Interview with a health journalist...

I spoke to freelance health journalist and author Natalie Blenford about health journalism in women's national magazines.

What publications have you written health stories for?
Zest, Top Sante, Cosmopolitan, CosmoGIRL!, Bliss, Scarlet

Why are health/fitness stories important to journalism?
The NHS/COI publishes flyers and posters about hot health issues of the day, such as giving up smoking and the importance of eating a low-fat diet (which is currently being advertised all over bus shelters) and GPs should be the first port of call for anyone in need of personalised, professional advice. But journalists can help educate the public about thousands of different health issues, in a range of accessible, non-preachy ways, simply by writing about them in a style and format that is original and interesting.

A first person feature about a woman who survived breast cancer, for example, might encourage readers to self-examine their own breasts regularly and lead to them making healthy lifestyle choices. The impact comes from the detailed, honest and accurate nature of the stories being told – they have much more punch than a flyer you can pick up at your local doctor’s surgery.

Can you give an example of a health feature you have written which has had an impact on you?
I wrote a feature for Cosmopolitan in 2006 headlined “How Normal Are Your Breasts?”. The feature showed the bare breasts of 15 Cosmo readers, all of whom had different sized/shaped breasts from AA cup to E. Working on this feature made me realise there really is no such thing as a normal pair of breasts – everyone is unique, and hence everyone in normal. The feature caused a massive reaction in Cosmo’s readership – the magazine received lots of letters of thanks from readers who now feel happy with themselves, and this was a very gratifying and useful thing to happen.

I was also very moved by the story I wrote for April Cosmopolitan 2009, of Whitney Cerak, a 21-year old student who survived a car-crash and 5 weeks in a coma before waking up to discover she had been the victim of a case of mistaken identity, and her parents thought she had died in the accident. This is billed as a “real-life” story rather than a health feature, but the medical detail heavily influenced the story and her recovery has been miraculous from a health perspective.

How hard is it to work as a freelance in the area of covering health/fitness/beauty?
Not too hard (although as a side point, actually it’s harder now than ever due to budgets being tightened). It takes a while to get established as a trustworthy, accurate writer and it takes time to work out the best methods for finding health stories, case studies and feature ideas that editors want. But actually there are people out there who can help you. All beauty brands, all charitable foundations and all consumer companies such as gym chains have press officers or PR companies who can help you source cast studies or products, and once these people know who you are, they will help you get your job done.

The hardest thing about freelancing (in general) is establishing a daily routine that works for both yourself and your editors; managing your cash-flow, and finding ways to say “yes” to more changes when it’s appropriate, and “no, sorry”, when you are convinced the job is 100% finished but an editor thinks otherwise. You also have to be very self-motivated, organized and an excellent communicator who can talk to all types of people, from pushy PRs to people who’ve survived seriously harrowing experiences. Often you don’t meet case studies face to face, so you need to be good on the phone and able to strike up a rapport with an interviewee, in seconds.

Have you got any tips for aspiring health journalists who want to work in magazines?
Firstly, know your market: there’s a difference between health journalism in Cosmo, let’s say, and Zest. One is a general interest women’s mag; the other is a specialist magazine for people who take an active, daily interest in health and fitness. Consequently, the same ideas won’t necessarily work for both magazines.

It’s vital to know who you are applying to before you write off asking for work experience or freelance work. There’s nothing worse than general letters, and avoid writing clichéd sentences like “I’m passionate about health journalism because I think it can change lives” – it might be true, but it will probably sound simple in a letter or email. Instead, communicate exactly what you can offer the publication in question. Do you know lots of 20-something girls who are keen to be case studies in their magazine? Have you got a good contact in a PR company, who can hook you up with some new facts/stats that would be the basis of a health news story? Are you a first-time marathon runner willing to keep a journal of your progress as you train for this year’s London marathon? Everyone has something unique to offer, and magazines thrive on ideas and creativity, so channel lots of this into any letters you send off.

Also, start interviewing people and writing these interviews up – publish them on a blog, and paste the link to the bottom of your email signature. Show editors that you are doing everything you can to get started, and hopefully they will reward you with a commission in the end. And keep working at it – these things don’t happen overnight and tenacity is required if you want to get into magazine journalism in the middle of what’s looking like a rather nasty recession.

Natalie is the author of "Dance Your Way to Fitness" published in 2007 by Collins & Brown in association with Zest Magazine.

Evil weed

I am currently working on a feature about the health risks of cannabis smoking to young people.

