I think I have calmed down enough to write about this. The tabloid and radio headlines a few weeks ago declared that if you were a child of a working mother, you were likely to be “less healthy” or “fatter and lazier” than children of non-working mothers. Yes, I’m sensitive about the care my children get. Guilt and worry are my bedfellows, despite knowing that my children love being looked after by people more patient and creative than I am.
The paper prompting my angst appeared in the Journal of Epidemiology and Community Health; it asked if there was a relationship between the hours a mother worked and her children’s diets and physical activity. The researchers analysed data provided by mothers of more than 12,500 five-year-olds.
They found that children whose mothers worked were more likely to drink unhealthy drinks, spend more “inactive” time on the computer or watching TV, and be driven to school than children of mothers who had never been employed. Children of mothers who worked full time were also less likely to eat healthy snacks between meals or have enough fruit in their diet.
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By Ross Tieman
France’s vociferous Committees for the Defence of local Hospital and Maternity Units are getting their marching boots back on after the country’s Health Ministry confirmed it will announce a raft of hospital operating theatre closures by the year end.
The Ministry says the decree will target about 180 theatres which each carry out fewer than 1,500 operations a year. Theatres that carry out fewer than 100 gynaecological operations a year are also thought to be threatened, though the Ministry wouldn’t confirm it.
National opposition to closures of this sort began back in 2004, at the instigation of defenders of my “local” hospital in Saint-Affrique, southern Aveyron. Although it’s not much bigger than a cottage hospital, it still seems to be functioning, five years on, though I’d never dream of going there.
So, just because something is statistically significant, doesn’t mean it’s clinically significant
And just because it’s clinically significant, doesn’t mean you should be doing it.
And here is why. In this illuminating article from the New England Journal of Medicine - Lost in Transmission – FDA Drug Information That Never Reaches Clinicians - Lisa Schwartz and Steven Woloshin illustrate how the distillation of evidence that goes into the package inserts of drugs is not always clear or complete.
Links to previous interviews by Margaret McCartney:
Professor David Colquhoun, professor of molecular pharmacology and campaigning blogger
Dr Tom Jefferson and pandemic flu vaccines
Two things in particular made me want to talk to Richard Bandler, the American co-creator of “neuro-linguistic programming”. The first is that an email arrived from his PR agency in London, entitled “Richard Bandler: Shrinks are a waste of money”. It went on:
“His method is to teach the depressed, stressed or disillusioned to dispose of their poisonous memories, their fears and self-doubt, by exploring how we think, communicate and behave, changing negatives into positives by adopting more successful ways of using the mind. Richard, whose techniques have successfully helped millions of people, including billionaires, sports stars, celebrities and the mentally ill, says: ‘… They come to me in desperation – and often, I only need to see them a couple of times to re-program their thinking and give them a whole new outlook on life, success and happiness.’”
I don’t mean to go picking on the How to Give it section of the Life and Arts FT, but this week it features Natalie Massenet, chairman of online boutique Net-a-Porter (and of which I should confess to being a fan.) However, Massenet says that she supports Fashion Targets Breast Cancer because she employs a lot of women, and because breast cancer ‘hits one in four women.’
This simply isn’t the case. Have a look at this page from the NHS Breast Screening website, which outlines the risks rather better: up to age 40, the risk is 1 in 200, and up to age 85, it’s one in ten. It’s a great pity that women don’t get better information about risk. We need reason, not needless fear.
Having declared myself not just a fan but a follower of evidence-based medicine, I feel a bit embarrassed to admit that I practise gut-reaction medicine too. When I speak to colleagues, though, I feel reassured: others also talk about the time they ordered a chest X-ray, a series of blood tests or even admitted someone to hospital for woolly symptoms to which no evidence-based protocol would respond. Trainee GPs are wisely warned to beware the person who describes seemingly innocuous symptoms – but whose attendance at the surgery is low and whose previous medical notes are sparse.
There are other times, too, when we should let our guts lead: when chest infections have gone on too long; when faced with a clutch of disparate yet worrying symptoms; and when a neat diagnosis is elusive.
Recently, I’ve been wondering if gut reactions are actually evidence-based in their own way. Medicine is all about managing uncertainty: there is rarely a point where you can be entirely sure of a diagnosis or the impact of a treatment. Surely the gut reaction is just a synthesis of honed experience, information about the patient and knowledge of the patterns of illness in that patient’s community?
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Aberdeen Art Gallery is hosting an exhibition of the work of Ron Mueck. Mr Mueck is an ex-puppeteer and model maker who makes incredibly detailed, life-perfect sculptures of people: usually naked or partially clothed, and mesmerically and startlingly human.
The enormous newborn “A Girl” is a good example - up close, the near grimace expression is incredibly true to life, as is the smear of blood and the umbilical cord.
So much of medicine is done under pressure and speed, surrounded by technology and measurements, and one never stares. Mueck puts the normal, or “imperfect” body in the spotlight and we are allowed and encouraged to look - and see the stories that lie within. I found it very moving. No airbrushing, no sanitisation.
My two year old, however, merely opened his eyes gleefully wide and called loud attention to anyone who would listen: “Baby’s bum! Baby’s bum!”
The US Food & Drug Administration has recruited one of its own long-standing critics, hiring Peter Lurie from the watchdog Public Citizen as a policy adviser. That suggests a more enlightened approach from the regulator under Margaret Hamburg, the new commissioner named by President Barack Obama.But what is good for goverment is bad for independent scrutiny. Earlier this year, the agency hired Sidney Wolfe, another vocal critic from Public Citizen, which must now be reeling from the departures. Who will be left to provide commentary and outside analysis?
It all tastes less of poacher turned gamekeeper than of gamekeeper poaches critics.
Or not. The FT Weekend Life and Arts section’s back page has a regular ”How to Give It” section, this week featuring Evelyn Lauder, senior vice-president of the Estee Lauder Companies Inc and founder and chairman of The Breast Cancer Research Foundation.
We are reminded that October is Breast Cancer Awareness month, and she says that the embelmatic pink ribbons were “to remind women to investigate their breasts regularly. We’ve given away 100m ribbons to date…”
This is what we know. Teaching women to examine their breasts regularly does not reduce the death rate from breast cancer.
It does though increase the biopsy rate, which can mean large excisions. Breast cancer screening via mammography also has problems. One life, is prolonged per 2,000 women screened over 10 years.
But breast screening also causes 10 women to be treated for a cancer but which was not going to kill them. Additionally, 200 women will have, because of the screening, a “false alarm”. I also know that many woman who have had breast cancer loathe October and “awareness”.
And I worry that while campaigns like this might fund useful research, they may also fuel anxiety and misinformation about breast cancer.
This article: Reality check on breast cancer is from last year and won a prize from an Oncology society which I hope means that the potential public harms of awareness campaigns might be recognised to the point that they become openly discussed with charities.
By Rebecca Knight
My daughter woke up three days ago with a runny nose, a fever of 101, and a wheezy, puffing cough that made her sound as though she’d smoked a pack a day for the past thirty years. My girl – age 22 months – is precocious, but I was confident that she hadn’t been sneaking cigarettes.
So I did what any novice mother in my situation would do: I went straight to the internet. I logged on to my favourite medical site and dutifully typed in her symptoms. Immediately I got a diagnosis: croup.
“Croup is a condition that causes an inflammation of the upper airways, and it often leads to a barking cough or hoarseness especially when a child cries,” the site said. “Most cases of croup are caused by viruses, and it is most common in children 6 months to 3 years old, but can affect older kids, too.”