vocal longevity lost to singers today.

Paglin soon joined her in Rome, where they started spending hours each day at the national sound archive, La Discoteca di Stato, listening to early recordings. They also scoured libraries for texts that discussed how operatic and classical singing techniques had changed over the centuries. When they werent researching, they were performing; big talents in their own right, they performed in many of the major opera houses and music halls of Italy and Austria. This put them in the presence of more masters, whom they peppered with questions. They also tracked down other ageing opera stars, teachers and conductors.

Their research pointed Brilla and Paglin to a surprising conclusion: that responsibility for the modern decline of the voice lay at the feet of Verdi, Wagner and Puccini. These three composers were the pop music sensations of their day. Music scholars credit them with being the first to challenge their singers to push their voices to new limits, in order to capture the emotional ups and downs their characters were feeling. Think of the teenage Japanese bride in Puccinis Madama Butterfly, her heart breaking, desperately watching the seas for a sign her love will return, or the thunderous battle cries of the Valkyries in Wagners Ring cycle. If youre going to kill off the main character of your show, you need genuine rage and pathos on stage.

But Brilla and Paglin heard something different that the emotionally charged, full-throated, operatic singing style Verdi and Wagner made popular in the late 19th century and that Puccini amped up even further in the early 20th century had subsequently infiltrated all singing genres and public performances. With each passing decade, the style grew more extreme. To illustrate the point, when I visited the duo earlier this summer, Paglin pulled from their sprawling research library a file containing a series of images. The first was a photograph, taken in 1920, of the legendary Italian tenor Enrico Caruso mid-aria. Caruso seems to be enjoying himself, even as the camera flashes; its as if hes talking to a friend, not baying at the audience. This is natural singing, Paglin said.

As she flipped from image to image, we travelled towards the present, a decade at a time. The photographs of the more contemporary singers including the tenor Rolando Villazn, who has suffered multiple vocal injuries looked like horror-movie stills: their mouths were wide open, eyes bulging, neck veins popping, as if they were screaming. There was none of Carusos easy calm.

Caruso and Gigli produced legendarily big sounds, but with an effort that todays performers might deride as somewhat wimpy. Compare Carusos 1916 recording of O Sole Mio with Villazns 2010 rendition. Carusos is powerful, but not so powerful that the lyrics crash into one another and become indecipherable; and even at the height of the aria, he doesnt drown out the strings. That Brilla and Paglin had identified this contrast wasnt enough. They wanted to reverse-engineer exactly how Caruso and his contemporaries sang.

Rolando
Rolando Villazn on German TV in 2015. Photograph: Hannes Magerstaedt/Getty Images

In 1983, Brilla convinced Maria Carbone, a retired Italian operatic soprano, to work with them. Carbone was nearing 80, but still had a powerful voice. While Carbone sang, Brilla would clasp Carbones abdomen to feel what was happening inside her body. Carbone started with an aria from Tosca. As her voice rose, hitting higher and higher notes, Brillas eyes widened. I could feel this tick, tick. Tick, tick, she recalled. It was the natural up-down release of her diaphragm. Nothing else was happening. Carbones ribcage wasnt ballooning out as she sang, and there were no deep gulps of air, as is common with todays big-voiced singers. More amazing still, the movement of Carbones abdomen while singing was just as quiet and rhythmic as when she spoke. It was a discovery of what the perfect singers posture should be, Paglin said.

Brilla added: Whereas all the teachers in my life had been telling me to open, open, open to exaggerate her breathing and lunge into every high note to produce the biggest sound Carbone was demonstrating the opposite.The root of the problem, they realised, is in classrooms. Too many students graduate from conservatories who dont know how to sing, and its leading to injury, Brilla said. Weve got to stop this. Its ass-backwards!


It is not just singers whose careers are threatened by deteriorating vocal cords. In 1989, the Italian actor Maddalena Crippa momentarily lost her voice during a live performance of Shakespeares bloodiest work, Titus Andronicus. Crippa was playing Tamora, the vanquished queen of the Goths. After Tamoras son is murdered before her eyes, Crippa said she unleashed these uncontrollable cries. But, for a moment, her next line wouldnt come out. It was the first time in her acting career that Crippas vocal cords had failed her. The suffering I felt was indescribable, she told me.

That suffering continued for more than a decade. Crippas voice was no longer reliably crisp and sonorous, and a burning pain lingered in her throat. After visiting vocal coaches and throat specialists, she got the prognosis that all performers dread: nodules on her cords. Cortisone injections and voice exercises worked well enough to get her back on stage, but her confidence was shaken. You mean you still dont know how to use your voice? she remembered thinking. Its demoralising. Then, in 2002, at the suggestion of a fellow actor, Crippa visited Brilla and Paglins Osimo studio.

Unlike medical doctors, Brilla and Paglin dont own a laryngoscope that allows them to peer into the throat. If someone comes to them with injuries, they treat the problem by ear. They sing a soft note and ask the student to match it precisely. They can hear in the response where the pitch is off-key, and where the damage is located on the cord. (When I spoke with Adeles surgeon, Steven Zeitels, he demonstrated something similar, singing a scale to isolate where his own cord is damaged a perturbation, as its called, the result of years of long hours in the classroom.)