We have all heard by now of the risks to mental health associated with the drug. The Government's new FRANK campaign, which coincides with the reclassification of the drug from Class C to Class B, has focussed on psychological risks, such as panic attacks, paranoia and depression .

Although it is an effective campaign, they have overlooked the physical effects smoking cannabis can have on young people's health.

As part of my research for the feature, I have interview the British Lung Foundation, National Treatment Agency, a leading consultant physician in respiratory medicine, Dr Onn Min Kon and the chief executive of the charity Drugscope.

Research has found that smoking a few joints a night could do as much damages to you lungs as a 20-a-day cigarette habit. And these negative health effects are being seen in people much younger than we would expect to present with lung cancer, bronchitis and other respiratory problems. The drug has also been linked with early onset of a particular type of testicular cancer in young males.

My feeling is that the reclassification will do little if not nothing to reduce usage in young people -stats even show that when the reclassification was lowered to C previously, usage decreased slightly. Though there is still more research to be done, the physical damage caused by a nation of under 25s who are experimenting with cannabis, could be a potential timebomb for the health service. As they say...where there's smoke, there's fire.

He's just not that into you...

New research, conducted by the Time to Change campaign, has found that a partner is four time more likely to leave you because of a mental health condition like depression than because of a physical disability.

Attitudes to severe mental illnesses like schizophrenia are even worse. The survey, which asked people about issues that would make them break off a romantic relationship found that 20 per cent of British women wouldn’t stay with someone if they were diagnosed with schizophrenia, yet only per cent of them would break up with someone who became disabled and needed to use a wheelchair.

Dave Stocks, who had a breakdown and gets depression, says: “I think people do feel awkward when they know you have a mental, rather than physical illness. They’re embarrassed, don’t know what to say to you. Some of my mates reacted like that. But Jools, my girlfriend, she’s been great. We’ve been through some tough times together, but even in my darkest days she stood by me. It can be hard though – I told her it might be easier for her if she didn’t tell her friends about my problems, just to make life easier. We both know that mental health conditions are stigmatised, but it hasn’t stopped us. Being able to be open about it has actually helped my recovery. We’re strong and happier now than ever, having been through this together”

Stuart Baker Brown, who has been diagnosed with schizophrenia says: “I have been well for a few years now and made a good recovery, but the stigma attached to having a schizophrenia diagnosis still follows me around. Dating can be hard at the best of times, but it can be even harder when you’re facing outdated attitutdes about mental health conditions. I met one woman, and everything was going well, we planned to meet up for a date. Then she found out about my diagnosis before I had a chance to tell her and that was it – she just didn’t turn up. I later discovered she was worried about her children. She’d assumed I might be dangerous. She was wrong, the idea that someone is going to be a danger just because they have had schizophrenia is a myth. It was really hurtful. I’ve met somebody new now, and she sees the real me, not just the label. Thankfully some people can see through the stigma and see the person”.

Time to Change is England’s most ambitious programme to end the discrimination faced by people with mental health problems, and improve the nation’s wellbeing. Led by Rethink, Mind and Mental Health Media and backed up with £16m from the Big Lottery Fund and £2m from Comic Relief. The campaign has a string of celebrity supporters, such as Alastair Campbell, Stephen Fry, Ruby Wax and Patsy Palmer – all of whom have experienced mental health problems. It also has the backing of Gordon Brown, David Cameron and Nick Clegg.

Cash for recession depression

The Government has allocated an extra £13m to therapy services for people who are suffering from depression because of the impact of the recession on their lives.

The mental health charity Mind welcomed the extra funding and said there had never been a more important time to invest.

Mind's Chief executive Paul Farmer told BBC News: "Redundancy and money worries put strain on family relationships, cause sleepless nights, trigger stress and increase the risk of developing depression.

"When it comes to the scale of the current recession we are in uncharted territory about how many people could be affected.

"We must learn from the mistakes of past recessions where people lost their job, their confidence and their self esteem leaving them unable to return to the workforce."

Paul Corry, from the mental health charity Rethink, said: "One in four of us is going to experience a mental health problem at some point in our lives.

"We know from history that recessions, depressions and economic troubles bring on mental health problems in people."

Shadow Health Secretary Andrew Lansley said: "We welcome this announcement, not least because we called for these measures to be introduced last year.

"Yet again we see that where the Conservatives lead, the government follows."

I wouldn't go as far as agreeing with the Tories, but I do agree that this is a positive move - I recently wrote a feature about the increase in mental health problems that have been a consequence of the credit crunch, and I am glad that this is being acknowledged by the Government.

