Doctors urged by Labour leadership to call off strike
Andy Burnham, the shadow Health Secretary, called for a rethink over the walk-out planned for June 21, adding that doctors should find other ways of registering their anger over changes to their pensions.
Non-urgent operations and routine GP and hospital appointments will be cancelled when British Medical Association (BMA) members stage their first strike for almost 40 years in protest against the pensions shake-up.
Doctors â€" who backed the move by more than two to one â€" and health service chiefs have insisted emergency treatment will not be affected by the action.
But Mr Burnham said it was it was "incredibly hard" to draw their line between urgent and non-urgent cases.
"I don’t see how it is possible to take industrial action that doesn’t have implications for patient care and patient safety," he said.
"I understand the strength of feeling and I think [the vote] was a proxy for dissatisfaction on a number of levels. There should be o ther routes to communicate that strength of feeling."
Mr Burnham said he believed profession should only walk out in "pretty extreme circumstances".
He said: "Doctors striking is a pretty difficult thing to countenance when the impact on patient care could put patients at risk."
He was echoing Andrew Lansley, the Health Secretary, who has said the public would not "understand or sympathise" with the industrial action.
The BMA said today its decision to strike had not been "taken lightly", but the action was necessary "in order that our voice is heard by the government".
Doctors are angry their retirement age will be raised from 65 to 68 and their pension contributions will also increase under the Government’s plans.
Dan Poulter, who has worked as a part-time hospital doctor since becoming a Tory MP, said today he had resigned from the BMA. He said:
"This is going to damage the reputation of the medical profession and it's going to hurt patients."
Meanwhile, the King’s Fund said today that the number of patients facing lengthy waits in accident and emergency departments has reached its highest level since 2004.
A report by the health charity said 4.2 per cent of patients spent more than four hours in AE before being discharged or admitted from January to March, compared with 3.4 per cent in the same period last year.
The Government's national target that no more than 5 per cent of patients face more than a four-hour wait in AE was met last year, the King’s Fund said.
But it expressed worries that 48 NHS providers breached the threshold in the final quarter of last year compared with 18 in the second quarter.
Cambridge University Hospitals Foundation Trust hopes to earn £1m in five years and will offer the service to other trusts. The Patients Association condemned the move yesterday as an example of the creeping commercialisation of the NHS.
Ads will be vetted for suitability and will not include unhealthy foods, alcohol, funeral directors or accident-compensation companies.
Acceptable examples could include health-related products such as Stannah stairlifts and Benecol, the cholesterol-lowering margarines and yoghurts, a spokesperson for the trust said.
It is believed to be the first time an NHS trust has launched an advertising venture, though many trusts receive advertising income. The agency, Campus Media Solutions, is being jointly launched by the trust and its partner Big Brand Media, according to the medical newspaper Hospital Doctor.
The trust runs Addenbrooke's Hospital and a maternity hospital, has 1,000 beds and employs 7,000 people.
A spokesman said: "Our priority is to treat people who are sick. That is what we are here for. If we can make some money and put it back into patient care, that is what we want to do."
But Katherine Murphy, the chief executive of the Patients Association, said: "It is more evidence of how commercialised the NHS is becoming. It is a huge concern. The core purpose of the NHS is to make the sick better. This is distracting and moves the NHS away from the values of caring. Patients and the public don't view the NHS as an organisation promoting commercial ends... We are deeply concerned by this development."
In 2001 a quarter of secondary school pupils drank alcohol at least once a week, but in 2010 the figure fell to just 13 per cent.
The number of adults binge-drinking has fallen over the past six years; 74 per cent of men and 83 per cent of women are now drinking within the weekly recommended guidelines.
But drinking is landing more people in hospital. Ten years ago 142,000 people were treated for injuries or illnesses directly related to alcohol.
Its research, published in the British Medical Journal, suggests that, if British people adjusted their daily alcohol intake, it could save 4,600 lives. The only trouble is, the adjustment they recommend is to half a unit a day. That's a quarter of a pint of beer, or a third of a glass of wine. Holy mackerel.
Can you imagine how boring life would become if we took this seriously? Popping into the Builders' Arms after work for "just a quarter of Timothy Taylors, thanks, Sam". Imagine the Bridget Jones generation, grown a little older, meeting for shrieky gossip over 50ml (a standard glassful is 175ml) of Chardonnay. Would you want to end your busy day with teeny-tiny pipette-sips of wine in the evening?
The truth is, few people pay much heed to the government's "recommended" daily alcohol intake. I've never met anyone who thinks (or drinks) in "units". I suspect a self-policing gene tells you it's unwise to have more than three pints after work, to floor "nightc aps" of Scotch during the week, or to mess with red Burgundy at lunchtime unless you want to punctuate the teatime hour with loud snores. Department of Health guidelines operate mostly as a nagging finger in your consciousness, a background rumble of disapproval that's audible when you're having your glass refilled just one more time at a party.
There's evidence, though, that this is a generational matter. When we read that there's a rise in hospital admissions attributable to alcohol, we can be sure that most of the admissions are in the 30- and 40-something age groups. According to new figures from the Drinkaware organisation, young people haven't inherited their parents' compulsion to get regularly rat-arsed. Since 2003, there's been a 16 per cent decrease in the number of British 11-to-15-year-olds who have tried alcohol. And fewer of them are happy to tolerate their friends' fascination with cheap lager and supermarket vodka.
They're a generation who'll prob ably take seriously the words "Please Drink Responsibly" emblazoned on the side of a bottle of Jack Daniels. The rest of us, I'm afraid, will continue in our folly, laughing at "guidelines", and deciding that a life in which we all consume no more than five grams of alcohol a day would be a life strangely denuded of texture and excitement.
A report by health charity the King's Fund showed that 4.2% of patients spent more than four hours in AE before being discharged or admitted from January to March, compared with 3.4% in the same period last year.
Its authors said the increase was a cause for concern and reflected growing pressures on the hospital sector.
The Government's national target that no more than 5% of patients face more than a four-hour wait in AE was met last year, the think-tank's quarterly monitoring report found.
But 48 NHS providers breached the threshold in the final quarter of last year compared with 18 in the second quarter.
John Appleby, chief economist at the King's Fund, said: "The number of organisations that are in breach of Government targets is really worrying.
"That's almost one in four hospitals in England. That is not good."
Health Secretary Andrew Lansley said the figures did not reflect the amount of time people spent waiting for treatment in AE.
He said: "This measure records the total time people spend in the department, including the time they are being treated. It does not just measure waiting.
"People are waiting on average only 49 minutes for their treatment to start. In addition, the NHS has continued to meet or exceed the target of 95% of patients spending a total time of four hours or less in AE."
The King's Fund said the rise in time spent in AE coincides with emerging evidence of increases in "trolley waits" as some hospitals struggle to find beds for patients.
Data obtained from 60 NHS finance directors as part of the study revealed that 40% of trusts did not meet their productivity targets in 2011/12.
The report said: "This will be a significant concern as last year was the first in a four-year spending squeeze, during which the NHS needs to find £20 billion in productivity improvements."
Just four of the finance chiefs questioned said their organisation was forecasting a deficit this year, backing up national figures that estimate a surplus of £1.5 billion across the NHS.
The study found the NHS was performing well against a number of other key indicators, including hospital treatment waiting times and superbug infections.
The proportion of inpatients waiting more than 18 weeks for treatment fell, while outpatient waits remained static, the report said. C difficile and MRSA infections dropped by 33% and 14% respectively.
Mr Appleby added: "Overall, the NHS continues to perform well, despite the spending squeeze. However, this masks growing pressures in hospitals and significant performance issues in some NHS organisations.
"Given the strength of the political commitment to keep waiting times low, the steep rise in AE waits will be a concern for the Government.
"The productivity challenge will only get harder, so evidence that large numbers of NHS organisations failed to meet their productivity targets last year does not bode well."
STIs: Diagnoses of increasingly antibiotic-resistant gonorrhoea infections rise by 'unprecedented' 25 per cent
Gonorrhea, the second most common bacterial STI in the UK, is becoming increasingly resistant to antibiotic treatment and Britain faces “the very real danger of the untreatable gonorrhoea in the futureâ€, health experts said.
There were 20,965 new cases of gonorrhoea diagnosed in England in 2011, up from 16,835 in the previous year. Overall, diagnoses of STIs were up by two per cent in the UK in 2011, reversing a small decline observed in the previous year.