The moment Crippa said hello, Brilla and Paglin knew there was something very wrong with her voice. She exuded tension, as if bracing for confrontation, and took big, gulping breaths before speaking. Brilla and Paglin often see this problem with singers; their vocal cords are so used to having great quantities of air shoved at them that the cords wont respond without that force. Once you start pushing, youre condemned to push for the rest of your life, Paglin told me. Unless you learn a new way of doing it.

In their studio, Brilla and Paglin instructed Crippa to lie on her back and produce a series of high notes, which Paglin demonstrated for me. It sounded like a faint squeaking, as if she was gently releasing air from the neck of a balloon. When Crippa was told to reproduce what Paglin called a floating high C, she protested, saying she couldnt get that far up the scale. Finally, she gave it a try, producing a barely audible piff, followed by a more sustained tone. Hearing herself, Crippa broke down and cried. They were tears of joy, Crippa told me. They touched a nerve deep inside me. I mean, this is my voice. My voice.

Brilla and Paglin say they can restore most vocal cord problems naturally, via exercises that massage out the defect over time. They aim to stimulate the cords precisely where they arent coming together properly, and to break students out of the bad habits that cause problems in the first place: taking big gulps of air, tensing the throat and jaw muscles, forcing the mouth to open to exaggerated proportions, and the urge to scream out the high notes.

There are limits to what Brilla and Paglin claim to be able to do for an ailing artist. Paglin told me of a time when she was watching a singer perform on stage, and could tell there was something very wrong. She got a message to the singer that he urgently needed to see a doctor. He did, and was diagnosed with a form of throat cancer.

But their track record with other difficult cases has earned them a small international following. The veteran Italian stage actor Moni Ovadia was one of their earliest big-name success stories. Throughout his mid-40s, he performed up to 250 shows a year, in Europe and the US, but by 48 he was ready to quit showbusiness. His voice had become flat and raspy, and he found it physically painful to perform. He credits Paglin and Brilla with restoring his voice and his career. They saved my life, he told me. Today, at 71, he is a bull on stage, and can perform non-stop for up to three hours.

In May, at Brilla and Paglins studio in Osimo, I watched an aspiring dramatic soprano named Emanuela Albanesi rehearse the high-energy duet Mi Volete Fiera?, from Gaetano Donizettis comic opera Don Pasquale. There are few, if any, widely accepted standards for teaching singing, and many teachers complain that too many of their peers get jobs because of how they sound, not what they know. Paglin and Brilla mine the internet for teaching videos that concern them, such as one in which a soprano chides a student to open her mouth wider and wider as she sings an aria, in order to achieve more volume; not until the student plugs her fist into her mouth is the teacher satisfied.

Albanesi, however, sang with an ease that belied the strength of her highest notes. As she came to the final grazie!, I was expecting a thunderous, take-the-roof-off moment, but she never lost the disarming grin with which she performed. I thought of that photo of Enrico Caruso singing with such relaxed ease. I whispered to Brilla that it was the first time I had ever been able to make out each and every lyric in a such an intense operatic number. Im telling you, she said. Weve cracked it.


The question remains: could Brilla and Paglins approach permanently cure an artist like Adele by teaching her to sing in a more natural way? Steven Zeitels is dismissive of such an approach, and quick to defend Adele and his other clients against the contention that bad technique is causing their vocal problems. People used to think if you needed an operation it meant you dont know how to sing. The people I see they know how to sing!

Zeitels believes that medical specialists such as himself are becoming increasingly important to the arts, which he compared to other demanding physical pursuits. Any athletic endeavour will eventually take a toll if done for long enough, he said. Whats terrific is were getting better and better at bringing people back.

Specially trained vocal therapists have also restored performers to health through voice training, but medical experts advise taking this route only for minor vocal injuries, such as small nodules. Otherwise, they strongly suggest surgery. This attitude rankles Brilla and Paglin, who have cured artists such as the internationally renowned jazz singer Maria Pia De Vito, who suffered from vocal edema, a painful swelling of the cords, for which surgery is the generally recommended course of action. What irony, Paglin said. There is an industry built around singers who harm themselves while singing, and there is another one built around fixing them up.

Another renowned throat surgeon, Dr Robert T Sataloff, who has performed voice-corrective surgery on several Grammy Award winners, including Neil Diamond and Patti LuPone, bristles at the notion that surgery is not a sensible way to keep singers healthy. Combined with proper education on the dangers of improper singing technique, he believes it can keep people on stage for longer. Is it perfect? No. And it probably never will be, he told me. Like Zeitels, Sataloff drew a sporting analogy. Injury is inevitable and thats when they end up in my office.