A cotton bud emergency

As a lot of my recent posts have been about rather serious issues, here is a lighter story, from one of my favourite health-related blogs, Nee Naw.

The blog is written by a London Ambulance Service worker, who deals with incoming emergency calls at the Emergency Operations Centre (or Nee Naw Control, as she calls it).

The most recent post is about a young man who called an ambulance because he had a cottonbud stuck in his ear. You can't make this stuff up.

Dignity in dying?

For several reasons, the issue of assisted dying has cropped up in my working life this week. And it's a subject that I am still chewing over, and finding remarkably difficult to digest.

I work for a Labour MP, who has received a number of requests to sign an Early Day Motion which calls for a debate on the law on assisted dying and assisted.

I think for both my boss, and me on a personal level outside of work, it's hard to make a snap judgement about what changes do need to be made to the law, if any. The Coroners and Justice Bill is currently going through Parliament, and with it comes the opportunity to MPs to: "Modernise the law on assisting suicide to help increase public understanding and reassure people that it applies as much on the internet as it does off-line."

The issue has been in the news this week because of British couple's decision to go to Switzerland to die. Peter and Penelope Duff, who both had terminal cancer, travelled to a Dignitas clinic Switzerland last week to die together.

Mr Duff, 80, a retired wine consultant, and his 70-year-old wife are believed to have been helped to end their lives last Friday with an overdose of barbiturates. They are the first Britons to die at the clinic since the Lord Chief Justice signalled that anyone helping a terminally ill person to organise an assisted suicide abroad would not be prosecuted.

Sarah Wootton, Chief Executive of the UK charity Dignity in Dying said this week:

"This is an extremely sad case of two more terminally ill UK citizens being forced to travel to an unfamiliar country to die. It demonstrates, yet again, that we are currently on a slippery slope which forces people to make difficult and often desperate decisions so that they can take control of the time and manner of their deaths.

"Dignity in Dying campaigns for terminally ill, mentally competent adults to have the choice of an assisted death, subject to strict legal safeguards. Mr and Mrs Duff were both terminally ill and therefore may have been eligible for an assisted death under this sort of legislation. Had they had the option of an assisted death in this country they may still be alive, as their physical ability to travel would not have been a factor.

"It is time for Parliament to fully debate this issue, and there is that opportunity now. The Coroners and Justice Bill is being debated in Parliament at the moment, and within this Bill is the opportunity to modernise the 1961 Suicide Act. Parliament currently has no plans to change the scope of the Suicide Act to allow assisted dying, but surely this case highlights the importance of addressing this issue with urgency to prevent any more people from having to take the decision to travel abroad to die."

Dignity in Dying say that 80% of the British public (ie voters) support a change in the law on assisted dying for terminally ill, mentally competent adults.

There are some complicated issues to consider with this. For example, in terms of modern medicine and healthcare systems, how do we define who is 'terminally ill' and who is not? People can, fortunately, live many years with illnesses such as cancer, AIDS, and various degenerative diseases. We have the technology to give them a far better quality of life than they would have had a decade or so ago.

There is also the issue of identifying the 'mental competence' deemed to be necessary to make the decision to be assisted in ending your life. By the time a person with a terminal illness has degenerated to a level where they would consider ending their life, in many cases their mental competence has degenerated along with their physical health, and again it is questionable of whether they can be left to make such a decision.

This issue poses a challenge for the current Government and future ones, as it is nigh on impossible to consider the issue without brining your own personal feelings and experiences along with you. But if the Government can't make decisions on this who can? It is too risky and area not to be regulated by legislation - it poses too much of a risk to the people and families involved to just leave it up to personal choice in each case. And I think it is too much to ask the family members to have to be put in the position of making such decisions. And so, the debate will rumble on...I hope that whatever changes are made to the law, they still convey what is really meant by having dignity at the end of your life.

Work and mental health

As the recession deepens in Britain, a huge rise in the number of people with mental health conditions has been predicted. Stigma and lack of support in the workplace means people are losing jobs or being refused work at the time when they need them most, and recent Government welfare reforms could complicate things further for those in mental distress. Gemma Pritchard reports.

“The mentally ill are an easy target. Despite the fact 1 in 4 people have a mental health condition, only sufferers and their families understand what it’s like, because you can’t see their symptoms or their distress.”

“The Great British public get whipped up into a frenzy about the idea of people unfairly claiming money from the state, which means people with mental health problems become a target – we are classed as workshy and useless. Our illnesses may not be visible at all or take socially unpleasant forms, so we end up being doubly ostracised. There is a huge amount of hostility.

