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Morning has broken

The Threat to Fairtrade

The combination of companies abandoning 'fairtrade' commitments and the UK government's determination to scrap the DFID pose a significant threat to ethical trade. 
Support for co-operatives and Fairtrade risks being diluted and diverted with Prime Minister Boris Johnson’s "reckless" proposal to scrap DFID (Department for International Development), Labour has warned. Abandoning DFID isn't a new idea.  The Tories have been targetting it for some time.  Their arguments against it are that it spends far too much money,  but there is another,  more sinister reason.  It gets in the way of trade based on poverty wages.  There lies the rub of it.   They don't really want ethics to block trade deals. 




In 1997, the then Labour government set up a dedicated Department for International Development, and over the next decade, the UK development budget tripled.  Support was targeted at the poorest, with work to promote good governance, encourage growth and economic dev…

It wasn't always late summer

This is a powerful story of Mary, a single teenage mother, living on a housing estate plagued with predatory abuse and prostitution, and Annie, an innocent girl whose ghostly presence links the central characters over two generations, bringing the events that led to her death, the loss of innocence and the unfolding story to a dramatic, thrilling conclusion.
The characterisation in the book is brilliant and entirely believable. From page one, I was completely drawn into the story and found the book difficult to put down.This is a stunning first time novelAn intense, gripping and highly personal thriller, with a modern ghostI found it hard to put down the book and the story very compelling.

Spend, spend, spend is not enough

Some thoughts on the Chancellor's measures for recovery.



The Chancellor's measures are a big package, but likely to be not big enough. There is much to be welcomed, even if it is a commitment with some half-measures. The government should not allow political philosophy to get in the way of doing what is required. Now more than ever, we need a unity of purpose across the political divide. That is never easy. We did it once before in what became known as the 'post-war consensus' on the need for spending on social infrastructure.

It helped us recover from the ravages and debt of war. Far from increasing national debt, the social investment-led recovery helped stimulate demand and the national debt tumbled. All the main parties, Tory, Labour and Liberal put employment at the heart of the strategy.

Merely urging people to spend is not the answer. In the long term, we need an investment-led recovery. Investment creates jobs, increases earnings and thus spending people can aff…

I Feel it in My Fingers

I Feel it in My Fingers

Vitamin D may prevent side-effect of cancer treatment

New research indicates that taking vitamin D supplements may help prevent a potentially serious side effect of a revolutionary form of anti-cancer therapy. The findings are published early online in CANCER, a peer-reviewed journal of the American Cancer Society (ACS).


An important capacity of the immune system is its ability to distinguish between normal cells in the body and those it sees as “foreign.” This lets the immune system attack the foreign cells while leaving the normal cells alone. To do this, it uses “checkpoints.” Immune checkpoints are molecules on certain immune cells that need to be activated (or inactivated) to start an immune response.

Immune checkpoint inhibitors help the immune system recognize and combat cancer cells, and although these treatments have helped many patients and have prolonged lives, they can cause side effects such as colitis, an inflammatory reaction in the colon.
 “Immune checkpoint inhibitor-induced colitis can limit the use of such life-saving dru…

Pull down the Statues?

As I write, it is 3.0 am, and I cannot sleep. Several images I remember in my life flash before me as in one of those old newsreels they used to show in cinemas. These images arise from the 'Black Lives Matter' protests at the murder of George Floyd by a police officer in America. Here in the United Kingdom, we must confront our racist past and present, as statues of prominent slave traders are taken down or pulled down.



In 1970, on a cold, wet December day in Warsaw, the then West German Chancellor Willy Brandt laid a wreath at the memorial of the Jewish ghetto. I remember it. The lasting image of that day was a photo taken when Brandt unexpectedly fell to his knees in front of the memorial and remained still for half a minute on the wet stone floor - that half a minute seemed an eternity. Somehow, the world seemed to pause and take a deep breath. Willy Brandt said, 'No German is free of History'— and nor are we.

We will only defeat racism if we acknowledge racism …

Blundering Boris has cost lives

The UK government incompetency has cost lives.   So many voters invested their hopes in Prime Minister Boris Johnson.  That hope has been cruelly dashed.  It will take time for this to impact in opinion polls, although the first signs of shifting public opinion are there.

The Leader of the Labour party, Keir Starmer, now offers a different style of leadership.  The contrast is stark.  The rambling, incoherent dishonesty of Boris Johnson, or the clear, inciteful, yet compassionate approach of Sir Keir.   The one evokes doubt and uncertainty; the other, confidence in an ability to deliver.

