Thursday, 27 August 2015

Riu de la Fontana



Jaufre Rudel was the Prince of Blaye and a troubadour of the early12th century. It is thought he died during the Second Crusade, in or after 1147. He is noted for developing the theme of "love from afar" (amor de terra lonhdana). Much of the Trobador love poems related the pain of inaccessible love. This features in this song Riu de la fontana (waters of the fountain) here performed by the Oxford Trobadors with a contemporary arrangement and music by Ray Noble who sings it (yes that's me).

Time to stop counting calories?


Isn't it time public health initiatives were positive about food?  We hear so much about what is bad for us and not enough about what is good.  Perhaps we have been concerned about the wrong aspect of food intact.  We have been focused too much on counting calories.  Of course we have had the 'five a day' promotion for fruit and vegetables, but this has led to confusion in labelling of food packaging - 'one of your five a day' - labelling which is at best misleading, at worst purposefully deceptive. 'Five a day' should refer to fresh fruit and vegetables, and not to processed food containing too much sugar or salt.

Now leading food experts have argued for a shift in focus from calorie counting to nutritional value of foods for heart health. 

Drawing on published evidence, Drs Aseem Malhotra and James DiNicolantonio and Professor Simon Capewell argue that rather like stopping smoking, simple dietary changes can rapidly improve health outcomes at the population level.

It’s time to stop counting the calories, and instead start promoting the nutritional value of foods if we are to rapidly cut illness and death from cardiovascular disease and curb the rising tide of obesity, say these experts in an editorial published today in the online journal Open Heart.

The results of a new strategy on nutrition could be dramatic. One example they give, boosting omega 3 fatty acid (from fatty fish), olive oil, and nut intake have all been associated with reductions in deaths from all causes and from cardiovascular disease, within months, they say.

But they argue clinicians have failed to act for far too long, amid an excessive focus on the calorific content of food by the food and weight loss industries, despite mounting evidence that it’s the nutritional content that matters.

 Daily consumption of a sugary drink (150 calories) is associated with a significantly increased risk of type 2 diabetes whereas daily consumption of a handful of nuts (30 g of walnuts, 15 g of almonds and 15 g hazelnuts) or four tablespoons of extra virgin olive oil (around 500 calories) is associated with a significantly reduced risk of heart attack and stroke.

It has been estimated that increasing nut consumption by two servings a week could stave off 90,000 deaths from cardiovascular disease in the US alone.  In contrast the authors argue that emphasis on low calorie diets has little impact on cardiovascular disease.

The Action for Health in Diabetes trial shows that a low calorie diet on top of increased physical activity in patients with type 2 diabetes was not associated with a reduced risk of cardiovascular death despite significant weight loss and a monitoring period of 13.5 years.

“Shifting the focus away from calories and emphasising a dietary pattern that focuses on food quality rather than quantity will help to rapidly reduce obesity, related diseases, and cardiovascular risk,” they insist.

“Primary and secondary care clinicians have a duty to their individual patients and also to their local populations. Our collective failure to act is an option we cannot afford,” they write, citing the human and economic toll this is taking.

Obesity costs the NHS over £5 billion a year, while the costs of type 2 diabetes add up to more than £20 billion and are predicted to double over the next 20 years. Similarly, the cost of diabetes has risen 40% in the past five years in the US, adding up to $245 billion in 2012, they say.

The evidence shows that poor diet is consistently responsible for more disease and death than physical inactivity, smoking and alcohol put together, they say, calling for sugary drinks to be taxed; government subsidies to make fruit, vegetables, and nuts more affordable; and tighter controls on the marketing of junk food.

“Applying these population wide policies might achieve rapid reductions in disease and hospital admissions visible even within the electoral terms of most politicians,” they suggest.

“It is time to stop counting calories, and time to instead promote good nutrition and dietary changes that can rapidly and substantially reduce cardiovascular mortality. The evidence indeed supports the mantra that ‘food can be the most powerful form of medicine or the slowest form of poison’,” they write.