“The paradox is that people with mental health conditions do want to work, but often people won’t employ them, which says a great deal about the insecurity of employers,” says Chris Danes, 47, from Essex.

Chris has Bipolar Disorder (Manic Depression). His condition has meant that 11 years ago he was forced to leave a successful career in teaching as a Deputy Head of a public school, after a serious episode of the illness. Chris is one of millions of people in the UK who have found that a mental health condition has become a massive barrier to their employability and career. Chris has been able to continue to earn a living by writing books from home and doing some media work about his experiences. But Government research shows others are less fortunate, and many people in the UK with psychological problems fall into a benefit trap which is then very difficult for them to get out of.

At the end of last year, the Government announced a package of welfare reforms intended to get people on benefits back in to work. This includes the introduction of the Work Capability Assessment which will push people on benefits onto Jobseeker’s Allowance, placing emphasis on the responsibility of the individual to find work. But a growing body of evidence suggests that employers are not willing to take on people who have experience of a mental health condition, and they are failing to provide staff with adequate mental health support.

As the recession deepens, this problem can only get worse, with unemployment currently around the 2 million mark, and increased anxiety amongst employees about their future. The Conservative party predicted in November that we will see a massive 26 per cent increase in the number of people experiencing mental health problems by 2010 as a direct result of the economic crisis in Britain. And for people already struggling with mental distress, debt will only make their problems worse.

A poll by mental health charity Mind found that 58% of people had to leave a job because of lack mental health support, 31% had been sacked or forced out of a job after disclosing a mental health problem and 26% had been demoted after disclosing a mental health problem. Even more worryingly, 1 in 4 had job offers withdrawn after disclosing a mental health problem, which is illegal under the Disability Discrimination Act. Yet they found themselves powerless to do anything about it.

Over 200,000 people with mental illnesses move from work onto benefits each year. Although one review has found 9 out of 10 people with mental distress still want to work, Government research has shown that less than 4 in 10 employers would be willing to take them on.

Chris has experienced first-hand the gung-ho attitude of employers who are unwilling to accept a mental health condition as a legitimate reason for sick leave.

“When I was ill and off work for six months,” he says, “no-one from the school visited or came for a meeting with me. My ex-wife, herself a doctor, was bombarded with phone calls from my fellow deputy saying ‘he’s just got to get back’. As in many boys’ schools of its time, it was ‘sink or swim’ for the boys and the staff. Thus medical evidence and doctors’ opinions were overridden. I was made to feel that it was a moral failure.”

The major mental health charities in the UK, which include MIND, Rethink and the Sainsbury Centre, have battled workplace discrimination for many years. Julia Lamb, spokesperson for MIND says: “There remains a long-term stigma and discrimination around people with mental health issues.

“In the workplace, this can translate as anything from problems applying for jobs in the first place, being turned away from jobs, and even cases where people who have been made a job offer disclose a diagnosis and then have the offer withdrawn. There are off course long-term problems too, such as if they get the right support when they are in a job. It can be a massive barrier.

“Of course, there are people who are lucky enough to have employers who are willing to make adjustments to help them and take their needs in to account, for example if someone is taking medication which makes them slow in the morning, an employer could say they can start work a bit later.

“Generally though, there is a lack of awareness in the workplace about mental distress and people don’t get the support they need. This can put a lot of stress on people, and they may have to take time off sick from work. The problem is the longer they are away from work, the harder it is for them to return and get back into it, because they lose their confidence. There are also incidents where people have been off sick for so long that they get sacked.”

MIND are supportive of the Government’s ‘fit note’ scheme, but remain cautious of how it should be implemented. The idea is that instead of ‘sick notes’ people will be assessed for ‘fit notes’, where their doctor will liase with their employer to tell them what they are capable of doing at work. This should raise retentions rates, with people working at a reduced capacity until they are well enough. The idea has caused a lot of noise and even outrage, but MIND say they are for anything that supports people who want to remain in employment.

“It is more complex than that though,” says Julia. “In some cases, it might have been their job which caused the problem in the first place. There are also concerns over whether GPs will have the ability to say what people are capable of- mental health problems aren’t as tangible as physical health conditions – someone may be physically capable of working a 40 hour week, but psychologically can’t cope with the stress. GPs aren’t psychologists or occupational health experts, and for this to work they will need a lot of training and a great deal of sensitivity when making their assessments.”