Faithfully doing as they were advised, UK citizens have been suckered into a strategy to protect, not the NHS, but the Tory government. Thousands of lives have been lost in so doing.  That is the tragedy.

So many voters put their trust in Mr Johnson as the Prime Minister to deliver Brexit.  However, it is now apparent, he had little else to offer.  Of course, any government might be put off its stride…

Do benefits of weight loss surgery persist?

When people regain weight after having weight loss surgery you might think that any benefits would be lost if they subsequently regain the weight. But this is not the case. Curiously many of the benefits persist, such as metabolic improvements and reduced risk of type 2 diabetes. How could this be so? Researchers have now found some of the answers.

Altered gene expression in fat tissue may help explain why individuals who have regained weight after weight loss surgery still experience benefits such as metabolic improvements and a reduced risk of type 2 diabetes. The findings come from a study published in the Journal of Internal Medicine.

The study included women who underwent weight-loss surgery, and gene analyses were conducted before and two and five years after surgery. Analyses were also conducted in women who did not undergo surgery.

Most gene expression changes in fat tissue occurred during the first two years after surgery; however, a subset of genes encoding proteins involv…

Taking care of care homes?

The Leader of the Opposition, Keir Starmer, was right to question the Prime Minister on Care Home deaths. Our loved ones in care homes should have been kept safe. 
A new report today finds that the number of people dying from COVID-19 in care homes is double the figure given by the government.

The government's advice up to 13th March was that there were unlikely to be infections in care homes. This conclusion could not have been based on scientific advice. 


What logic were they applying?


There is no reasoning in science why a virus would behave differently because it is in a care home! A virus has no idea it is in a care home!

Did they think older people were immune if they were in care homes?

The government was slow to understand the problem we faced, slow to act, and still refuses to publish the advice it receives.

The consequence in our care homes has been catastrophic.

The government should come out of its self-congratulatory mode and start listening. The jingoistic bluster abou…

Testing key to easing lockdown

Test, track and treat must be an essential ingredient coming out of COVID-19 lockdown.  This was acknowledged by the British Prime Minister, Boris Johnson, in his statement to the House of Commons today spelling out a little more detail of the strategy moving forward. 
With more testing, it will be possible to predict at a more localised level in the community where infections will spread and target both community testing and more social interventions on high-risk areas in the future.  This might then prevents further national lockdown in response to any rebound of the virus. 


The Prime Minister rightly refers to the R-value in informing strategy. It represents the rate of infection - or how many people can be infected by another.  At the outset, this was above 3, and anything above one means a dramatic increase in infections and deaths. 
The Prime Minister also, on that basis, is right that there might be a need for differences in approach in different regions of the country, and he a…

Strategy? What strategy?

Following the PMs address this Sunday.  I have found no need to alter my earlier assumption that "the government strategy is to not have a strategy."

I have come to the conclusion that the government doesn't have a strategy for easing lockdown and we, the public, are going to make it up as we go along.

So, I hope you all have the appropriate skills to consider the risks.

Why did the Prime Minister not make a statement earlier? He has added only confusion, where once we had clarity. 
They are attempting to come out of lockdown by stealth, without testing, so we have no idea where the virus is. We have, instead, a vague ambition to increase testing. Meanwhile we will all be at risk if people are going out more and going back to work.

The message was that we should stay at home and socially distance to 'save the NHS'. The truth of that is that it wasn't about saving lives, which is why initially the figures we were given didn't include deaths in care homes or…

Half of UK doctors have to source own PPE

In a major survey of frontline NHS doctors since the Coronavirus crisis began, over 16,000 UK doctors1 have responded to a BMA survey, answering questions on PPE provision, their well-being and drug shortages.

The survey shows that overall, nearly half the doctors say they had to source their own Personal Protective Equipment, PPE,  for personal or departmental use, or they have relied upon donations.



Breaking it down by profession, the majority, at 55%, are GPs with 38% being hospital doctors.

Dr Chaand Nagpaul, BMA Council Chair said:

“In what is the biggest survey of frontline NHS staff during this crisis, thousands of doctors have told the BMA that they have had to personally buy PPE for themselves or their department or rely on donations. 55% of GPs told us they sourced their own PPE or relied on donations and 38% of hospital doctors."
While it shows how resourceful doctors have been and how much support there has been from the general public in providing kit, it is a damning…

Boris is back

He is back. UK Prime Minister, Boris Johnson, is back at the helm following his illness with COVID-19. At the media conference this evening, he seemed to have much of his old bounce.