Swedish
Swedish opera singer Sigrid Onegin (18891943) having her vocal cords examined. Photograph: Bettmann/Bettmann Archive

Some conservatory teachers in Italy dismiss Brilla and Paglins natural-singing approach as heretical, and their disciples as a sect. Over time, the duo have made a number of enemies. An invitation in 2011 to teach a series of master classes at Romes Conservatorio di Musica Santa Cecilia, one of Italys top conservatories, met with near universal opposition among the faculty. The classes were popular with the students, but many teachers didnt want them on campus. Edda Silvestri, the former director of Santa Cecilia, told me she didnt recall any overt hostility towards the duo, but she did remember the rift Brilla and Paglin created between faculty and students. Unfortunately, this is common when you try to introduce any new approach to a conservatory. They are conservative places, Silvestri said. Elizabeth Aubry, the vice president of Italys most influential organisation of singing teachers, the Associazione Insegnanti di Canto Italiana, finds Brilla and Paglins critiques terrible. She said the main objective of her organisation and its counterparts in the UK and US is to teach teachers precisely not to do damage.

For his part, Zeitels is working on a futuristic fix to dysphonia. Anyone who relies particularly heavily on their voice schoolteachers, talkshow hosts, sales reps, preachers, lawyers, frazzled parents is vulnerable to chronic raspiness, or to going hoarse. One of Zeitels patented innovations is to apply a biomaterial a gel implant in the tissue of damaged vocal cords to restore pliability. He sees it as a potentially huge breakthrough. It will be just as important what you put into a vocal cord as what you remove, he told a journalist in 2015.

But some of Brilla and Paglins students are thriving without such intervention, including Maddalena Crippa, who at 59 years old is in the midst of a remarkable second act. Her voice has been injury-free since she started working with Brilla and Paglin 15 years ago, and last May she wrapped up a critically acclaimed tour of LAllegra Vedova, a one-woman-show based on a 1905 operetta. For 75 minutes each night, she sang and acted two roles, the husky-voiced Danilo and the high-pitched Anna, who at one point sing a virtuosic duet. Critics were impressed, with one raving that Crippa is still a brilliant singer.

Adele, however, is one of those rare figures in the arts. Her unique voice, and her story, are so big that many people believe that what she does (or doesnt do) to correct her latest injury will determine future approaches to protecting the voice.

On 1 July, when news broke of Adeles cancellations, Paglin sent me a Whatsapp message. She was frustrated by the press coverage. Recalling that Adeles original surgery in 2011 had proved to be a huge PR victory for vocal-cord microsurgery, she worried that the message from Adeles latest setback would be that, not to worry, a second or third surgery will get the star back on stage. What makes matters worse is that the mechanics are still convinced that all there is to it is to keep operating, while the singers themselves still talk about air travel, drafts, allergies and stress. #elephantintheroom could be a good hashtag, she wrote, referring to what is wrong, as she sees it, with how people are taught to sing in the first place.

A few hours later, she sent me another note. She felt bad for Adele, and wanted to help. We know how to fix Adeles problems (sans surgery), and for good. If only we could talk with her.

Main photograph: Sascha Steinbach/Getty

Follow the Long Read on Twitter at @gdnlongread, or sign up to the long read weekly email here.

Read more: https://www.theguardian.com/news/2017/aug/10/adele-vocal-cord-surgery-why-stars-keep-losing-their-voices

READ MORE

Rule that patients must finish antibiotics course is wrong, study says

Experts suggest patients should stop taking the drugs when they feel better rather than completing their prescription

Telling patients to stop taking antibiotics when they feel better may be preferable to instructing them to finish the course, according to a group of experts who argue that the rule long embedded in the minds of doctors and the public is wrong and should be overturned.

Patients have traditionally been told that they must complete courses of antibiotics, the theory being that taking too few tablets will allow the bacteria causing their disease to mutate and become resistant to the drug.

But Martin Llewelyn, a professor in infectious diseases at Brighton and Sussex medical school, and colleagues claim that this is not the case. In an analysis in the British Medical Journal, the experts say the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance.

There are some diseases where the bug can become resistant if the drugs are not taken for long enough. The most obvious example is tuberculosis, they say. But most of the bacteria that cause people to become ill are found on everybodys hands in the community, causing no harm, such as E coli and Staphylococcus aureus. People fall ill only when the bug gets into the bloodstream or the gut. The longer such bacteria are exposed to antibiotics, the more likely it is that resistance will develop.

The experts say there has been too little research into the ideal length of a course of antibiotics, which also varies from one individual to the next, depending in part on what antibiotics they have taken in the past.

In hospital, patients can be tested to work out when to stop the drugs. Outside hospital, where repeated testing may not be feasible, patients might be best advised to stop treatment when they feel better, they say. That, they add, is in direct contravention of World Health Organisation advice.

Other experts in infectious diseases backed the group. I have always thought it to be illogical to say that stopping antibiotic treatment early promotes the emergence of drug-resistant organisms, said Peter Openshaw, president of the British Society for Immunology.