Although the dramatic increase in gonorrhoea cases was partly attributed to more sensitive testing, the HPA said that too many people were still putting themselves at risk, with gay men and young heterosexual adults were the groups causing the greatest concern. Instances of gonorrhoea were up by 61 per cent among men who have sex with men and young heterosexual adults, between 15 to 24-years-old, represented 57 per cent if all new gonorrhoea diagnoses. Â
Dr Gwenda Hughes, head of STI surveillance at the HPA, said: “We anticipated some increase in diagnoses due to improvements in testing in recent years, but not on the scale seen here,†she said. “Too many people are putting themselves at risk of STIs and serious health problems by having unsafe sex.â€
Dr Hughes said that in the past five years laboratory testing of the gonorrhoea bacterium had shown greatly increased resistance to the main drugs used to treat the infection.
Gonorrhoea can have serious effects if left untreated. Young women with gonorrhoea can develop pelvic inflammatory disease (PID), which can cause chronic abdominal pain and also lead to infertility.
New diagnoses of syphilis were up by 10 per cent to 2,915 and herpes was up five per cent to 31,154. Although the number of new cases of Chlamydia was down by two per cent to 186,196, Dr Hughes said this was most likely a reflection of fewer young people getting tested.
Sexual health campaigners warned that public health authorities had “taken their foot of the pedal†on informing and warning the public about the dangers of STIs and said that the upcoming transfer of responsibility for public health to cash-strapped local authorities risked worsening the problem.
 “These figures are a salutary lesson,†said Lisa Power, policy director of the Terrence Higgins Trust, the UK’s leading sexual health charity. “Sexual health services have had a much lower profile in recent years and it’s demonstrable what happens when you let up on informing the public about the risks. We’ve been working hard with local authorities and our experience is that the services on offer will incredibly variable. There will be a postcode lottery for sexual health unless services are improved across the board.â€
Sexual health services and advice are currently available from a variety of NHS providers. Next year local authorities will take over responsibility for public health, including sexual health.
The GMB said its members at the BMA, which is taking its own industrial action next month over doctors' pensions, backed action by 4-1.
GMB members have already rejected a pay offer the union said was worth 1.5% plus an additional 0.5% for high performers only.
Under a grading re-structuring, the offer was worth less than 1.29% for two-thirds of staff, said the GMB.
Union official Anna Meyer said: "We have asked the BMA to re-open negotiations to avert industrial action.
"The next step is for GMB officials and shop stewards to meet to consider the ballot result and to plan the industrial action if the dispute is not resolved.
"The pay offer from BMA fell far short both of the RPI inflation for the year and of the median increase for pay settlements, which stands at 3% for the three months to January 2012.
"This is double what the BMA offered and which GMB members rejected.
"Despite repeatedly criticising the Government for refusing to enter into serious negotiations on doctors' pensions, the BMA has stated this is its final offer. Ironically, the BMA says that the cost of supporting the final salary pension scheme for just under half of its staff is a key reason for suppressing pay."
The BMA announced yesterday that doctors will take action on June 21 in protest at the Government's controversial pension reforms.
BMAÂ chief executive Tony Bourne said: "Whilst we respect the rights of staff to take action, we are disappointed by the outcome of the GMB ballot.
"We continue to believe that the pay offer made to our staff this year is a fair one given the challenging economic environment facing all employers, given the very attractive terms and conditions of employment afforded to BMA staff and given the 5% award paid to staff last year.
"The BMA provides secure employment and offers competitive salaries, as well as maintaining a generous p ension scheme. This year, we have also made very substantial, additional contributions to the staff pension scheme."
The BMA said it has offered staff a general rise of 1.5% plus an 0.5% performance pot as part of the 2012/13 pay award.
But can a doctor have a good bedside manner if they are not actually at your bedside? That's what a pioneering new stroke service in Cumbria and Lancashire aims to find out. It allows expert stroke consultations to take place when doctors are not in the hospital.
Stroke consultants might be having dinner, watching television, gardening on a Sunday or asleep in bed. That is, until they receive a call from hospital notifying them that a patient needs attention. Then, they spring into action at a speed The Flying Doctors team could only marvel at, and examine their patient an average of 15 minutes later.
The service gives patients access to top stroke specialists 24 hours a day, seven days a week. How? It's simple. Doctors are now doing what many of us do at work or via Skype: they are appearing via webcam at the patient's bedside.
Using telecommunications systems in this way seems (like plenty of bright ideas) rather obvious â€" but it's the result of years of work. After a highly critical report into national stroke services in England published by the National Audit Office in 2005, the Cumbria and Lancashire NHS Trust organised a clinical advisory group to devise the best care for stroke patients in line with the Government's 2007 National Stroke Strategy.
A stroke occurs when the blood supply to the brain is cut off. This can happen for two reasons: a clot or a haemorrhage. Clots cause 80 per cent of all strokes so doctors need to quickly establish if a patient is eligible for thrombolysis, known in non-medical terms as "clot-busting" medication.
Timing is crucial in this situation as there is a four-and-a-half hour window in which a patient will respond to clot treatments. Beyond this there can be irreparable damage to a patient's brain and victims can end up needing round-the-clock medical care for the rest of their lives. Strokes are the third-largest cause of death in England and the single largest cause of adult disability.
Other NHS Trusts with limited stroke services elect dedicated hospitals to which patients with suspected strokes are sent. But geography made this impossible in Cumbria and Lancashire. Journey times from remote areas would be too long and patients would have deteriorated by the time they were examined. They were forced to think more creatively.
"We came up with a system based around wherever the consultant happened to be because there are not enough specialists in our area to give thrombolysis treatment at local hospitals," says Kathy Blacker, director of the Cumbria and Lancashire Cardiac and Stroke Network. "A couple of the hospitals had 9am to 5pm stroke service units but others had no capability at all. We needed to provide a 24/7 service and knew we couldn't centralise because of the geography."
After three years of discussions, Cumbria and Lancashire launched Telestroke in July 2011. It brings 16 stroke physicians across eight hospit als to patients on screen via a specialist telecommunications network.
Similar systems exist in other parts of the country â€" the Scottish Centre of Telehealth (SCT) has been running since 2006. Other countries, too, are keen on the technology, which doctors in Barcelona use for HIV consultations. There are similar schemes being set up in Africa, too.
So far in Lancashire 24 patients' lives have been saved, 40 more this year have recovered with no symptoms or disabilities and 30 fewer patients require full-time care, according to the latest estimates.
Strokes cost the NHS and economy in Britain £7bn a year. But the Cumbria and Lancashire model has saved the NHS Trust more than £8m so far, according to estimates. The bulk of the expenditure saved would have gone on long-term care for those left without means to look after themselves.
Clinical staff worried initially that patients wouldn't like Telestroke. But they've conducted satisfaction surveys a nd of the 250 to receive Telestroke consultations only one has responded negatively.
"Everything has changed so quickly in terms of smartphones and interactive engagement," Blacker says. "Patients are unfazed by it."
CASE NOTES
The patient's view
Howard Thomas, 70, a retired insurance broker, was the very first patient to use the Telestroke service after he had a stroke on 31 July 2011:
"I had been staying at a campsite in Cumbria with my wife. I felt fine when I went to bed but woke up the next morning around 11am to go to the loo and I didn't make it. I was all over the place. My wife phoned 999 and the ambulance took me to Kendal Hospital.
"It was a Sunday so no stroke specialists were there but I was seen by a consultant via Telestroke. Less than 24 hours later I recognised and spoke to my son and my wife. I've never heard of anyone getting over a stroke as quickly as I have.
"Th e lady I'd seen on the Telestroke came in to see me on the Monday and I recognised her. I couldn't recollect seeing her on screen but I knew she was a familiar face straight away."
The doctor's view
Dr Mark O'Donnell, Stroke Consultant at Blackpool Teaching Hospital NHS Foundation Trust and clinical lead for the Lancashire Cumbria Cardiac and Stroke network:
"We are at home and get a call. After a brief discussion with the referring doctor we decide whether or not to proceed with the Telestroke consultation. Some discussions resolve the difficulty and in some cases it's apparent that nothing can be done.
"We dial into the teleconferencing technology from our home PCs. It takes a matter of minutes.
"I think all of us on the scheme had a little bit of anxiety to start off with about the impersonal nature of the technology.
"The system has gone down on a couple of occasions. Both times it was a problem with the internet conn ection. There is a 24-hour helpline but under such circumstances you just have to wait. Thankfully it is rare."
How it works
1. Patients visit AE with stroke symptoms and are wheeled into cubicles which contain Telestroke screens
2. Doctors at the hospital telephone the stroke specialist on call
3. The stroke specialist dials into the Telestroke technology and communicates directly with the patient via webcam
4. The specialist can look at brain scans using the Telestroke technology
5. A patient and their family can ask questions of the consultant
6. The stroke specialist might prescribe thrombolysis treatment which will be administered by hospital staff
Cutting average daily intake to the equivalent of half a small glass of wine would prevent almost 4,600 premature deaths a year in England alone, according to a study carried out by University College London.