Dr Jed Boardman, from the Royal College of Psychiatrists adds: “The Welfare Reform Bill is seemingly designed to combat the workshy, currently in the unreformed benefits system.

But it encompasses a large number of people with a range of mental health problems, many of whom want to work and with the right kind of support could be helped in to work.

“It is crucial that the systems to support people in to work are fair, adequately resourced, and based on evidence of what works for people with mental health problems. As psychiatrists, a key role of ours is to help in the recovery of people with mental health problems and help break down the barriers to social discrimination.”

The Government at present remain optimistic about the benefits of the new welfare reforms and argue that we are in a good position to provide people with the support they need, both in and out of the workplace. Public Health Minister, Phil Hope MP, says: “We are building stronger links between the NHS and employment services, to give people integrated support if their depression is linked to unemployment.

“Our programme for expanding psychological therapies has set up 35 new services in 35 PCTs this year and training more than 1,100 people to deliver cognitive behavioural therapy. More services will come on stream over the next two years.

“We are also piloting Employment Advisors in 12 of the 35 new talking therapy services. This will test whether integrated services like this can help prevent people losing their jobs and help people return to work as soon as possible.”

Despite this, there is no question amongst mental health professionals that these new reforms will provide significant challenges for them and their medical colleagues.

Professor Sally Hardy, Head of Mental Health & Learning Disabilities at City University says: “Mental health care professionals, working from a recovery approach, aim to support and enable survivors to regain their sense of self worth and their place in the world, but at a level that feels right for each individual. Using such a person-centred approach can work well alongside the ‘Fit Note’ scheme, as long as it is focusing on what people can achieve rather than on what they cannot offer.

“However, training GP’s to work with people to identify their strengths is a new technique for the consulting rooms that will take more time than many GP’s are able to offer. Many people experience their GP as hardly someone they can collaborate with and share knowledge, but rather as a one-sided diagnostic procedure. The new fitness scheme will certainly take some getting used to, but if implemented with adequate resources could prove beneficial to mental health care sufferers and survivors seeking employment opportunities, as they offer some valuable insights into what it means to be vulnerable and human in a tough world.”

Grief brings the political world to a halt

I want to join the rest of the country in expressing my condolences and heartfelt sympathy for Conservative leader David Cameron and his wife Samantha, whose six-year-old son Ivan died yesterday. Ivan had a severe, progressive neurological condition, and his
parents knew from the day he was born that he could die in childhood. But, I imagine, this doesn't make it any easier to deal with.

I was completely shocked when I woke to the news yesterday. I was very moved by Brown's decision to cancel Prime Minister's Questions; and by the tributes in the Commons. It was a strong reminder that whatever our political beliefs, and however fiercely one side may oppose the other, we are united in our humanity, and grief. Brown too, after all, knows what it is like to lose a child.

“I know that in an all too brief life, he brought joy to all those around him and I know also that for all the days of his life, he was surrounded by his family’s love,” said Brown.

"Politics can sometimes divide us. But there's a common human bond that unites us in sympathy and compassion at times of trial, and in support for each other at times of grief.

William Hague, speaking in place of his leader said: “His parents lived with the knowledge for a long time that he could die young, but this has made their loss no less heartbreaking."

There is an article here here in the Times by writer Andrew Brereton whose son also dies from cerebral palsy.

Interestingly, the political comment that has come out of this tragic event is of how much Ivan has shaped Cameron and his Conservative party - namely his strong appreciation of the NHS given how much his family had come to rely on it.

In his first speech as party leader he said: “I believe that the creation of the NHS is one of the greatest achievements of the 20th century. When your family relies on the NHS all the time – day after day, night after night – you really know just how precious it is.”

Today's big health stories...

1. Cheap alcohol fuelling health crisis in Scotland

It has been revealed the World Health Organisation (WHO) figures that half of men and 30% of women in Scotland drink to excess. The country has the fastest growing rate of cirrhosis.
Alcohol misuse is estimated to cost Scotland £2.25bn per year in extra services across the NHS, police, courts, social services and lost economic productivity. The availability of cheap alcohol in supermarkets has been flagged up as a possible cause.

2. Mental health taboo

Research shows that coming out as being gay is easier than admitting to a mental health condition.

A survey commissioned by the Time to Change campaign, found that of 2,000 people across Britain, almost 30% said they would find it difficult to admit publicly to having a mental illness, compared with 20% who said they would have difficulty coming out as gay. Admitting to a mental health condition was also deemed harder than admitting to a drink problem or going bankrupt.