This brief but authoritative review supports the idea that antibiotics may be used more sparingly, pointing out that the evidence for a long duration of therapy is, at best, tenuous. Far from being irresponsible, shortening the duration of a course of antibiotics might make antibiotic resistance less likely.

Alison Holmes, a professor of infectious diseases at Imperial College London, said a great British authority, Prof Harold Lambert, had made the same point in a Lancet article entitled Dont keep taking the tablets as early as 1999. It remains astonishing that apart from some specific infections and conditions, we still do not know more about the optimum duration of courses or indeed doses in many conditions, yet this dogma has been pervasive and persistent.

Jodi Lindsay, a professor of microbial pathogenesis at St Georges, University of London, said it was sensible advice. The evidence for completing the course is poor, and the length of the course of antibiotics has been estimated based on a fear of under-treating rather than any studies, she said. The evidence for shorter courses of antibiotics being equal to longer courses, in terms of cure or outcome, is generally good, although more studies would help and there are a few exceptions when longer courses are better for example, TB.

But the Royal College of GPs expressed concerns. Recommended courses of antibiotics are not random, said its chair, Prof Helen Stokes-Lampard. They are tailored to individual conditions and in many cases, courses are quite short for urinary tract infections, for example, three days is often enough to cure the infection.

We are concerned about the concept of patients stopping taking their medication midway through a course once they feel better, because improvement in symptoms does not necessarily mean the infection has been completely eradicated. Its important that patients have clear messages and the mantra to always take the full course of antibiotics is well known. Changing this will simply confuse people.

The UKs chief medical officer, Prof Dame Sally Davies, said: The message to the public remains the same: people should always follow the advice of healthcare professionals. To update policies, we need further research to inform them.

[The National Institute for Health and Care Excellence] is currently developing guidance for managing common infections, which will look at all available evidence on appropriate prescribing of antibiotics.

The Department of Health will continue to review the evidence on prescribing and drug-resistant infections, as we aim to continue the great progress we have made at home and abroad on this issue.

Read more: https://www.theguardian.com/society/2017/jul/26/rule-patients-must-finish-antibiotics-course-wrong-study-says

READ MORE

Journalist under fire for calling it ‘crazy’ not to be disgusted by homeless people

/ by / Tags: , ,

Prominent Mother Jones writer Kevin Drum says critics deliberately misreading his response to study on peoples reaction to seeing homelessness

A high-profile Mother Jones writer has suggested that it would be crazy not to have a reflexive disgust of homeless people, stirring the anger of those who say he is perpetuating the worst kinds of stereotypes.

Writing on Friday, Kevin Drum was responding to a study which found that some people with a propensity for feeling disgust might experience it when faced with someone living on the street.

Glenn Greenwald reacted by posting photographs of homeless people who have performed altruistic acts alongside a screen shot from Drums story. The two authors of the study, meanwhile, say Drum glossed over subtleties in their work.

outside in america

He seemed to just be endorsing the worst stereotypes without any nuance or without any humanization of these people, said Scott Clifford, one of the authors and an assistant professor of political science at the University of Houston.

Drum said his critics were guilty of deliberately misreading what I wrote.

The authors of the study which is admittedly eyebrow-raising owing to its lexicon set out to untangle a contradiction. Across the country, cities seek to aid homeless people by providing shelters and millions of dollars in funding, while also passing laws against sitting or lying on sidewalks, or restricting where RVs can park, which serve to exclude them.

They examined survey data and focused on a particular feeling that seemed to play a role in perpetuating this paradox: While most of the public wants to help homeless people, they write, sensitivity to disgust drives many of these same people to support policies that facilitate physical distance from homeless people.

Disgust, they propose, might help explain nimbyism in this casea desire among housed people to prevent camps or housing being built in the vicinity of their own homes. And they argue that the media exacerbates disgust with stories that mention disease and unsanitary conditions.

But they do not say that this kind of reaction of reaction is universal: while some people are prone to feeling disgust in the presence of homelessness, others are less likely to.

In his brief response to a summary that the authors published in the Washington Post, Drum said he found their results unsurprising. About half the homeless suffer from a mental illness and a third abuse either alcohol or drugs, he wrote, before commenting how crazy it would be not to not to be disgusted by a population like that.

He finished by suggesting that it was the work of a decent human being to overcome these reflexive feelings and find empathy.

It certainly is the work of of a good human being not to act fully based on immediate reactions, said Maria Foscarinis, executive director of the National Law Center on Homelessness & Poverty. She said the study seems to make sense, though she had some reservations. But she did not agree with Drum, calling the post really over the top and not true to what the paper is saying.

Its just a manifestation of the worst kinds of stereotypes. As a subscriber to this publication, Im really disappointed.

Pete White, head of the Los Angeles Community Action Network, said he thought Drums conclusions risked tarring an entire group of people, as if every houseless person is addicted to drugs and had a mental illness.

Both of the studys authors expressed displeasure. He appears to believe that everyone will in all circumstances feel disgust towards homeless people, said Spencer Piston, the other author and an assistant professor of political science at Boston University. Theres a clear irony here, which is that we argue that the connection between disgust and attitudes about the homeless depend in part on media coverage and the extent to which homeless people are portrayed as disgusting.