“Recommending a high fat Mediterranean type diet and lifestyle to our patients, friends and families, might be a good place to start,” they conclude.

Thursday, 20 August 2015

More gobbledygook science on alcohol and cancer risk

We would have seen the headlines this week.  Light drinking increases risk of cancer in women. You might have thought you knew that already. So what is it all about?

A large study (that means the cohort was large enough to have some meaning in terms of the population) published in  The BMJ yesterday suggests that even light and moderate drinking (up to one drink a day for women and up to two drinks a day for men) is associated with an increased risk of certain alcohol related cancers in women and male smokers.  It is a study full of nuances and should be taken with a dose of caution.

Overall, light to moderate drinking was associated with minimally increased risk of 'total' cancer in both men and women.

However, among women, light to moderate drinking (up to one drink per day) was associated with an increased risk of alcohol related cancer, mainly breast cancer.  This is not new. We already have sufficient information to conclude that alcohol consumption increases risk of cancers.  The problem is how much alcohol is 'safe' to drink. 

According to Cancer UK,  alcohol causes 7 types of cancer, including breast, mouth and bowel cancers. Essentially, studies have shown that the less you drink the less risk there is of these types of cancer.  When you drink alcohol, cancer-causing chemicals are formed. Alcohol also affects hormone levels and makes cells even more likely to be damaged by for example smoking.  This is what is meant by 'increased risk'.  As Cancer UK stress, not everyone who drinks alcohol will develop cancer. But on   the whole, scientists have found that some cancers are more common in people who drink more alcohol than others. Every year, alcohol causes 4% of cancers in the UK, around 12,800 cases.

Much depends on other risk factors such as smoking. 

The study shows that risk of alcohol related cancers was also higher among light and moderate drinking men (up to two drinks per day), but only in those who had ever smoked. No association was found in men who had never smoked.

Heavy alcohol consumption has been linked to increased risk of several cancers. However, the association between light to moderate drinking and overall cancer risk is less clear. The role of alcohol independent of smoking has also not been settled.

So a team of US researchers based at Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital in Boston, set out to determine whether light to moderate drinking is associated with an increased risk of cancer.

They used data from two large US studies that tracked the health of 88,084 women and 47,881 men for up to 30 years. They assessed risk of total cancer as well as known alcohol related cancers including cancer of the the colorectum, female breast, liver, oral cavity, pharynx, larynx and esophagus.

Light to moderate drinking was defined as up to one standard drink or 15g alcohol per day for women and up to two standard drinks or 30g alcohol per day for men. One standard drink is roughly equivalent to a small (118ml) glass of wine or a 355ml bottle of beer.

Influential factors, such as age, ethnicity, body mass index, family history of cancer, history of cancer screening, smoking, physical activity and diet were also taken into account.

During the follow-up period, a total of 19,269 and 7,571 cancers were diagnosed in women and men, respectively. The researchers found that overall, light to moderate drinking was associated with a small but non-significant increased risk of total cancer in both men and women, regardless of smoking history.  We should emphasise the conclusion 'small but non-significant'.  This means the study found no effect.

For alcohol-related cancers, risk was increased among light and moderate drinking men who had ever smoked, but not among men who never smoked. However, even in never smoking women, risk of alcohol-related cancers, mainly breast cancer, increased even within the range of up to one drink a day.

This large study sheds further light on the relationship between light to moderate drinking and cancer, says Dr J├╝rgen Rehm at the Centre for Addiction and Mental Health in Toronto, in an accompanying editorial.  The truth is it doesn't shed much more light at all.  It reaffirms an association between light to moderate drinking of alcohol  with what are already known to be 'alcohol related' cancers in women.  It sheds no further light on why such a link exists.

Indeed, as the authors state 'more research is needed to explore the interaction between smoking and drinking on risk of cancer'.  But 'roughly speaking' women should not exceed one standard drink a day and men should not exceed two standard drinks a day.  So there  you have it!  Note the use of the scientific 'roughly speaking'.  Scientifically 'roughly' means...?