About a third of respondents believed someone with a mental health problem couldn't do a responsible job.


3. Start the obesity battle as early as possible

Department of Health officials have asked experts to develop ways to test children as young as two to determine if they are becoming overweight.

Tam Fry, Chairman of the Child Growth Foundation, said it was crucial to be monitoring the weight of children.

He told the Daily Mail: "One reason we have an obesity problem is that for 25 years we have consistently failed to monitor children and their increasing wirght from pre-school, such that we now hat 20 per cent overweight or obese at school."

4. Peanut allergy cure

Good news for sufferers of peanut allergies. In a world first, doctors have managed to cure children with severe forms of the allergy, by using a form of desensitisation treatment.

Doctors at Addenbrooke's hospital, Cambridge gave four children tiny doses of peanut flour every day, gradually increasing the dose. They can now eat ten or more nuts a day.

Previously the children would have been at risk of anaphylactic shock or even death if they accidentally ate even a trace amount of peanut.

5. Work pressure behind binge drinking boom?

Britons work hard and play harder, say psychologists. Bottling up our emotions at work leads us to let off steam by drinking a lot at weekends.

Prof van Wersch said (reported in the Daily Mail): 'Young people go out in large groups for the purpose of getting drunk because they have spent all week working hard and bottling up their emotions. It is an adventure. They do not know where the night will take them.'

She added: 'If people didn't have the 'big night out with friends' to look forward to, what would they do and feel like at the end of the week? We don't want a nation on Prozac, do we?'

re my previous post: there's an interesting video here of Jade Goody's publicist Max Clifford discussing her battle against cervical cancer with the Guardian's Stephen Moss

Screening saves lives

I wanted to write something today about Jade Goody, the terminally ill reality TV star who married partner Jack Tweed yesterday. Jade has been given weeks to live, after being diagnosed with cervical cancer last year.

I think for various reasons, this story has had a massive impact on a lot of people. For me personally I think it raises very important issues about cervical cancer screening in young women. Jade is only three years older than me and is dying from the disease. Cervical cancer is the second most common cancer in women under 35. Yet, Government regulations in England mean young women are only routinely screened from the age of 25 (it's lower in Scotland). Apparently doctors have been talking about the 'Jade effect' which has resulted in something like 20% more women making enquiries to their GPs about smear tests and cervical cancer. And some cynical commentators have translated this as a sort of 'cancer phobia' sweeping the nation, partly as result of possible media scaremongering. We saw something similar when Kylie was diagnosed with breast cancer four years ago.

I agree there is no point in worrying for worries sake, but I see the decision of these two celebrities to make their battle public as a very positive thing. Young women are, I think, overly complacent of the risk of cervical cancer to their health. Women's magazines are full of cases of women diagnosed with the disease at under 25. When caught early there is much that can be done. But if people don't have the test in the first place...the risk are high. I understand the Government's Department of Health are currently considering the merits of lowering the screening age and I hope that we might see pilot schemes for younger screening rolled out in the near future.

I was really quite horrified to hear of an experience a friend of mine had at a family planning clinic last week (out of discretion I won't say which one). When she made enquiries about whether she would need a smear test (she is 24), the nurse said something like 'oh you don't need to worry about that unless you've had an STI.' Now I assume she is referring to the HPV virus which is implicated in a large majority of cervical cancer cases. But given that you won't necessarily know if you have HPV, as it often presents with no symptoms, and that up to 80% of people in the UK are infected with HPV at some point in their lives, I see this as hugely irresponsible. HPV is not prevented by condom use and most people don't know they have it. My friend commented that the nurse was commenting on Jade's lifestyle prior to her diagnose, the implication being that she had slept around and this had resulted in her developing cancer. This is just completely unacceptable, especially coming from a sexual health nurse, and I am very concerned that if this transpires to be a common approach then many young women may feel they don't need to be screened - a decision which could be potentially life threatening.

Picture copyright of Keira76

War, what is it good for...

Yesterday I visited the Wellcome Collection's War & Medicine exhibition. Divided into three parts (organisation, the body and the mind), the exhibition looks at the paradox of war which means that as through history mankind has developed increasingly horrible and effective ways to maim and kill through warfare, so to we have had to rapidly adapt our medicine and health care to try to stem the damage we can do to each other.


Starting at the Crimean War and working through to modern day Afghanistan, the exhibition is an impressive collection of salvaged objects and memorabilia, photography, installation, videos and significantly, a lot of art - the link between art and science is present throughout all of the exhibits at the Wellcome Collection.