In an email, Drum said that he did not think his blogpost was unfaithful to the study. He also pushed back at those condemning him. Please note that I didnt say I was disgusted by the homeless, nor that they are inherently disgusting, he said. Only that, given the nature of the demographic, its not surprising that most people find them disgusting.

Clara Jeffery, the editor-in-chief of Mother Jones, said that the anger was fueled by the terms used in the study and not Drums writing itself. But it is one brief post about a study, she added in her email. Mother Jones has an extensive body of work on the homeless, the housing and mental health and opioid crisis fueling it.

Do you have an experience of homelessness to share with the Guardian? Get in touch

Read more: https://www.theguardian.com/us-news/2017/jul/17/homelessness-kevin-drum-mother-jones-disgust

READ MORE

To the Bone confirms there are (almost) no good movies about anorexia

The Netflix drama, which stars Lily Collins, leans on some outdated tropes. But only a handful of novels and films have evoked the reality of the illness, or explained why so many women turn their unhappiness on themselves

No talk about food. Its boring and its unhelpful, announces Keanu Reeves playing (hold on to your hat) a doctor specialising in eating disorders in To the Bone, the much-discussed upcoming film about anorexia, starring Lily Collins and distributed by Netflix. And this is excellent advice, but it can be hard to see beyond the surface issues when you are dealing with someone who is literally starving themselves to death: the shoulder blades jutting out like birds wings, the food hidden under place mats, the limbs so wasted you can circle them with your fingers. It is even harder if a part of you is turned on by skinny, self-destructive women, as the movies invariably are, and this one definitely is.

Its not easy to make a good movie about anorexia, which is why almost almost none exist. How to depict a mental illness that unlike, say, schizophrenia or bipolar disorder has such a well-known and hard-to-fake physical manifestation? To the Bones writer-director, Marti Noxon who based the movie on her own experiences with the illness got around this by getting Collins, who has spoken about her own struggles with eating disorders, to lose an astonishing amount of weight so that she looks credibly anorexic on screen. Given how thin female actors now have to be just to look slim, your heart breaks at the thought of how much weight she must have lost to look so painfully ill.

To the Bone has been wildly praised since it debuted at Sundance in January, and I can only assume this is because critics get weirdly overexcited when actors undergo physical transformations. The truth is To the Bone is not a good movie about anorexia. In fact, it is a bad one. We could talk all day about the ethics of hiring a young woman who is known to be vulnerable to eating disorders, and then telling her to lose weight to look anorexic, but lets give Collins the benefit of the doubt and say she is an adult woman who is free to make her own career choices. Instead, lets talk about To the Bones real problem, which is that it is shallow, sexist and sick.

The only justification for making a movie like this is that it is going to provide some insight into a much-discussed if little understood problem, a requirement Netflixs earlier and similarly exploitative foray into self-destructive young women, 13 Reasons Why, notably failed to meet. But from the very first scene it is obvious that To the Bone leans on some wearily outdated tropes. We first see Ellen (Collins) in an in-patient unit, in which she and her fellow anorexia patients are beautifully styled in the universally recognised signifiers of crazy-but-sexy young women: heavy kohl eyeliner and mascara, Tank Girl-esque distressed clothing and biker boots. We have gone from 1999s Girl, Interrupted to 2017s Meal, Interrupted.

Click here to watch the trailer for To the Bone.

From there on, the anorexia stereotypes are ticked off with the regularity of hospital mealtimes. The movie disregards its own advice almost immediately about not focusing on the food and does so with voyeuristic intensity, without ever asking why so many women feel so unhappy, and why they then turn this unhappiness on themselves. All the anorexia patients, with one male exception, are young, attractive, middle-class white women, when the illness affects a far broader demographic. Reeves, as Ellens psychiatrist, Dr Beckham, is a self-described unconventional doctor, who proves his unconventionality by swearing occasionally and insisting his methods are totally different from anyone elses (theyre not: they rely on therapy and healthy eating, as almost all eating-disorder treatments do). He also clearly enjoys his power over his mainly female patients and a braver, less conventional film would have explored this more. Instead, To the Bone merely accepts the doctors version of himself as the brilliant, patriarchal medical professional who can fix women.

I am going to show my cards here and say that I am undoubtedly biased on this issue, because I had a doctor similar in some regards to Beckham during my first three hospitalisations: Dr Peter Rowan, then based at the Priory in Roehampton. I was only 14 when I first met him but even then it seemed to me that he revelled too much in his authority over a ward of vulnerable women, who in turn viewed him as god-like. In 2011, 18 years after we parted ways, he was struck off when it emerged he had what was described as a blurred and secretive relationship with a female patient, who left him more than 1m in her will.