Scientists used a mathematical model to show that the ideal level of alcohol consumption to prevent chronic disease in England was five grams, or about half a unit.
Doctor, doctor: why is my GP going on strike? Because a £53,000-a-year pension deal isn't enough...
The decision to take industrial action over pensions on 21 June was immediately condemned by Andrew Lansley, the Health Secretary.
He said that, even after the changes, a new doctor joining the NHS could expect a pension of more than £53,000 at age 65 while if they worked three years longer they could expect a pension of about £68,000 a year. Doctors said this failed to take into account the increased contributions they would be expected to make under the new scheme.
Both sides insisted that patient safety would remain paramount but hospital managers warned the 24-hour strike would "impact on care and cause distress and disruption". Some operations are expected to be cancelled along with routine GP appointments. This is expected to have a knock-on effect as consultations will have to be rescheduled. More stoppages are predicted later in the year with neither side predicting an early end to the dispute.
The decision to strike, announced by the British Me dical Association (BMA), was taken after a ballot of members who are furious over the Government's proposed pension reforms.
The BMA claims the reforms will result in doctors working longer, paying more in contributions and getting a smaller pension when they retire. They add that the reforms renege on an agreement reached with the Government on pensions four years ago and comes at a time when the overall NHS pension scheme is in surplus.
However the Government counters that doctors have one of the most generous pension schemes in the country, with many retiring on pensions of around £50,000 a year. It adds that other much less well-paid NHS workers â€" who will also lose out under the new scheme â€" have not chosen to strike and say the decision shows that doctors are putting their own interests ahead of patients.
Privately, ministers believe the BMA is on the wrong side of public opinion and say they are not prepared to negotiate. "This strike makes the BMA look awful and shows that they are no more than a trade union representing a part of the NHS which is already very well paid," said a source close to Mr Lansley. "There is no chance of any negotiation at all because if we give way to the doctors then nurses and other far less well-paid staff who are not striking will rightly say you have got to reopen negotiations with us as well. That would bring the whole house of cards down."
But Alan Robertson, chair of the BMA's pension committee, said the decision to strike was based upon principles of fairness. "This is something we have been reluctantly pushed into because the Government is reneging on a pensions deal which was signed just four years ago," he said. "We are also concerned it will force some doctors to stay on working longer and longer and that could potentially be a concern with regards patient care."
In the ballot for industrial action, there was a 50 per cent turnout among the 104,544 doctors eligibl e to vote. They voted by two to one to take strike action. BMA leaders are to meet tomorrow to decide how the action will progress. However it is likely to see doctors providing all urgent and emergency care, but postponing non-urgent cases.
Dean Royles, director of the NHS Employers organisation, said regardless of BMA reassurances, patient care would suffer. "We are deeply disappointed with the announcement from the BMA about their decision to take industrial action," he said. "Doctors know that any industrial action will impact on care and cause distress and disruption to patients and undermine trust and confidence in the medical profession. Industrial action could potentially mean delays to treatment. It would be particularly distressing for patients and extremely worrying for staff who are dedicated to putting patients first."
Mr Lansley said the public would not "understand or sympathise" with the BMA. "People know that pension reform is needed as people li ve longer and to be fair in future for everyone. Every doctor within 10 years of retirement will receive the pension they expected, when they expected. Today's newly qualified doctor who works to 65 will get the same pension as the average consultant retiring today would receive at 60 â€" the BMA have already accepted a pension age of 65. If doctors choose to work to 68 then they could expect to receive a larger pension of £68,000."
Hamish Meldrum, chairman of council at the BMA, said it was taking industrial action "very reluctantly and would far prefer to negotiate for a fairer solution". "But this clear mandate for action â€" on a very high turnout â€" reflects just how let down doctors feel by the Government's unwillingness to find a fairer approach to the latest pension changes and its refusal to acknowledge the major reforms of 2008 that made the NHS scheme sustainable in the long term."
QA: How the strikes will affect patients
Q. Will the action put patients at risk?
A. The last time doctors took industrial action, in 1975, death rates fell. But it will be small comfort to those who find their operations cancelled or appointments postponed.
Q. Will the whole NHS be affected?
A. Just because the British Medical Association has called on doctors to join the day of action, it doesn't mean all of them will. Only half of doctors voted in the ballot. The response could be patchy.
Q. Will hospitals and GP surgeries close?
A. The BMA says they will stay open and staffed. Urgent and emergency care will be provided but non-urgent appointments will be postponed.
Q. Will doctors be on the golf course?
A. Doctors are instructed to be at their workplace in order that they are available for urgent cases. The BMA says patients turning up at th eir GP's surgery who say they need "urgent" treatment will be seen. Patients will not, however, be able to make appointments for 21 June and, on the day, they will not be able to make appointments further ahead.
Q What should you do if you have an operation booked for 21 June?
A. Routine operations may be cancelled. Treatment for cancer patients will proceed as normal. Labour wards will also be unaffected. Doctors will review test results, act on any found to be abnormal, and issue urgent prescription requests in the normal way.
Q. What will happen to waiting lists?
A. Management meetings and routine paperwork will be pushed back. Patients will be inconvenienced and waiting lists may rise. The most likely outcome on the day? Confusion.
The "liquid biopsy" test identifies defective fragments of DNA shed into the bloodstream by cancer cells as they die.
Scientists have already used it to detect genetic faults involved in tumour growth in blood samples from 20 women with ovarian cancer. They were also able to build a "real time" picture of how one woman's breast cancer responded to treatment over more than a year.
Study leader Dr Nitzan Rosenfeld, from Cancer Research UK's Cambridge Research Institute, said: "This type of blood test has the potential to revolutionise the way we diagnose and treat cancer. The great advantage is that it can be used to identify cancer mutations without surgery or a biopsy, making it safer and cheaper."
In future, patients could be given treatments based on the result of a quick blood test, rather than having a tissue sample surgically removed for analysis.
The test is said to overcome a major drawback of tumour biopsies, which may provide only a limited snapshot of the genetic mutations present in cancer.
Diagnoses of increasingly antibiotic resistant gonorrhoea infections rise by 'unprecedented' 25 per cent
Gonorrhea, the second most common bacterial STI in the UK, is becoming increasingly resistant to antibiotic treatment and Britain faces “the very real danger of the untreatable gonorrhoea in the futureâ€, health experts said.
There were 20,965 new cases of gonorrhoea diagnosed in England in 2011, up from 16,835 in the previous year. Overall, diagnoses of STIs were up by two per cent in the UK in 2011, reversing a small decline observed in the previous year.
Although the dramatic increase in gonorrhoea cases was partly attributed to more sensitive testing, the HPA said that too many people were still putting themselves at risk, with gay men and young heterosexual adults were the groups causing the greatest concern. Instances of gonorrhoea were up by 61 per cent among men who have sex with men and young heterosexual adults, between 15 to 24-years-old, represented 57 per cent if all new gonorrhoea diagnoses. Â
Dr Gwenda Hughes, head of STI surveillanc e at the HPA, said: “We anticipated some increase in diagnoses due to improvements in testing in recent years, but not on the scale seen here,†she said. “Too many people are putting themselves at risk of STIs and serious health problems by having unsafe sex.â€
Dr Hughes said that in the past five years laboratory testing of the gonorrhoea bacterium had shown greatly increased resistance to the main drugs used to treat the infection.
Gonorrhoea can have serious effects if left untreated. Young women with gonorrhoea can develop pelvic inflammatory disease (PID), which can cause chronic abdominal pain and also lead to infertility.
New diagnoses of syphilis were up by 10 per cent to 2,915 and herpes was up five per cent to 31,154. Although the number of new cases of Chlamydia was down by two per cent to 186,196, Dr Hughes said this was most likely a reflection of fewer young people getting tested.
Sexual health campaigners warned that public heal th authorities had “taken their foot of the pedal†on informing and warning the public about the dangers of STIs and said that the upcoming transfer of responsibility for public health to cash-strapped local authorities risked worsening the problem.
 “These figures are a salutary lesson,†said Lisa Power, policy director of the Terrence Higgins Trust, the UK’s leading sexual health charity. “Sexual health services have had a much lower profile in recent years and it’s demonstrable what happens when you let up on informing the public about the risks. We’ve been working hard with local authorities and our experience is that the services on offer will incredibly variable. There will be a postcode lottery for sexual health unless services are improved across the board.â€
Sexual health services and advice are currently available from a variety of NHS providers. Next year local authorities will take over responsibility for public health, including se xual health.
Adam Lambert makes history and releases new music video in the same week - not bad for a runner
Remember the playground rhyme 'first's the worst, second's the best and third's the one with the hairy chest'?