He had at least some good news. The UK is now turning the corner in its struggle with COVID-19. The curve of deaths appears now in a downward direction. The UK has passed its peak of COVID-19 deaths, and this is all good news.

We now have a better idea of the numbers of COVID-19 deaths because we are no longer merely counting those in hospitals. Testing has undoubtedly gone up, even if it hasn't reached the target of 100,000 set by the Health Secretary.

The emphasis is now turning to reduce collateral deaths (from cancer, heart disease, etc.) due to patients not accessing vital health care. We still don't know how many may die as a result of this. This needs more effort and should be a key factor now and in coming out of lockdown. It would be wrong to sacrifice cancer patients and others. After al…

UK Health Secretary talks nonsense

The UK government won't tell us who sits on the body advising them on how to deal with the COVID-19 pandemic. It isn't surprising because what we do now know is that it lacks critical expertise in virology, immunology.

This lack of expertise certainly shows at the daily media briefings, which seem more to do with putting a government spin on stories than revealing what is happening. To the greatest extent, we are being kept in the dark.



Take today, for example. The Health Secretary Matt Hancock came up with this shockingly misleading statement. He told us that


“The UK has already gone past the number of tests per day for instance that they carry out in South Korea, we’re approaching the levels that Germany undertakes"
This just is not the case by any reading of the statistics.

The UK’s daily testing average over the past week has been just shy of 23,000 tests a day. Germany has been carrying out 450,000 tests a week, according to its foreign minister, equivalen…

Animal infection with COVID-19 virus

The virus vector for COVID-19 pandemic is a novel zoonotic coronavirus,  SARS-CoV-2,  most likely originating from bats.  One problem in combating the virus is that we know so little about it.  We don't know, for example, whether any immunity developed in humans will last, or how long it will last.  Nor do we know to what extent it jumps from species to species.  Is it possible that our livestock, or our domestic pets,  will become infected?
Whether SARS-CoV-2 can also infect other animal species is being investigated by various research institutes worldwide. The Friedrich-Loeffler-Institut (FLI) started infection studies in pigs, chickens, fruit bats, and ferrets several weeks ago. 


First results show that fruit bats and ferrets are susceptible to SARS-CoV-2 infection, whereas pigs and chickens are not. The susceptibility of ferrets in particular is an important finding, as they could be used as model animals for human infection to test vaccines or drugs.

In the infection studies,…

No evidence for vaccine link with autism

Public health bodies are worried that an alarming drop in childhood vaccinations is leading to a resurgence of diseases in childhood that we had all but eradicated.  Misinformation and scare stories about the harmful effects of vaccines abound on the internet and in social media.  Where they are based on 'science', it is highly selective, and often reliance is placed on falsehoods. 
Conspiracy theories also abound - cover-ups, deception, lies. As a result, too many parents are shunning vaccinations for their children.  So, what does the published, peer-reviewed literature tell us about vaccincations? Are they safe and effective, or are there long term harmful effects? 
A new report now provides some of the answers.

New evidence published in the Cochrane Library today finds MMR, MMRV, and MMR+V vaccines are effective and that they are not associated with increased risk of autism.

Measles, mumps, rubella, and varicella (also known as chickenpox) are infectious diseases caused by …

Family history vital in early detection of colorectal cancer

Family history has always been important in medical diagnosis and treatment.  In the treatment of cancers, early detection can improve the chances of survival.  Now a new study published online in CANCER shows the importance of family history in the detection and prevention of colorectal cancer.

In the analysis that included information on adults diagnosed with colorectal cancer between 40 and 49 years of age, almost all patients could have been diagnosed earlier if they had been screened according to current family history–based screening guidelines. 


In many countries, colorectal cancer rates are rising in adults under 50 years of age. To identify those at risk, current guidelines recommend early screening for colorectal cancer among individuals with a family history of the disease. For example, for individuals with a first-degree relative with colorectal cancer, several medical societies recommend initiating screening at 40 years of age or 10 years prior to the age at diagnosis of t…

UK government failures on COVID-19

While the UK Government is not doing enough, our doctors and nurses are struggling at the frontline. Some are losing their lives to COVID-19.