Finally, the author concluded that people with a family history of cancer “should consider reducing their intake to below recommended limits or even abstaining altogether, given the now well established link between moderate drinking and alcohol-related cancers.”   So there you are then, wiser than we were, and you can have a drink to that -  'roughly speaking' of course! 

Thursday, 13 August 2015

Can a real Labour leader please step forward?

It is all so simple.  You stand for the leadership of the Labour party and say what we want to hear.  Student fees? Scrap them.   Spending on the NHS? No problem.  Social Care?  Increase spending.  The economy? Nationalise the energy companies.  Any questions? And there is the worry.  No questions. Why is the media not asking the questions it would ask if Jeremy Corbyn was leader of the Labour party?  It is almost a conspiracy of silence.

Now I don't really believe there is a 'conspiracy' in the media to give Corbyn an easy time.  But Labour members and supporters should be wary.  Corbyn is not being tested in this election. It is time he was.  Labour needs to know if he can cut the mustard.  What would his answers be on the economy?

Should the improbable happen and Labour won the next election it would only do so if it can persuade voters it is sensible about the economy.  Voters are not without the ability to add up. They can add up the cost of promises.  If you offer the earth, then it will cost the earth.

Jeremy Corbyn has to date been unchallenged in the leadership debate. It is about time he was. He says what many on the left want to hear.  He sounds socialist.  But nationalisation isn't socialism. It didn't provide all the answers in the past and it won't do so now. We do not live in a society where the majority do not have a stake in the 'capitalist system'.  Most of us do, and some would argue, we all do.  Old rhetoric about 'workers' and public ownership won't do.  We need a more realistic approach to the economy.   We need coherent approaches to the cost of social care and the NHS.  We need sensible approaches to economic growth.  We need to address inequalities of opportunity, yes, but we need also a thriving economy to provide opportunities for success. Aspiration isn't a dirty word. We need a society where all can strive and achieve their aspirations: decent education, housing and job opportunities.

This doesn't mean Labour can't or shouldn't be anti-austerity.  On the unit-austerity argument I am with Jeremy Corbyn.  I have argued in this blog against the Tory and Lib Dem narrative on the economy.  But we do need to be realistic about the choices we need to make if we are going to pull the NHS and Social care out of crisis.  It will cost and we need to accept that we will have to demonstrate how it will be funded.  We need also to be realistic about welfare.  There are problems and there is unfairness at the margins of qualification for benefits. There is a poverty trap that needs addressing.  If Labour doesn't address these concerns it fail to reach out to voters who are concerned bout these problems.

Stand up the leadership candidate who will address these issues realistically and who will be capable of presenting a coherent voice for the Labour party.  The country needs you!

Sunday, 9 August 2015

Jeremy Corbyn is wrong about nationalisation

Jeremy Corbyn is wrong about nationalisation.  He is carried away by the reception he gets in the bubble of left wing politics.  It was a mistake made by Michael Foot as leader of the party.  He convinced himself that the public mood was swinging his way because of the rapturous reception he received at rallies up and down the country.  The faithful cheered, but voters turned away and Labour became unelectable.

Nationalisation isn't socialism.  There is more socialism in 'wider share ownership' than in nationalising major companies.   In that sense Mrs Thatcher was more socialist than any party wishing to nationalise major companies. Jeremy Corbyn seems intent on taking the Labour party backwards whilst what the country needs is a forward looking party that recognises and understands the changed economic and social landscape, and has real answers to the problems we face.  Nationalisation isn't the answer.  What people need is enhanced opportunities for education, for work, for housing and social and health care.  Reverting to the politics of the 1970s doesn't offer that.  It fights old battles with old and tired ideas.