Well, it might be making a comeback thanks to music talent shows on the telly.
American Idol runner-up Adam Lambert made history last week by becoming the first openly gay artist to achieve number one in the Billboard 200 album chart with his second studio release 'Trespassing'.
And today he's released the music video for his next single Never Close Our Eyes which features all of the trademark styles that Lambert is known for.
Lambert Lunging: Doing a dance that every drunk guest at a wedding would be proud of
His spiky hair - fixed with Vo5 spray - and his unique emo style fit perfectly with the catchy tune that will undoubtedly continue his chart success.
The song is a bit of a sing-a-long while the video - where Lambert is trapped in an experimental facility and forced to chomp down on multi-coloured pills - has the style of Lady Gaga.
His album has already topped the US albums charts though it won’t be released in the UK until 2nd July.
Lambert told Instinct magazine: “As a community, we’re a little bit resistant to a gay male popstar ourselves.
"There’s something weird there. We’re very eager to celebrate a strong female. But to celebrate a fellow gay man â€" it gets catty sometimes."
Maybe contestants auditioning for the X Factor this year should try their best not to win the competition if they want to be rich and famous - and have a successful music career, obviously.
Matt Cardle won the competition in 2010 but parted ways with his record label last week after a very uneventful couple of years.
Adam Lambert comes to the UK next week and will be performing alongside X Factor runners-up JLS at the Rays of Charity event at the Royal Albert Hall on 7th June and a solo gig at G-A-Y on 9th June.
The single Never Close Our Eyes is on sale 24th June.
Oh, and if any American Idol trivia buffs are reading then it was Kris Allen who wo n the show in 2009 and according to the rhyme it's third place Danny Gokey who has the hairy chest.
Neither Selena or her dress look upset about the alleged battery case her boyfriend Justin's facing
Selena Gomez wore a long grey maxi dress with a smiley face on it to a Memorial Day BBQ in Malibu yesterday. And, not just any Memorial Day BBQ we should add, but Hollywood producer Joel Silver's Memorial Day BBQ. Other guests included Ashley Greene, Josh Hartnett, Gwen Stefani, Gavin Rossdale, Robert Downey Jr., Tobey Maguire, Barbra Streisand and James Brolin.
Not bad.
This is the most high profile BBQ we've ever heard of
Â
She accessorised the dress with a smile and oodles of bling, all of which may have helped her feel a smidgen better about the rumours that her boyfriend, Justin Bieber, could be facing battery charges after an alleged altercation with a photographer outside a cinema in LA on Monday.
Justin didn't join her at the BBQ because he's in Norway. Which is a shame because it was VERY cool
Gratuitous bum shot Â
The teens were on an old-school date to the cinema - how quaint that they visit public cinemas when they probably have their own private ones - when Justin reportedly roughed up a snapper who took a picture of Selena.
Here's 'the look'. We want our mummy
Â
In the scuffle Justin even lost his high top trainer, which has led us to imagine there was some kicking involved. There may not have been, of course, he may just not have done it up properly.
Beiber sans high top
Â
The 30-year-old pap filed a complaint against Justin with police investigating the episode as a misdemeanour criminal battery case.
Spokesman Robert Wiard of the Malibu/Lost Hills sheriff's station said, "Singer Justin Bieber and actress Selena Gomez were at The Commons at Calabasas shopping centre.
"As the victim attempted to take a picture of Mr Bieber, Mr Bieber and the victim were involved in a physical altercation."
It's been reported that the case has been referred to the Los Angeles County Prosecutors which is usual in high profile legal shenanigans.
Justin has yet to be quizzed by police as he's in Norway kicking off a series of secret concerts across Europe.
Look, Lively! Blake flashes her fit in the name of fashion and admits she’s happy Gossip Girl’s over (noooo...)
“I’m ready to move on with my life, and I can’t do that with Gossip Girl tracking my every move.†Okay Blake, Blake Lively, we get it, you’re okay with Gossip Girl being cancelled (clearly 3am aren’t handling the news quite so well…)
Serena van der Woodsen â€" or Blake Lively, whatevs â€" has become a firm fixture on the small screen since Gossip Girl seized the small screen back in 2007. In turn, Blake Lively has become something of a real-life fashion luvvie herself with her pick of designer threads, she can even add Christian Louboutin and Chanel muse to her VIP CV.
Miss Lively â€" who is currently romancing one Ryan (beep beep hrnk hrnk hubba hubba) Ryan Reynolds is also fronting this month’s Bull ett Magazine and wearing some LOVELY CLOTHES TO BOOT.
Don’t just take our word for it though, take in through your eyes too with these sexy, sexy, very very sexy (and stylish) shots below...
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Blake bites, on Bullett          Â
"I think the best way to describe it is like someone who really enjoyed high school, and is like, I’m a senior and I can’t wait for the next thing! Gossip Girl was so great, but what’s the next challenge in life? Because, you know, six years is a long time."
Much like a really glamorous long-term relationship between us and a TV...
That metal peplum dress would be a b*tch going through airport security...
Lovin' the red Lanvin Lively, and that bed hear is pretty fit too...
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...The actress will film the final and last season of Gossip Girl this year. The final episode to be aired in the US next year (... noooooooo etc)Â Â Â Â Â Â Â Â Â Â Â
Check out that BUST! (Not that one, jeez, head, gutter, much)
And will you be our new BFF pretty please pretty Blake? “My friendships always end up being long and lasting. The way that I meet people is the same way that I’ve always met people.
“I meet so many people in passing at parties, but I’ve never been a person who’s like, I know I just met you, but let’s exchange numbers and be best friends.â€
Um, we know we just e-met you via a story, but let’s exchange numbers and be best friends...Blake? BLAKE!? Nevermind...
Either Blake is Borrower-size or those are some whopping roses...
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Bullett magazine is out now... Â Â Â Â Â Â Â Â Â Â Â
Better Porn: Alain de Botton's naked ambition pushes the wrong buttons
Botton's idea is certainly topical, given the current debate on how best to police the web, but does the answer to pornography's bad rep lie in this makeover? Botton's concept comes up against all sorts of potential contradictions: can pornography be exciting if it is joined up with an intellectual and aesthetic endeavour? Can it still be as joyfully mucky, visceral and unfettered if it is "revolutionised for the better"? Doesn't better really mean sanitised?
Botton says: "Ideally, porn would excite our lust in contexts which also presented other, elevated sides of human nature â€" in which people were being witty, for instance, or showing kindness, or working hard or being clever â€" so that our sexual excitement could bleed into, and enhance our respect for these other elements of a good life. No longer would sexuality have to be lumped together with stupidity, brutishness, earnestness and exploitation..." This reads well but wouldn't it be highly contrived in real ity, to create such elevating sexual scenarios? It seems as if he is inviting us to feel the same kind of thrill watching smut as we would've felt in front of a nude at the National Gallery's Leonardo da Vinci show.
Better Porn also has a touch of the smug and self-congratulatory about it. The idea that people can switch on to watch "good filth", knowing they're not really doing anything too demeaning or animalistic because its values have been thought-out by a celebrated philosopher. The School of Life wants the site to become one that parents would feel comfortable with their sons or daughters accessing at a certain age without particular shame but I wonder whether these young people could even stomach watching porn that has been vetted and approved of by their parents.
I suspect that sex desire and appetite can't be as easily re-conditioned to be "better" in the way that this idea pre-supposes. Of course, the more a teenage boy watches sites that have hairless , surgically enhanced women being treated like meat, the more he internalises this as the norm, but Better Porn only works if you believe that sexual appetites can â€" and should â€" be subject to this level of self-surveillance. We are being asked to watch Better Porn and by extension, have Better Sex. What about politically incorrect fantasies? What about the exhilaration of the illicit and the thrill of guilt? Will Botton's holier-than-thou naughtiness satisfy or end up being a pale reflection of what presses people's buttons?
Our appetites for sexual simulation seem to be growing as internet porn becomes an infinitely expanding industry, and as we increasingly seek out erotic reading material, with books like the SM saga, Fifty Shades of Grey, hitting the bestseller lists. A cynic might be forgiven for thinking that Botton's site will ride on the back of society's addiction to pornography, that he is not challenging this bad addiction, only re-arranging its aesthet ics to make it high-end.
On paper, Botton's Better Porn has great integrity. In reality, I fear it might end up at best, being prettified, anodyne stuff, and at worse, confining our desires.
The problem is so acute that girls as young as five now worry about their size and appearance, with children in danger of picking up their parents' body-related anxieties, their report said.
Cosmetic surgery rates have increased by nearly 20% since 2008 and the rise was said to be fuelled by advertising and "irresponsible" marketing ploys, the cross-party group of MPs was told.
