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.