Instead of addressing the issues, the government are asking doctors and nurses to use personal protective clothing in ways that are considered dangerous. The Royal College of Surgeons has issued a statement saying that doctors should not be coerced into putting their lives at risk.

Meanwhile, doctors and nurses are being gagged from speaking out about the shortages.

Responding to criticism that Prime Minister Boris Johnson missed five emergency COBRA meetings, the Education Secretary said at the press conference today, Sunday:
"This is a whole government effort. We are doing everything that is required, everything that is needed."
Well, what is needed is PPE and testing, among other things, and on both these fronts the government is failing to do everything required.

Our doctors and nurses are being asked to put their lives at further …

Humans and trees

When you approach a plant or a tree, you would perhaps be surprised how much it senses your presence. This isn't surprising when you consider the intimate relationship between animal and plant life. The trees harness the sun's energy, and we scatter its seed. 


When we take from our ecosystem, we must give something back. We could share our planet instead of assuming it was ours. Plundering our forests, laying waste with our concrete jungles, polluting our rivers and streams, making noise, a mountain of human detritus, like a scar on the landscape. 
Imagine, while we are driven into lockdown by a virus we cannot see, imagine how the forest feels about us...now it takes a moment to breathe, and the silence allows the birds to fly free, imagine.

There stood a tree in my childhood days
And there grew grass under sunlight rays
But where are these now so rare?
Under the concrete lain so bare.
My children will not know
In the world in which they'll grow.
They'll read it in a book

Shortage of PPE putting surgeons at risk

Doctors should not be coerced into risking their lives if there is a shortage of PPE, says the Royal College of Surgeons in response to the new PHE guidelines on PPE.

Instead of addressing the dangerous shortage of PPE, the guidelines are being changed to enable levels of protection to be reduced. This is unacceptable.



Professor Neil Mortensen, President-elect of the RCS, said:

“We are deeply disturbed by this latest change to PPE guidance, which was issued without consulting expert medical bodies. After weeks of working with PHE and our sister medical royal colleges to get the PPE guidance right, this risks confusion and variation in practice across the country." It is utterly disgraceful that the new guidelines have been introduced without consultation of health care representative bodies.   Professor Mortensen continues: 

“The new guidance implies that, even in the operating theatre, surgeons and their teams may not require proper PPE. This is simply unacceptable. While we app…

Attributing death to COVID-19

As we move to the 'surge stage' in the coming weeks of COVID-19 deaths in the UK, we do need to get more detailed information on deaths outside hospitals.

This week the Office for National Statistics reported the highest total number of deaths since ONS weekly death reporting began in 2005. 


That gives us some idea of what the underreporting of COVID-19 deaths might be. It is extremely difficult to be sure.  One question is to what extent the virus is the cause of deaths that would not have happened without an infection, and to what extent it is hastening deaths that would have occurred in any event.  
The provisional number of deaths registered in England and Wales in the week ending 3 April 2020 (Week 14) was 16,387; this represents an increase of 5,246 deaths registered compared with the previous week (Week 13) and 6,082 more than the five-year average.  
COVID-19 was mentioned in 21.2% of all deaths registered in that week - a significant increase on the previous week (4.8…

Ventilators and COVID-19

Reports today that the UK government have decided not to go ahead with the plan to get ventilators manufactured by Formula 1 teams like Renault and Red Bull.

Ventilation of the lungs isn't like filling a balloon with air. The use of PEEP, positive end-expiratory pressure, isn't how the lungs function usually. 


Inflation of our lungs occurs by developing a negative pressure in the thorax by contracting the diaphragm and raising the muscles between our ribs. This both keeps the air sacs (alveoli) open and inflates them, producing airflow. It is the negative pressure compared to the air surrounding us that pulls air into the lungs.  The air moves down the pressure gradient. 
Applying a pressure inside the air sacs can cause damage to the delicate lining leading to pulmonary oedema and worsening hypoxemia that can prolong mechanical ventilation, this can then lead to multi-system organ dysfunction, and increased mortality. 
Not all COVID-19 patients in ICUs have air sacs congeste…

A plan for PPE?

The UK government has now published its plan for Personal Protective Equipment) for frontline health workers.


The plan incorporates 3 strands for guidance, distribution and future supply.  It seems to follow the kind of line adopted by the Health Secretary when he urged doctors and nurses to treat PPE as a 'precious resource' and not to misuse it.  
This wasn't well-received by bodies representing the various strands of Health Care workers, not least the Royal College of Nurses. 