According to Reflections on Body Image, co-authored by the MPs and health and education charity Central YMCA, negative body image was seen as an underlying cause of health and relationship problems, a key contributor to low self-esteem and a major barrier to participation in school and progression at work.
Appearance is also the greatest cause of bullying in schools, evidence suggested.
The report, published by the All Party Parliamentary Group (APPG) on Body Image after a three-month public inquiry, identified a growing amount of evidence that body image dissatisfaction was on the increase, with the issue seen to be one affecting all of society regardless of age, ethnicity, gender, sexuality, disability, body size or shape.
Children and adolescents were seen to be more vulnerable to body image concerns however.
Around half of girls and up to one third of boys have dieted to lose weight and children and young people with body image dissatisfaction were less likely to engage in learning and participation in school, the report said.
Parents were identified as one of the main influences on children but by secondary school age, the peer group was seen to become a more important influence.
The inquiry heard that health issues attributed to excess body weight may be overstated meanwhile because body mass index, the measure commonly used, was seen to be an inaccurate way of classifying all individuals and their health risks.
And although being overweight or obese was associated with a range of health conditions, the inquiry received evidence challenging the notion that weight always entailed poor health.
The diet industry acknowledged the public had "unrealistic expectations" about weight loss, while critics argued there was no evidence diets work in the long term.
The inquiry, which took evidence from academics, the public, industry, charities and other experts, heard that:
:: Getting rid of dieting could wipe out 70% of eating disorders;
:: More than 95% of dieters regain the weight they lost;
:: 1.6 million people in the UK suffer eating disorders;
:: Up to one in five cosmetic surgery patients could suffer from body dysmorphic disorder;
:: One in three men would sacrifice a year of life to achieve their ideal body;
:: One in five people have been victimised because of their weight;
The report made a series of recommendations targeted at policy-makers, healthcare professionals, industry and the education sector designed to change public perceptions, attitudes and behavioural patterns.
These include compulsory body image and self-esteem lessons for primary and secondary schools, getting advertisers to commit to running campaigns that reflect consumer desire for "authenticity and diversity", and reframing public health messages in "weight-neutral" language.
It also called for a review of broadcast and editorial codes on reporting body-related issues, a review of the evidence base to support the long term efficacy and safety of diets and a separate code of regulations governing cosmetic surgery advertising.
Patients should be screened before undergoing cosmetic surgery and a review should be carried out into whether the Equality Act ought to be amended to include appearance-related discrimination, the recommendations said.
Central YMCA will launch a campaign on the issues in the autumn after consulting the public beforehand.
APPG chairwoman Jo Swinson MP said: "Body image dissatisfaction in the UK has reached an all-time high and the pressure to conform to an unattainable body ideal is wreaking havoc on the self-esteem of many people."
Central YMCA chief executive Rosi Prescott branded the report's findings shocking.
"It's clear that there's something seriously wrong in society when children as a young as five are worrying about their appearance, based on the messages they are seeing all around them," she said.
"Body image has become more important in our culture than health, and children are mimicking their parents' concerns about appearance.
"We all have a responsibility to act now to bring about the attitudinal and behavioural change that's necessary to prevent damage to future generations."
The British Association of Aesthetic Plastic Surgeons agreed a separate code of regulations should be drawn up governing cosmetic surgery advertising and called for an outright ban on adverts of this type in public places like billboards and public transport.
BAAPS also announced it was funding long-term research into psychological assessment of patients.
:: The finding that more than half of people have a negative body image comes from a study by the Centre for Appearance Research at the University of the West of England, to be published in full later this year.
'Abortions are like air strikes on civilians': Turkish PM Recep Tayyip Erdogan's rant sparks women's rage
Turkish law sanctions abortions within 10 weeks from conception. But Mr Erdogan has publicly voiced his opposition, comparing them to "murder".
Yesterday the Health Minister Recep Akdag said the government aimed to reduce the number of abortions and Caesarean births performed in Turkey.
Mr Erdogan told a gathering of the women's branches of his Justice and Development party that "each abortion is one Uludere" â€" a reference to air strikes on a village on the Iraqi border that killed 34 civilians in December. Abortions, said the PM, were, "a sneaky plan to wipe the country off the world stage".
Mr Erdogan added: "I am a prime minister who opposes Caesarean births, and I know all this is being done on purpose.
"I know these are steps taken to prevent this country's population from growing further. I see abortion as murder, and I call upon those circles and members of the media who oppose my comments: You live and breathe Uludere. I say every abortion is an Uludere."
The comments were condemned by women's rights activists and opposition MPs. Safak Pavey, an opposition MP from the Republican People's Party, said Mr Erdogan had made similar statements in 2005, when he accused the EU of promoting birth control in Turkey in order to lower the population. "Paranoia is really working for him at a time when all these human rights violations are happening," Ms Pavey said. "I don't think he cares at all about Uludere or abortion or Caesarean sections."
On Sunday, dozens of women demonstrated in Istanbul, carrying banners reading, "Is the right to abortion the prime minister's business?" and "It's our womb, we have Caesarean delivery or abortion," according to Agence France-Presse (AFP).
Mr Erdogan's statement carries particular weight as Turkey prepares to rewrite its constitution and is no longer focused on its European Union accession process.
Recent figures quoted by AFP show that abortion is on the ris e in Turkey, climbing from 60,000 in 2009 to nearly 70,000 last year. The country's population of nearly 75 million is youthful in comparison to many countries in the European Union and Mr Erdogan has promoted a policy of high birth rates.
Non-urgent cases will be postponed on the day of action on June 21 and further action has not been ruled out.
The British Medical Association said it was taking action "very reluctantly" but attacked the Government for going back on a deal on pensions agreed four years ago.
The move followed a big vote in favour of action by doctors.
Dr Hamish Meldrum, chairman of council at the BMA, said: "We are taking this step very reluctantly, and would far prefer to negotiate for a fairer solution.
"But this clear mandate for action - on a very high turnout - reflects just how let down doctors feel by the Government's unwillingness to find a fairer approach to the latest pension changes and its refusal to acknowledge the major reforms of 2008 that made the NHS scheme sustainable in the long term.
"Non-urgent work will be postponed and, although this will be disruptive to the NHS, doctors will ensure patient safety is protected.
"All urgent and emer gency care will be provided and we will work closely with managers so that anyone whose care is going to be affected can be given as much notice as possible."
The BMA said doctors will see anyone who is ill, or who believes they are ill, on the day of action, but will not do paperwork.
Health Secretary Andrew Lansley said: "The public will not understand or sympathise with the BMA if they call for industrial action over their pensions.
"People know that pension reform is needed as people live longer and to be fair in future for everyone. We have been clear that the NHS pension scheme is, and will remain, one of the best available anywhere.
"Every doctor within 10 years of retirement will receive the pension they expected, when they expected.
"Today's newly qualified doctor who works to 65 will get the same pension as the average consultant retiring today would receive at 60 - the BMA have already accepted a pension age of 65.
"If doctors c hoose to work to 68 then they could expect to receive a larger pension of £68,000."
The BMA Council made the decision after considering the results of its ballots on industrial action which showed that 50% of the 104,544 doctors eligible to vote took part.
Across separate ballots covering six branches of practice, a clear majority of GPs, consultants, junior doctors, staff, associate specialist and speciality doctors, and public health and community health, doctors said they were prepared to take part in both industrial action short of a strike and a strike, while a majority of occupational medicine doctors voted against industrial action.
The BMA complained that the Government has begun to implement major changes to the NHS pension scheme, despite "widespread criticism" of its approach from organisations representing health professionals.
"In 2008, the BMA, other health unions and the Government negotiated a major reform of the NHS scheme, which all agreed made it fair and sustainable well into the future.
"The NHS scheme currently delivers a positive cashflow of £2 billion a year to the Treasury, and NHS staff have already accepted responsibility for any future increases in costs due to improved longevity.
"The latest changes will see doctors paying up to 14.5% of their salaries in pension contributions - twice as much as some other public sector staff on a similar salary in order to receive a similar pension. They will also have to work longer to receive their pension - up to 68 for younger doctors," said the BMA.
Dr Meldrum said most doctors would be taking industrial action for the first time, with the last dispute stretching back almost 40 years.
The big vote for action showed the strength of feeling among doctors, who were "acutely aware" of the impact of any action on patients.
"There will be some inconvenience, but the last thing we want to do is harm patients when our real bone of contention is with the Government," he said.
Doctors have been hit by a pay freeze and increased workload so the increased pension contributions were the "final straw".
Given the strength of feeling among doctors, the BMA had no choice but to call action among its members across the UK.