Labour can do nothing if it reverts to being a party of opposition and protest.  It needs to reach out to voters who are not 'socialist'.  It demonstrated it could do this and win in 1997.  Jeremy Corbyn is critical of New Labour, but New Labour introduced the minimum wage,  reduced pensioner poverty, increased spending on the NHS and brought waiting lists and times down.  Labour could not have achieved that by sitting on the opposition benches remaining 'pure'.   Jeremy Corbyn and his supporters regard New Labour as a 'cancer' or 'virus' in the Labour party.  Symbolic of this was the change in Clause 4 section 4 of the Labour party constitution.

Clause 4 was itself symbolic.  No modern Labour government had any intention to nationalise banks and major companies.  The problem with Jeremy Corbyn is that he would have such intention. He makes nationalisation an objective rather than a means.

State ownership of the means of production and exchange isn't 'public ownership'.  True public ownership involves more than that.  John Lewis Partnership has more socialisms in it than does nationalisation.  If Jeremy Corbyn had ideas about how to promote such approaches to business structure and ownership he would do well.

Jeremy Corbyn appealed to my heart, but my head told me different.  Now his position on nationalisation has lost my heart.  I won't be voting for him.

Wednesday, 5 August 2015

My heart is with Jeremy Corbyn, but my head is not

Oh dear! What should the Labour party do? Who should it choose as its next leader? My heart would be with Jeremy Corbyn but for all the wrong reasons.  What he says resonates with my anger at the injustice of the Tory government austerity programme.  It makes the poorest pay the most for the financial crisis. But Labour needs to keep a clear head and not retreat into its comfort zone where it says 'all the right things'  but could never do anything.  The danger is that Labour would become unelectable as it was in the 1980s - rejected by voters election after election.  Labour should not turn itself into simply a party of protest.  It needs to present a coherent programme for government. It needs to face up to difficult decisions, and it needs a leader who will be able to unite the party.  Jeremy Corbyn could not do that.  I fear his election would be divisive and more so since so many of his supporters are using his campaign to attack 'the virus' of New Labour.   
Whatever they think of Mr Blair he won three elections for Labour, and his government produced the biggest increase in spending on the NHS as per cent of GDP and reduced pensioner poverty.  Whilst there is much I did not like about his period of office, there were substantial achievements, and not least the minimum wage. It is foolish not to recognise this. 
Labour cannot achieve things by sitting on the opposition benches. This supreme fact the party learned during the Thatcher period. It took 18 dark years before that lesson was learned.  It is vital the Labour party gets this one right else it risks alienating voters.   There will be no easy path to winning elections. Whoever wins the leadership will have a difficult mountain to climb. It will take time.  Labour must address the concerns of the voters and not retreat into its own 'socialist' bubble. 
Labour needs not just a simple message but also a coherent voice. Sadly I do not as yet see that in any of the leadership candidates. For all that I warm to Jeremy Corbyn, and I do, he would be a comfort blanket. He says what we feel but that doesn't amount to a coherent and winning platform. When asked who had independently verified his economic plan he simply answered 'experts' but would not say who.  It certainly wasn't the IFS or any other recognisable body of 'expert' analysis. He would be torn to shreds if he became leader with the simple approach he has adopted. You cannot fool the media and voters with promises that have not been costed or without a clear means of paying for them. Simply being against austerity does not mean we have no responsibility for dealing with the nations finances. 
Of course we should not expect the Leadership candidates to have all the answers, But we should expect them to have some ideas about how to achieve their aims. 
Labour  needs a leader who will be capable of pulling the party together at this difficult time. Sadly, it is unlikely Jeremy Corbyn could do that.  I fear Labour is marching into the wilderness when the country needs it most.  Labour needs a leader who can reach out to voters and work with business.  The economy matters. 
Suddenly 'aspiration' has become a dirty word on the left.  It is dismissed as it if it synonymous with greed or perverse.  It is not.  It means the aspirations of ordinary working families. Labour should be the party of aspiration and hope. It shouldn't go back to fighting old battles of the 1970s and 80s.  But it needs a leader who will challenge the injustice in our society and who will speak up for the poorest and disadvantaged.  My heart is with you Jeremy Corbyn, but my head is not.