The plan instead restates the obvious.  
1) guidance: being clear who needs PPE and when, and who does not, based on UK clinical expertise and WHO standards. This will ensure workers on the frontline are able to do their jobs safely, while making sure PPE is only used when clinically necessary and isn’t wasted or stockpiled
2) distribution: making sure those who need PPE can get it and at the right time. The government will ensure those who need critical PPE receive it as quickly as possible by set…

The ethics of PPE

If health care resources and staff are stretched to the limit, difficult life or death choices must be made.  Who to treat? That will be the question.

At ordinary times decisions might be made based on whether treatment will do more harm than good.  It might even be the patient who decides.  End of life decisions are more often like that.  Will further treatment help?



But these are not regular times.

The British Medical Association guidance on pandemics says

"In dangerous pandemics the ethical balance of all doctors and health care workers must shift towards the utilitarian objective of equitable concern for all – while maintaining respect for all as ‘ends in themselves’."
If resources are spent on saving the life of one person at the expense of many others, how then is that balance to be made?

One thing is sure.  Our actions are also part of this ethical mix.  Our efforts will determine whether or not the anticipated surge in those requiring treatment overwhelms the limited…

Fall in stillbirths in UK not due to new protocol?

A new study suggests that the dramatic fall in stillbirths is not due to the adoption of new growth assessement protocols in pregnancy.

In 2015, the Secretary of State for Health in the UK announced a national ambition to halve the rates of stillbirths, neonatal and maternal deaths and brain injuries at birth by 2030, with a 20% reduction by 2020.

The target is well on track to be met.  But what lies behind its success.  It was thought that it was the result of new protocols for assessing the growth of the baby in the womb.

By comparing the growth of the fetus with expected growth for gestational age can indicate if something is going wrong.  For this vital assessment, growth charts are used.  The problem with the older growth charts was that they took no account of heterogeneity in the population.  More accurate growth assessment could save the lives of babies if problems could be detected sufficiently early in pregnancy.

One approach in recent years has been the adoption of a Growt…

Herculean effort to find a vaccine

Scientists across the globe are searching for a vaccine against the virus that causes COVID-19.  Let's applaud them too.

A vaccine for the COVID-19 virus is still said to be 'a long way off' with best estimates being early next year.    The first potential vaccine entered clinical trials on 16th March 2020.  Vaccines cannot be conjured with a magic wand.

Ordinarily, vaccines can take up to ten years to produce. The first Ebola vaccine took five years, and that was considered fast.



The imperative is now to find a COVID-19 vaccine a lot faster.   Teams across the world a working flat out developing and testing possible agents.

One reason it usually takes so long is what is termed the attrition rate - that is, the number of potential vaccines that don't make it through trials.

The failures could be hundreds.  Safety and effectiveness are of paramount importance, and that means rigorous testing.

The production of a vaccine isn't what we see in the movies -  brave scie…

Testing our way out of lockdown

There is some good news on the horizon.  The government might meet its target of 100,000 tests for COVID-19 by the end of the month.

Testing is vital to bringing us all out of lockdown, getting people back to work, and gradually returning to normality.

The US company producing the tests here in the UK has ramped up the facilities for its manufacture.  But initially, the tests will be for the antigen, indicating whether someone has got the virus.  We also need to test for the presence of antibodies, showing whether someone has had the infection and has developed an immunity.



Meeting the testing target offers hope that the lockdown can be released gradually, perhaps first, with those who have recovered from the virus. Slowly, people can get back to work, getting the economy moving once again and critically enabling key health workers to return to the frontline.

One thing the lockdown has demonstrated is just who our key workers really are.  The many we have taken for granted, and on who…

Cancer drug agents harmful to wildlife?

Harmful neoplastic agents from cancer therapies are leaching into the environment but do we know enough about what this is doing to wildlife and other humans?
Chemotherapeutic drugs, also known as antineoplastic agents, that are prescribed to treat a range of cancer types, enter the aquatic environment via human excretion and wastewater treatment facilities. A review published in Environmental Toxicology and Chemistry indicates that very few studies have characterized the effects of antineoplastic agents that are released into aquatic environments.


Cancer is a leading cause of death worldwide.   With an increasing incidence of cancers in growing and ageing populations, there has been a massive increase in cancer therapeutic drugs. 
Agents from these drugs are leaching into the environment through human excretion and wastewater.  Yet, we know little of the consequences on other humans and animal life in general. 
So, what do we know about the extent of the problem and potential risks?…