Dean Royles, director of the NHS Employers organisation, said: "We are deeply disappointed with the announcement from the BMA about their decision to take industrial action.
"Doctors know that any industrial action will impact on care and cause distress and disruption to patients and undermine trust and confidence in the medical profession.
"Doctors will now work locally with NHS trusts to assess the impact on local services and to consider the important question of communication with patients and public.
"We know that doctors are anxious about changes to their pensions. But no-one wants to see patients dragged into the argument.
"Industrial action could potentially mean delays to treatment.
"It would be particularly distressing for patients and extremely worrying for staff who are dedicated to putting patients first."
Teeth whitening and manicures... Behind the (very girly) scenes of the One Direction tour
We've given a lot of thought to what One Direction do when they're backstage on their tour. XBox marathons, perhaps, or some questionable smells, being the teenage boys that they are.
But we didn't expect to see this. It's One Direction getting their nails done (Zayn) and having their teeth whitened (Harry). We thought Harry already had lovely teeth... though thinking about it we can't remember seeing Zayn's nails.
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Probably the only time in our lives we've questioned whether we definitely do fancy Harry
Niall's clothes have got all American, haven't they? Â The one on the right isn't in One Direction, just so we're clear
The boys are currently performing in Canada at the Molson Amphitheatre. Someone seems to have allowed Niall to climb on to a wall too, which his mum's probably not happy about.
Their tour's carried on in to Canada after visiting various arenas in America.
The other day Harry treated us to a bit of One Direction action over the airwaves though, playing Call or Delete on Nick Grimshaw's Radio 1 show.
'Abortions are like air strikes on civilians': Turkish PM's rant sparks women's rage
Turkish law sanctions abortions within 10 weeks from conception. But Mr Erdogan has publicly voiced his opposition, comparing them to "murder".
Yesterday the Health Minister Recep Akdag said the government aimed to reduce the number of abortions and Caesarean births performed in Turkey.
Mr Erdogan told a gathering of the women's branches of his Justice and Development party that "each abortion is one Uludere" â€" a reference to air strikes on a village on the Iraqi border that killed 34 civilians in December. Abortions, said the PM, were, "a sneaky plan to wipe the country off the world stage".
Mr Erdogan added: "I am a prime minister who opposes Caesarean births, and I know all this is being done on purpose.
"I know these are steps taken to prevent this country's population from growing further. I see abortion as murder, and I call upon those circles and members of the media who oppose my comments: You live and breathe Uludere. I say every abortion is an Uludere."
The comments were condemned by women's rights activists and opposition MPs. Safak Pavey, an opposition MP from the Republican People's Party, said Mr Erdogan had made similar statements in 2005, when he accused the EU of promoting birth control in Turkey in order to lower the population. "Paranoia is really working for him at a time when all these human rights violations are happening," Ms Pavey said. "I don't think he cares at all about Uludere or abortion or Caesarean sections."
On Sunday, dozens of women demonstrated in Istanbul, carrying banners reading, "Is the right to abortion the prime minister's business?" and "It's our womb, we have Caesarean delivery or abortion," according to Agence France-Presse (AFP).
Mr Erdogan's statement carries particular weight as Turkey prepares to rewrite its constitution and is no longer focused on its European Union accession process.
Recent figures quoted by AFP show that abortion is on the ris e in Turkey, climbing from 60,000 in 2009 to nearly 70,000 last year. The country's population of nearly 75 million is youthful in comparison to many countries in the European Union and Mr Erdogan has promoted a policy of high birth rates.
He told how his trust in Hull had done a third hip replacement on a woman aged 90. He described a mother in her 20s who had brought her seven-year-old son to the Accident and Emergency department because he was crying after his hamster had died.
And he related how a man awaiting a shoulder replacement operation was phoned to be given the good news that his operation would be next Thursday only to respond: "Oh, I can't do Thursday. Can you make it Friday?"
They were illustrations, he said, of why the NHS was unsustainable. Combined with an ageing population and advances in medical techniques, the limits to what medicine can do, and what patients expect it to do, are ever expanding.
It is a familiar tale. But today, researchers suggest another driver of this inflationary trend which threatens to divert the entire GDP of the UK and of all developed countries across the globe into health care. It is medicine itself .
Its ability to recognise illness has been so finely honed, its tests have become so sensitive, its definitions of ill health so broad, that more and more "patients" have been sucked within its ambit. And while its capacity to heal the sick is unquestioned there is growing anxiety about its propensity to harm the healthy.
In the US as much as $200bn a year is said to be spent unnecessarily. In the UK , the tax-funded NHS and absence of financial incentives offers some protection. But in all developed economies, including the UK , too many people are being "over-dosed, over-treated and overdiagnosed", researchers writing in the online British Medical Journal say .
"Screening programmes are detecting early cancers that will never cause symptoms or death, sensitive diagnostic technologies identify "abnormalities" so tiny they will remain benign, while widening disease definitions mean people at ever lower risks receive permanent medical labels and lifelong treatments that will fail to benefit many of t hem," they say.
The problem is not greedy or negligent doctors. It is the reverse â€" an excess of enthusiasm. Doctors are trained to heal the sick and that is what they love to do. But the culture of medicine may now be getting the better of them.
The researchers from Australia and Canada cite a study which found that almost a third of people diagnosed with asthma may not have the condition, a review which suggested up to one in three screening detected breast cancers may be overdiagnosed, and the view of some experts that treatments for the bone-thinning disease osteoporosis may do more harm than good for women at very low risk of future fracture.
Widened definitions of Attention Deficit Hyperactivity Disorder have seen the number of children diagnosed escalate in recent years with a 30 per cent higher chance of being diagnosed among boys born at the beginning the school year (the youngest in class).
High cholesterol, high blood pressure, pregnant w omen with gestational diabetes, Asians with chronic kidney disease â€" in each case expanded definitions have led to thousands or millions of extra patients designated "ill".
Ivan Illich wrote in his seminal Limits to Medicine, published in 1976, that "The medical establishment has become a major threat to health."
Almost four decades on, even those who rejected that analysis may now accept that medicine is engaged in an unwinnable battle against death, pain and sickness which is threatening our humanity. The BMJ suggested in a theme issue, "Too Much Medicine", published 10 years ago, that modern health care had "sapped the will of the people to suffer reality."
Birth, ageing, sexuality, unhappiness and death had been medicalised. It cited Amartya Sen's observation that the more a society spends on health care the more likely are its inhabitants to regard themselves as sick.
Today the perils of medicalisation are still more acute. The agenda of global pharmaceutical companies, which have a clear interest in medicalising the sick, is a growing concern. But while the dangers may be better recognised, the way forward is not.
The Australian and Canadian researchers suggest fears about litigation, commercial and professional vested interests and health systems that favour more tests and treatments all drive the medicalisation of the human condition.
But a key factor is what they describe as "an intuitive belief in early detection, fed by deep faith in medical technology," which is, arguably, at the heart of the problem of overdiagnosis.
"Increasingly we've come to regard simply being 'at risk' of future disease as being a disease in its own right. Starting with treatment of high blood pressure in the middle of the 20th century, increasing proportions of the healthy population have been medicalised and medicated for growing numbers of symptomless conditions, based solely on their estimated risk of future even ts.
"Although the approach has reduced suffering and extended life for many, for those overdiagnosed it has needlessly turned the experience of life into a tangled web of chronic conditions."
Of course there is also much under treatment â€" patients diagnosed too late, or denied the best treatment. But every pound wasted on over-treatment is a pound denied to those who are under treated. In September, an international conference, Preventing Overdiganosis, is to be held at the Dartmouth Institute for Health Policy in the United States. As BMJ editor Fiona Godlee, a sponsor of the conference, points out, while the harm of overdiagnosis is becoming ever clearer "far less clear is what we should do about it."
A decade ago the BMJ called for doctors to become pioneers of demedicalisation, who would work to hand back power to patients, encourage self care and autonomy, and resist the categorisation of life's problems as medical. Their hour may finally have come.< /p>
Better Porn: De Botton's naked ambition pushes the wrong buttons
Botton's idea is certainly topical, given the current debate on how best to police the web, but does the answer to pornography's bad rep lie in this makeover? Botton's concept comes up against all sorts of potential contradictions: can pornography be exciting if it is joined up with an intellectual and aesthetic endeavour? Can it still be as joyfully mucky, visceral and unfettered if it is "revolutionised for the better"? Doesn't better really mean sanitised?