Initially, although fascinating, it does not seem like the most uplifting of viewing experiences. But there is, I think, an interesting angle for the optimist who cares to seek it. I was struck by how many of the most important medical developments of the last hundred years or so only came about as a response to the injuries and casualties of war. For example, the Russian's invention of triage as a method of treatment prioritisation during the Crimean War. The first facial reconstructive surgery and skin grafts were carried out during World War I because of the damage done by shell blasts. The extent of ongoing medical problems and injuries as a result of World War Two even led to the creation of the NHS. The horror of war through the ages has forced the medical profession to raise its game and now in the 21st century we are reaping the huge benefits of their discoveries, which save lives.

War has also transformed the way we deal with people's response to stress and trauma. The third and final section of the exhibition is focussed on just this - the injuries sustained by service personnel that although not outwardly visible were no less serious. This section of the gallery is quieter and calmer than the rest, with fewer interesting oddities to examine and an abundance of art and photography, almost all of which is fittingly black and white. There is an emphasis on art as being a release for people who have suffered the psychological horrors of war, and a way to communicate what they perhaps cannot vocalise.

By the end of WWI, the British Army had dealt with over 80,000 cases of shellshock. During the war, there were some medical officers and physicians who argued that shellshock was merely a physical reaction to the shell bursts, characterised by exhaustion, hallucination and insomnia amongst other undesirable symptoms.

Shockingly at that time, those who were incapacitated by this 'shellshock' to such an extent that they didn't feel able to continue fighting, could be accused of 'desertion' or 'cowardice', both of which were punishable by death. Over the years, medical officers began to understand that everyone is susceptible to battle-related stress. As the narrator on one US Army film about the psychological effects of battle says: "Every man has his breaking point." Now we call it Post Traumatic Stress Disorder (PTSD) - a term which can apply to the psychological outcome of any shocking or traumatic event, not just war. War has helped to develop our knowledge of this condition and out therapeutic response to it.

A list in one of the glass cases shows the names of 306 soldiers who were executed by the British Army during WWI for these reasons. I think this is something we now find very hard to swallow. There was an instance in 2005 were there was a prolonged campaign to secure a pardon for Harry Farr, a serviceman executed for cowardice, who had undergone five months of treatment for shellshock only a year before his death.

In 2006 the then Defence Secretary, Des Browne announced a formal pardon. He said: “Although this is a historical matter, I am conscious of how the families…have had to endure a stigma for decades.” The Government went one step further in Nov 2006 and agreed that all soldiers executed in WWI should be given posthumous pardons.

The last part of the exhibition is the most hopeful, and colourful. In 2006 Catherine Panter-Brick, an anthropologist at Durham University, conducted a large scale survey of schoolchildren aged 11-16 in Afghanistan, which aimed to assess their mental health in the context of their direct experience of war. As one part of this the children were asked to draw themselves as they saw themselves now and in the future. These drawings are displayed on the wall here. Though vastly different, they share a common theme – the children may be unhappy now, but the drawings of their future selves reveal optimism, hope and ambition. One Girl, 14, draws herself now collecting scrap plastic in the street for her father to sell to support their family. But she writes of her future, ‘I want to be a painter, newscaster and actress.’ I think the most striking thing about these drawings is they provide a visual manifestation of our ability to heal psychologically after even the most traumatic and horrible events. And it’s that thought that I take with me as I leave the Wellcome Collection.

(NB: The War & Medicine exhibition is a temporary collection which ends tomorrow, so if you want to check it out you need to be super quick. However, the two permanent collections at Wellcome are well worth a look, and I am also looking forward to their next exhibition ‘Madness and Modernity’ , with installations by performance artist Bobbi Baker about her experience of having a mental health condition).

Does our mental health policy work?

The Mental Health Foundation has issued warnings that employers should do more to support the mental wellbeing of their staff after they return to work after sick leave.

A new report has found that many people suffering on returning to work after a period of prolonged absence for both physical and mental illnesses.

The study, which was carried out at Loughbourough University, looked at the role of depression in returning to work after a period of sickness absence across 4 types of chronic illnesses: depression and anxiety, back pain, heart disease and cancer.

Using focus groups with employers and interviews with employees, the Foundation found that poor adjustment to work and continuing exposure to work-related stress may lead to a ‘relapse’ in sickness absence, early retirement or unemployment.

The report shows that almost half (45%) of those with a physical condition experienced mild to moderate depression, but were more worried about telling their employer about their mental health issues than their cancer or heart disease.