Now, clearly, there are plenty of excellent male psychiatrists who work with eating disorders, and my experience was an outlier. But given that anorexia is often a form of rebellion against gender norms, with female and male sufferers rejecting, respectively, sexualised femininity and macho masculinity by starving themselves, it is ironic that a movie should re-enact such gender cliches. The doctor is a man, the nurse is a woman, the women in Ellens life (her mother, stepmother and her mothers girlfriend) are all self-obsessed and bitchy, her father is absent but hard-working. The one male anorexia patient is wise and selfless in a way none of the female patients are, and spoiler alert he, along with the male doctor, helps to save Ellen. Many brilliant women are now the leading lights in eating-disorder treatment, not least the woman who treated me through my last three hospital admissions, Professor Janet Treasure, now the director of the Eating Disorder Unit at the Institute of Psychiatry at Kings College, London. So the idea that all that these hysterical female anorexia patients need is a couple of calm men to save them from themselves is, to put it mildly, grating. The film even tacks on a frankly ludicrous romantic subplot, and anyone who thinks patients with eating disorders are making out with one another on hospital wards has clearly never bothered to Google what starvation does to a persons libido.

There is currently a petition online demanding that Netflix pulls the show for two reasons. The first, that it might trigger sufferers, is a point I feel sympathy for but cannot agree with. Legislating against anything that might trigger the mentally ill or vulnerable is an impossible game of Whack-a-Mole. But the petitions other complaint, that it glamorises anorexia, will be less easy for the film-makers to dismiss. Contrary to what the character of Ellen might suggest, anorexia is not all thigh gaps and eyeliner. By the time I was admitted to hospital for the first time when I was 14, most of my hair had fallen out, I could barely walk because I was so cold and my knuckles bled constantly due to extremely dry and cracked skin. Instagram-ready, I was not. There is a line between rendering a complex subject filmable and sexing-up a serious illness, and To the Bone crosses it from the first scene. And when all a movie about anorexia tells you is that people with anorexia have issues with food, and that this makes them thin and unhappy, you have to wonder what the point of the movie is.

Anorexias physical manifestations distract even those of us who have suffered from it from grasping the internal issues. Indeed, that is the point of the starving: we dont have to think about the unhappiness that led us to this point. In one interview, Noxon said that being around Collins and the other actors who were losing weight was difficult for her. I started to need to turn to the other female producers quite frequently and say: Im going to need you to tell me that I dont need to lose weight, she said. When there is a part of you that still gets turned on by not eating, you will not be able to discuss anorexia properly, because you are still preoccupied by the surface symptoms.

Lily
Lily Collins in Netflix drama To the Bone. Photograph: Gilles Mingasson/Netflix/Netflix

Even beyond the directors own issues, it feels almost inevitable that anorexia should be glamorised in a movie made today. We have come a long way from 1983, when Karen Carpenter died of anorexia and people were shocked that someone could actually starve themselves to death, but despite the increased awareness, conversations about the illness still too often descend into voyeuristic fascination. Since the 90s, when skinny became the female beauty standard (a sharp diminution from the more Amazonian supermodels of the 80s), representations of anorexia in mass culture have come wrapped in a weird mix of prurience, spectacle and aspiration. The Daily Mail has a regular, long-running and wildly irresponsible column by a woman writing about her anorexia. The glamorisation of anorexia online is notorious by now, with the rise of pro ana (pro anorexia) websites, which pass on tips about how to avoid eating, and thinspo (thin inspiration) images on Instagram; anorexia has been reduced to an aesthetic expression and To the Bone reflects that.

In terms of art, there is remarkably little that is much better. Poor Richey Edwards, the late guitarist from the Manic Street Preachers, wrote probably the most brutally evocative song about it, 4st 7lbs (I eat too much to die / And not enough to stay alive / Im sitting in the middle waiting). But he himself was so caught up in the illness he could only depict the immediate experience, not the larger overview. In books, there are plenty of anorexia memoirs now both celebrity and non most of which, to be honest, are little more than a mix of food diaries, pop-psychology and self-help.

By far, the best book on the subject is Jenefer Shutes astonishing novel Life-Size, which captures the confusing early descent into the illness, the loneliness of it at its most extreme and the weirdness of hospitalisation better than anything I have ever seen or read. Noxon has responded to criticism of her movie by emphasising it is based on her indidvidual experience, but Life-Size reveals the laziness of this popular get-out clause. Everything is an individual experience, but if your re-telling of it strikes no general chord, the fault is in your telling. Life-Size is a deeply personal story, about a twentysomething with anorexia called Josie. But in its wholly original, quasi-poetic prose style that shifts between memory, the hospitalised present and Josies hallucinations, this is a book that eschews the cliches and, in doing so, touches a wider truth. No one thing can cure someone with anorexia and this book definitely didnt cure me. But it did help me get a fix on my own experience as I was finally starting to recover and, in that regard, changed my life.