Botton says: "Ideally, porn would excite our lust in contexts which also presented other, elevated sides of human nature â€" in which people were being witty, for instance, or showing kindness, or working hard or being clever â€" so that our sexual excitement could bleed into, and enhance our respect for these other elements of a good life. No longer would sexuality have to be lumped together with stupidity, brutishness, earnestness and exploitation..." This reads well but wouldn't it be highly contrived in real ity, to create such elevating sexual scenarios? It seems as if he is inviting us to feel the same kind of thrill watching smut as we would've felt in front of a nude at the National Gallery's Leonardo da Vinci show.
Better Porn also has a touch of the smug and self-congratulatory about it. The idea that people can switch on to watch "good filth", knowing they're not really doing anything too demeaning or animalistic because its values have been thought-out by a celebrated philosopher. The School of Life wants the site to become one that parents would feel comfortable with their sons or daughters accessing at a certain age without particular shame but I wonder whether these young people could even stomach watching porn that has been vetted and approved of by their parents.
I suspect that sex desire and appetite can't be as easily re-conditioned to be "better" in the way that this idea pre-supposes. Of course, the more a teenage boy watches sites that have hairless , surgically enhanced women being treated like meat, the more he internalises this as the norm, but Better Porn only works if you believe that sexual appetites can â€" and should â€" be subject to this level of self-surveillance. We are being asked to watch Better Porn and by extension, have Better Sex. What about politically incorrect fantasies? What about the exhilaration of the illicit and the thrill of guilt? Will Botton's holier-than-thou naughtiness satisfy or end up being a pale reflection of what presses people's buttons?
Our appetites for sexual simulation seem to be growing as internet porn becomes an infinitely expanding industry, and as we increasingly seek out erotic reading material, with books like the SM saga, Fifty Shades of Grey, hitting the bestseller lists. A cynic might be forgiven for thinking that Botton's site will ride on the back of society's addiction to pornography, that he is not challenging this bad addiction, only re-arranging its aesthet ics to make it high-end.
On paper, Botton's Better Porn has great integrity. In reality, I fear it might end up at best, being prettified, anodyne stuff, and at worse, confining our desires.
Half of abortions are given to women already with children
Latest statistics for 2011 published yesterday show that 51 per cent of women undergoing abortions already had at least one child.
Repeat abortions also rose to 36 per cent of the total, an increase of 5 per cent in the past decade. Among under-18s, 7 per cent had had one or more previous abortions
A leading abortion provider said the growing use of abortion to limit family size showed the need for contraceptive and sexual health services among older women and mothers had been neglected relative to younger women.
BPAS, formerly the British Pregnancy Advisory Service, said the "massive" emphasis on infertility could be lulling older women in to wrongly believing they could not get pregnant.
Marie Stopes International, which provides abortion and contraceptive services, called on the Government to boost contraceptive provision for women who had already terminated at least one pregnancy.
Tracey McNeill, UK director, said: "We believe we nee d to radically change the way we provide post-abortion contraception to women, if we're going to reduce the number of abortions by any great number. We look to the Government to support us in our efforts, by transforming contraception provision in the UK. We would like to be able to check in with a woman at regular intervals after her abortion to see if she's still using the contraception we provided her with, or if she'd like us to provide a different method."
The proportion of mothers having abortions has risen by 1 per cent a year since 2008 to reach 51 per cent in 2011, having been stable at 47 per cent until 2007. In total, almost 190,000 abortions were carried out last year, the same rate â€" 17.5 per thousand women of reproductive age â€" as the previous year but down from the peak of 18.6 per thousand in 2007.
The statistics show abortions rose among the over-25s while they have fallen among the under-25s.
A spokesman for BPAS said: "Older women have been neglected. It is almost as if there is a belief that women's sex lives stop at 25 or 30. Women in their 30s are going off the Pill because there is a belief that after 10 years you ought to switch to other forms of contraception. We all know contraception is not 100 per effective."
"There are so many messages about the chances of conceiving going down rapidly after 30. We get women in their mid-30s who, because of these messages , assume they are not going to get pregnant and then have a slip up. We think of abortion as a young woman's issue but women also want to control the size of their families."
Social changes, including the breakdown of partnerships, the expectation that older women would have more active sex lives, and the "huge focus" on providing sexual health services to younger women were also factors, she said.
189,931
Total number of abortions carried out in England and Wales last year.
It's true! Chocolate really can improve your health
Can chocolate really be good for us? It’s a bit like saying that ice cream will make you live longer.
How can something so naughty, so delicious, be good for us?
Stories about the health-giving properties of chocolate appear from time to time and I greet each one with profound scepticism, not forgetting that there are nearly always some commercial interests behind publicising the supposed benefits.
Research by the food and pharmaceutical industries can’t be true, can it?
The evidence on chocolate is accumulating and may have just reached the tipping point.
We’re talking about the dark kind, not the more addictive milk variety.
The latest study examined the effects of chocolate on stress in 30 healthy people for two weeks.
Every day, each volunteer was given 40g (about four squares) of dark chocolate, eating half in the morning and half in the afternoon.
Using standard, accepted psychological and biochemical tests, stre ss levels were measured before, during and after the study.
The results surprised me.
We know chocolate soothes, pampers and spoils. But it also turns out it relieves stress.
The levels of stress-related hormones like cortisol dropped in everyone, including those who were highly anxious at the beginning.
The research concluded that eating a small amount of dark chocolate every day as part of a healthy diet can help people who are stressed.
You’ll notice I keep repeating “dark chocolateâ€.
In the study, the chocolate was made of 70% cocoa solids and it’s these that are rich in the alkaloid chemicals, which affect cellular metabolism.
If you’re not convinced, there are two more studies.
The second involving 1,000 people found those who ate chocolate a few times a week were, on average, slimmer than those who hardly ate it at all.
The scientists claim chocolate contains ingredients that may favour weight loss r ather than fat accumulation.
The third study confirms that moderate quantities of dark chocolate can lower blood glucose and bad LDL cholesterol and therefore the risk of heart disease.
But it only works if you don’t gorge.
Men with a family history of breast cancer might be at greater risk of developing prostate cancer.
A study by the Institute of Cancer Research and the Royal Marsden Hospital, published in the British Journal of Cancer, has found that men with the BRCA1 gene, which gives women a six in 10 chance of developing breast cancer, have a one in 11 chance of developing prostate cancer.
A spokesman for the charity Prostate Action, which co-funded the study, said that men with a family history of either cancer should be tested for the gene, so that their health can be more closely monitored.
It’s important for a child with attention deficit hyperactivity disorder to have an orderly home life and a routine.
If your child knows that he has to do certain things at set times of the day, he’s less likely to be unruly.
Remember, too, that if your child has problems with self-control, he may well have low self-esteem because he meets with adult disapproval all the time.
Always praise and reward good behaviour and he’ll learn that certain types of behaviour win your approval, while others don’t.
When you want your child to do something, make requests clear and simple and give them one at a time. Praise effort as well as achievement.
Medication
Drug treatment is reserved for severe ADHD in children over the age of six and the main drug used is methylphenidate hydrochloride (Ritalin). It has significant side effects, so use is closely monitored.
Stress and strains
Parenting a child with ADHD can be very demoralising, since your child may have a reputation as a troublemaker.
Many parents feel isolated because their child is rejected by prescho ols, and even banned from friends’ homes.
Don’t blame yourself for your child’s behaviour and take time away from your child if you can when it all gets too much.
There are organisations such as the Hyperactive Children’s Support Group, which can offer help and advice. Visit www.hacsg.org.uk.
My wife recently died from brain cancer. I was later informed that she was administered by the Liverpool Care Pathway without my knowledge or permission. Can you please explain this procedure?
Dr Miriam says:
My deepest sympathy at losing your wife.
The Liverpool Care Pathway is a document that outlines the best care for a dying person irrespective of their illness or where they’re dying. Medication will be reviewed and tailored to their individual needs. Staff should have talked to you about maintaining your wife’s comfort and special care, like her position in bed, special mattress and regular mouth care.
If she stopped eating and drinking, a decision about the use of artificial fluids would have been made in her best interests and explained to you.
Personal support from a religious adviser regarding special needs at the time of death or after death might be offered.
Healthy: Eat your fruit and veg
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Research from Cambridge University has found that eating just one apple a day cuts your risk of premature death from heart disease by 20%. If you add one orange and one banana, that becomes 50%.
Minor infections like colds and flu are also less likely if you make sure you eat plenty of fruit and veg. Go for kiwi fruit, raspberries, blueberries, red peppers and citrus fruit for a very good way of getting vitamin C into your diet.
A high-fibre diet will help protect against breast and prostate cancer. Cabbage, peas, beans, berries and dried fruit are good rich sources, but there is fibre in nearly all vegetables and fruit.
It’s not only dairy products that help build bones. Try dark green, leafy veg such as broccoli and kale.
Five portions a week of red fruit and veg like tomatoes, water melon and red pepper can reduce the risk of lung cancer by a quarter.