This is one of several big stories surrounding work and mental health issues in the media recently. Another example which has caused much debate is Cheltenham Borough Council sueing its former managing director for just under £1m for failing to disclose a history of depression, after she took a period of paid sick leave from her current position. There is a good comment piece by the Guardian’s Clare Allan here.

This case raises important questions of what a person should be obliged to declare on a job description. Was the woman Christine Laird really ‘lying’ by not mentioning that she had suffered three bouts of depression in the last 12 years? I’m sure that many people with sympathise with her for not wanting to reveal this – after all Government statistics have shown that less than 40% of employers would even consider hiring someone with a history of mental health problems. It will be very interesting to see how this one plays out in the High Court over the next few weeks.

High morality

Does a drug suddenly become more dangerous just because the Government says so?

A.C. Grayling, a Philosophy Professor at Birbeck University, makes a valid point about cannabis use in the Times today, after the drug was reclassified from class B to Class C this week. At the same time there are plans to downgrade ecstasy.

He says: "Since the dawn of history people have wanted to ingest substances that alter their states of consciousness, whether for relief, recreation, spiritual experience or bliss. Coffee and chocolate are also mood and mind changers. If moralisers were logicians these would be outlawed too. At the very least alcohol, as dangerous as some of the other commonly used drugs, would be banned. Or, more sensibly, every other drug would be controlled, as alcohol is, thus at a stroke liberating the police, the public purse and the populace, who would not become any more drug-crazed than they were before 1914."

Not so much philosophy as a good dose of common sense. Which is perhaps exactly what we need.

No excuses...

Researchers in America have found that exercise does not aggravate the symptoms of a cold or reduce athletic performance.

Sweating it out in the gym may even do you good if you're under the weather, as it can boost the activity of your immune system cells to help fight off infection.

According to Professor Leonard Kaminsky, of Ball State University in Indiana, having a cold had no effect on lung function or exercise capacity. "I was surprised their lung function wasn't impaired," Kaminsky said. "I was surprised their overall exercise performance wasn't impaired, even though they were reporting feeling fatigued.

Us Brits tho seem somewhat unconvinced by such an idea. Though I too may have recently been bitten by the gym bug (I'm a regular at excellent Islington women's gym Sequin Park), I'm a firm believer that a cold is your body's way of telling you to rest. And I'm not sure your fellow gym-goers will thank you for choosing to share your germs with them. So take it easy, fitness fans :)

'Encouragement not judgement'

The NHS Stop Smoking initiative this week launched a new campaign to help pregnant women quit the habit.

The campaign will target 100,000 pregnant smokers.

It is based around NHS research which has found social stigma is a major factor in preventing pregnant smokers seeking help to quit.

According to a statement on the Royal College of Midwives' website, over a quarter of 224 pregnant smokers surveyed in England said they would like to seek support to stop, but were worried about being judged. A further third (38%) said they sometimes hide their smoking as they were concerned about people criticising them and 39% said they were ashamed to admit they smoked to their midwife or healthcare professional.

An NHS specialist midwife adviser in smoking in pregnancy Lisa Fendall said: ‘We’re making sure they see there is plenty of help on offer, from pregnancy focused one-to-one or group support sessions at their local NHS Stop Smoking Service or the NHS Pregnancy Smoking Helpline giving friendly advice and support – we work together to find the best solution for them.’

Midwives have been provided with information and new tools, including a new DVD, to aid expectant mothers to stop smoking. It will stress how harmful smoking is to them and their baby, showing how every cigarette smoked restricts the oxygen supply to an unborn baby.

Feature writing can be a chore...

...especially when you are constantly battling press officers for a small smidgen of relevant information.

But I'm pleased to report I've had a particularly positive experience this last week whilst writing a feature for my health journalism class about mental health and workplace discrimination. I have found SHIFT, the Department of Health, Rethink, MIND, the Royal College of Psychologists and the Sainsbury Centre all helpful, thoughtful and prompt in their response, even though I was upfront about being a student journalist. I also had interviews with two members of staff at City University, Yasmin Fulder from the Clinical Psychology course and Professor Sally Hardy the newly appointed Head of Mental Health and Learning Disabilities. I will post the feature up here after it has been marked.

I was really glad to have had such a response from these new contacts, as I believe, as you may have noticed from the contents of this blog, that it's really important for health journalists to cover mental health issues. The current economic downturn means we are potentially facing a huge increase in the number of people suffering from a psychological condition. Seeing it written about could be the budge people need to seek the help they need.