There have been only two good movies about anorexia: both treat the subject almost metaphorically and both were directed by Todd Haynes. Most obviously, there is Superstar: The Karen Carpenter Story, Hayness film about the most famous anorexia sufferer of all, retold with modified Barbie dolls, which perfectly captures the artificially perfect world that many with anorexia feel they need to embody. Then there is his 1995 film Safe, about a woman who seals herself off away into an antiseptic world. While not explicitly about anorexia, Safe evokes the real experience of the illness: the self-imprisonment, the illogicality, the sense you are being eaten up from within by forces you cannot control.

When I think back on my years of being ill, which went on long after I left hospital, I barely think about the food and the weight at all. Instead, I remember the cold, the isolation, the institutionalisation, the time lost and all the things Hayness movies and Shutes book depict so well. Keanu was right: its not about the food. Thats just the boring stuff that distracts even those who should know better.

To the Bone streams on Netflix from Friday.

Read more: https://www.theguardian.com/film/2017/jul/12/to-the-bone-confirms-there-are-almost-no-good-movies-about-anorexia

READ MORE

From Viagra to Valium, the drugs that were discovered by accident

From Alexander Fleming onwards, the lives of millions have been transformed and saved by treatments that scientists were not even looking for

When scientists in New Zealand discovered that a meningitis vaccine fortuitously protects against gonorrhoea, they were benefiting from an unpredictable force responsible for some of historys most striking medical breakthroughs: serendipity.

So many things have been discovered by chance. The German writer, scientist and all-round polymath Johann Wolfgang Goethe, a discoverer himself, wrote: Discovery needs luck, invention, intellect none can do without the other.

Viagra

In pharmaceutical giant Pfizers laboratories in Kent, a failed treatment for angina accidentally became a billion-dollar erectile dysfunction blockbuster, and the worlds most famous blue pill.

During early clinical trials of sildenafil, now better known by its trade name Viagra, male volunteers taking the pills consistently reported unprovoked, long-lasting erections. After further investigation, it turned out that Viagra, designed to relax blood vessels around the heart to improve blood flow, was having the same effect on arteries within the penis. Since its commercial release in 1998, it has been used to improve the sex lives of millions of men worldwide.

Incidentally, the 2007 Ig Nobel Prize, awarded annually for that years most useless research, was awarded to three Argentinian scientists who discovered that Viagra helped hamsters recover faster from jet-lag.

Penicillin

Returning to work after a month-long Scottish vacation in 1928, pathologist Alexander Fleming made a discovery in a discarded culture dish, which he had unintentionally left open to the elements on a window sill in his laboratory at St Marys Hospital in London.

In Flemings absence, the dish, growing the dangerous bacteria staphylococcus aureus, had become contaminated with an air-borne mould a type of fungus. Fleming noticed that, near the blue-green strands of fungus, growth of the bacteria had been stopped in its tracks.

Fleming had inadvertently stumbled across the first antibiotic, which he called penicillin.

For his accidental discovery, he shared the Nobel prize for medicine in 1945 with Florey and Chain, Oxford chemists who perfected the process of penicillin mass production in time to treat infected battlefield injuries sustained in the second world war.

When I woke up just after dawn on 28 September, 1928, I certainly didnt plan to revolutionise all medicine by discovering the worlds first antibiotic, or bacteria killer, Fleming later recalled. But I suppose that was exactly what I did.

Heart pacemaker

New York engineer Wilson Greatbatch invented the worlds first implantable heart pacemaker but he didnt mean to.

While trying to build a device to record heartbeats in 1956, he accidentally installed the wrong type of resistor into his prototype which promptly began to emit regular electrical pulses.

Realising these pulses were recapitulating the electrical activity of a normal heartbeat, Greatbatch immediately saw the potential of his device. After two years of refinements, his design for a pacemaker that could be implanted into the heart was patented in 1960 and soon went into production. Life-saving descendants of this first device now improve the lives of over half a million patients with slow heartbeats every year.

Stomach ulcers

In the 1980s, two Australian doctors were ridiculed for suggesting that stomach ulcers were caused not by business lunches and stress, but by infection with a common bacteria. Barry Marshall, a gastroenterologist and his pathologist colleague in Perth, Robin Warren, noticed that stomach biopsies taken from their ulcer patients all contained the same spiral-shaped bacteria, called helicobacter pylori.

To prove their hunch, Marshall deliberately downed a pint of foaming helicobacter broth that hed grown in his lab after isolating it from the stomach of one of his patients. Within a week, he had rampant stomach inflammation which was then completely reversed by taking antibiotics.

Their discovery has also meant the virtual eradication of a type of stomach cancer caused by helicobacter infection.

For their work (and presumably Marshalls bravery), Marshall and Warren were awarded the 2005 Nobel prize for medicine.

Antidepressants

Several classes of antidepressants owe their discovery to chance, from iproniazid, which was initially used to treat tuberculosis in the 1950s, to the tricyclics of the 1960s, which stemmed from an experimental treatment for schizophrenia and the more recent breakthrough involving the use of ketamine.

Valium

The entry-level benzodiazapine was developed in the 1950s by a Polish immigrant in the US, Leo Sternbach, from discarded chemical compounds he had synthesised 20 years earlier in Poland when he was working on experiments to create new dyes.

The dyes were a failure. The benzodiazapines quickly became the most popular prescription drugs in the US.

Read more: https://www.theguardian.com/lifeandstyle/2017/jul/11/from-viagra-to-valium-the-drugs-that-were-discovered-by-accident

READ MORE

People taking heartburn drugs could have higher risk of death, study claims

/ by / Tags: , , , ,

Research suggests people on proton pump inhibitors are more likely to die than those taking different antacid or none at all

Millions of people taking common heartburn and indigestion medications could be at an increased risk of death, research suggests.

The drugs, known as proton pump inhibitors (PPIs), neutralise the acid in the stomach and are widely prescribed, with low doses also available without prescription from pharmacies. In the UK, doctors issue more than 50m prescriptions for PPIs every year.

Now researchers say the drugs can increase risk of death, both compared with taking a different type of acid suppressant and not taking any at all.

We saw a small excess risk of dying that could be attributed to the PPI drug, and the risk increased the longer they took them, said Ziyad Al-Aly, an epidemiologist from the University of Washington and co-author of the study.

The team say the study suggests those who take the drugs without needing to could be most at risk. They urged people taking PPIs to check whether this was necessary.

Previous research has raised a range of concerns about PPIs, including links to kidney disease, pneumonia, more hip fractures and higher rates of infection with C difficile, a superbug that can cause life-threatening sepsis, particularly in elderly people in hospitals.

But the latest study is the first to show that PPIs can increase the chance of death. Published in the journal BMJ Open, it examined the medical records of 3.5 million middle-aged Americans covered by the US veterans healthcare system.

The researchers followed 350,000 participants for more than five years and compared those prescribed PPIs to a group receiving a different type of acid suppressant known as an H2 blocker. They also took into account factors such as the participants age, sex and conditions ranging from high blood pressure to HIV.

The results show that those who took PPIs could face a 25% higher risk of death than those who took the H2 blocker.

In patients on [H2 blocker] tablets, there were 3.3 deaths per 100 people over one year. In the PPI group, this figure was higher at 4.7 per 100 people per year, said Al-Aly.

The team also reported that the risk of death for those taking PPIs was 15% higher than those taking no PPIs, and 23% higher than for those taking no acid suppressants at all.

Similar levels of increased risk were seen among people who used PPIs but had no gastrointestinal conditions, a result which the authors speculated might be driving the higher risk seen overall.

Gareth Corbett, a gastroenterologist from Addenbrookes hospital in Cambridge who was not involved with the study, cautioned against panic, pointing out that in most cases the benefits of PPI far outweighed any risk. What was more, he said, while the increased risk sounded high, it was still very low for each person.

PPIs are very effective medicines, proven to save lives and reduce the need for surgery in patients with bleeding gastric and duodenal ulcers and several other conditions, he said.

The studys authors said it was important that PPIs were used only when necessary and stopped when no longer needed.

Corbett agreed that many people take PPIs unnecessarily. They could get rid of their heartburn by making lifestyle changes, such as losing weight and cutting back on alcohol, caffeine and spicy foods, he said.

The authors said the study was observational, meaning it did not show that PPIs were the cause of the increased risk of death, and that it was unclear how the drugs would act to affect mortality. They said the drugs could affect components within cells, known as lysosomes, that help break down waste material, or shortening protective regions at the end of chromosomes, known as telomeres.

Aly said people on PPIs should check with their GP whether the drugs were still needed, adding: In some cases we expect that PPIs can be safely stopped, particularly in patients who have been taking them for a long time.

Read more: https://www.theguardian.com/science/2017/jul/04/people-taking-heartburn-drugs-could-have-higher-risk-of-death-study-claims

READ MORE

Brain game: how quitting routine tasks can help you learn new tricks

/ by / Tags: , , , ,

Daniel Glaser explains the benefits of taking on new challenges in middle age

Although his previous attempt at a career break, by becoming an apprentice shoemaker in Florence, didnt last long, it seems Daniel Day-Lewis is serious about retiring this time.

Maybe hes looking for a newchallenge. As we get older, work can feel more routine andeasy, which is born out in terms of brain activity.

Scans show tasks we are practised at often use less energy than novel activities we tend to do them more efficiently, and the mental energy required decreases. Were all familiar with this as our careers advance.

We also get more skilled at spotting our mistakes and rectifying them; as an old hand, you can notice when the edge has gone but you have enough tricks in the bag to make amends. This neuroprotective effect may be behind some of the results that show an apparent delay in symptoms of age-related cognitive decline for those more active in middle age. In this light a preemptive move, like Day-Lewiss, may be more sensible as we become over familiar with what we do.

It is perhaps typical of this most uncompromising of actors that hes quitting while ahead.

Dr Daniel Glaser is director of Science Gallery at Kings College London

Read more: https://www.theguardian.com/lifeandstyle/2017/jul/02/brain-game-quitting-routine-tasks-to-learn-new-tricks

READ MORE