Digestion burns many calories. So if we greatly reduce the quantity of food we eat, ou r body will also reduce the rate of metabolism to save energy.
To increase our metabolism, we mustn’t reduce the meals we eat but choose food with fat-free protein and a lot of fibre. Also, eating small meals regularly helps to increase basic metabolism.
It’s important for a child with attention deficit hyperactivity disorder to have an orderly home life and a routine.
If your child knows that he has to do certain things at set times of the day, he’s less likely to be unruly.
Remember, too, that if your child has problems with self-control, he may well have low self-esteem because he meets with adult disapproval all the time.
Always praise and reward good behaviour and he’ll learn that certain types of behaviour win your approval, while others don’t.
When you want your child to do something, make requests clear and simple and give them one at a time. Praise effort as well as achievement.
Medication
Drug treatment is reserved for severe ADHD in children over the age of six and the main drug used is methylphenidate hydrochloride (Ritalin). It has significant side effects, so use is closely monitored.
Stress and strains
Parenting a child with ADHD can be very demoral ising, since your child may have a reputation as a troublemaker.
Many parents feel isolated because their child is rejected by preschools, and even banned from friends’ homes.
Don’t blame yourself for your child’s behaviour and take time away from your child if you can when it all gets too much.
There are organisations such as the Hyperactive Children’s Support Group, which can offer help and advice. Visit www.hacsg.org.uk.
Harry Styles: "I want to shave my hair off and I wear crotchless tights" (um, ok Harry)
It’s not our job to question Harry Styles (actually, it kind of is, but we don’t want to. Unless it’s face-to-face. While touching his hair). So when we heard him confessing to secretly borrowing his sister’s stockings on a daily basis, we just smiled and nodded. And then tried to pretend that it didn’t happen.
The One Direction star took a 12 minute break from caressing his latest girlfriend Audi to confess all kinds of things on Nick Grimshaw’s Radio One show, which was aired yesterday evening - including a fondness for lycra legwear, and the urge to expose his teenage scalp to the world.
This is the face of a boy who knows the nail-polish-on-your-ladders trick.
 Of course, this is not the face of a boy who wears nail polish (that confession is for a later date).Unlike Harry's legwear, Niall is not crotchless. Or nostril-less.Louis is too serious for all of this malarkey. And too busy trying to look French.Talking of ground breaking fashion trends, hands up who's seen Liam in this exact outfit before?...but at least he wins the biggest head competition.
Uh oh. Those 50 derniers giving you a bit of a wedgie, Harry?
Ooh. Looks like Zayn might have a pair of orange ones under there too. We take it all back.
Speaking to his former hairdresser over the phone, Harry admitted that he feels like his fanbase actually loves more than just his follicles. “I want to shave my hair off, and no one will really let me. Everyone’s telling me not to do it. And my argument is, like, I think my popularity is in my face, and not my hair.â€
Which only somewhat crushes our dreams of seeing him re-enact a Herbal Essences advert in the near future. But it's OK. Justin Bieber's angry face is more than enough for us to work with for the near future.
Not to be deterred by the audience of several million listeners, Harry, 17, decided to continue revealing all of his secrets on air, a nd decided to give his stylist Caroline (wonder who she’s next to in his phone book) a call too.
“I was reading a magazine today, and I saw this big article in the back, and it was talking about men wearing tights. And I was just wondering, because, basically it just feels really comfortable, so I’ve been putting them on under my jeans. So I’m just wondering if you could get me some good ones. Like, some crotchless ones. Just because I’ve been stealing my sister’s.
“The thing is, I’m not sure if I’m ready to bring them out. Maybe I should just keep them under my trousers for a bit. Do you think they do like, gold ones?â€
Of course, rumour has it that this was all a prank for Grimshaw's “Call or Delete†radio feature. But we know better than to believe that kind of thing.Â
The pre-recorded interview was aired just hours before One Direction took to the stage at Susquehanna Bank Centre in New Jersey as part of their US tour. Pres umably with rather clammy legs.
Listen to Harry's interview here...
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See a video of Justin Bieber throwing punches, after this week's alleged scuffle with a pap photographer (video)
Oh what timing. It’s only been a matter a day since we saw those pictures of Justin Bieber looking very scary (there is a lot of anger behind those eyes, who knew?) on the street after an alleged run in with a paparazzi and this new development could go some way to explaining things.
Here's 'the look'. We want our mummy
 Bieber went bonkers on a photographer while out with his lovely lady Selena Gomez in Los Angeles, CA.He lost his shoe and that makes him ANGRY!
Here’s the teenage pop squirt (don’t tell him we said that) having a boxing lesson with none other than Mike Tyson, who is something of a fighting legend, for those who’ve been living on the moon for the last 20 years / are girls.
Now we’re no boxing experts here at 3am online either - any knowledge we have is based on ogling sweaty muscles and being rather fond of watching men in shorts jumping about, but we know that Mike Tyson is a big old lump who’s rather nifty with his fists and has a bit of a reputation for being a bit um, crazy in the ring at times.
So, if you’re going to learn how to throw a left hook, you could do worse than ask him to teach you.
Seems like Mike rather enjoys himself here too. While holding the punch bag for Justin to do his best on, Mr Tyson makes what can only be described as sex noises as he excitedly utters a few words of encouragement.
Tyson's his mate. Yeah, we've always loved Justin. Always
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“Jab, jab, oh, oh, JB! Good combination. You looking good baby! Oh, oh!
“Come on JB! Come on JB†Oh, oh, oh. Give me that side step!†are a selection.
Those paparazzi might just be keeping their distance when Justin’s taking girlfriend Selena Gomez to the cinema next time.
Half a million patients a year may have unnecessarily paid to receive private dental treatment after receiving inaccurate information from their dentist about health service entitlements, an Office of Fair Trading (OFT) study found. Patients are given insufficient information to make informed decisions about their choice of dentists and the treatments they receive and the dental industry is not always working in their best interest, the report said.
The OFT has called for major changes to the dentistry market after the study also raised concerns about restrictions preventing patients from directly accessing dental care professionals, such as hygienists, without a referral from a dentist.
These restrictions are unjustified and likely to reduce patient choice and dampen competition, the OFT said. John Fingleton of the OFT, said: "Our study has raised significant concerns about the UK dentistry market which need to be tackled quickly in the interest of patients. A ll too often patients lack access to the information they need, for example when choosing a dentist or when getting dental treatment. We also unearthed evidence that some patients may be receiving deliberately inaccurate information about their entitlement to NHS dental treatment and we expect to see robust action taken against such potential misconduct by dentists."
There were 189,931 abortions performed for women resident in England and Wales in 2011, a 0.2 per cent rise on the 189,574 figure in 2010 and 7.7 per cent more than the 176,364 total in 2001, statistics published on the Department of Health website have shown.
The rise comes after the 2010 figure also registered a small increase on the previous year - up 0.3 per cent on the 189,100 total in 2009.
In spite of the increase, the abortion rate last year remained unchanged on the 2010 figure at 17.5 per 1,000 women aged 15 to 44 years old.
The abortion rate was highest at 33 per 1,000 for women aged 20, unchanged on the 2010 and 2001 figures.
But teenage pregnancy rates registered a fall with the under-16 abortion rate standing at 3.4 per 1,000 and the under-18 rate at 15 per 1,000 women in 2011.
Both figures were lower than the 2010 and 2001 rates - at 3.9 per 1,000 for under 16s and 16.5 per 1,000 women under 18 in 2010 and 3.7 and 18 per 1,000 w omen respectively in 2001.
The vast majority of abortions, 91 per cent, were carried out last year at under 13 weeks, with more than three quarters, or 78 per cent, performed at under 10 weeks.
A breakdown of the figures showed that there were 1,000 abortions in 2011 performed on girls under 15 years old, less than 1 per cent of the total, and 683 to women aged 45 or more, less than half a per cent of the total.
In 2011, 36 per cent of women undergoing abortions had one or more previous abortions, a figure that has risen from 31 per cent since 2001. More than a quarter, or 26 per cent, of abortions to women aged under 25 years old were repeat abortions.
There were 6,151 abortions for women who are not resident in England and Wales carried out in hospitals and clinics in England and Wales in 2011 compared to 6,535 in 2010. the 2011 figure was the lowest in any year since 1969.
Ann Furedi, chief executive of the British Pregnancy Advisory Service (BPAS) said: "Abortion is a fact of life, because contraception fails and sometimes we fail to use it properly.
"It is a service that one third of women will need in the course of their reproductive lifetimes so they can plan the timing and size of their families, and play a full role in society.
"There is no 'right' number of abortions above and beyond ensuring that every woman who needs to end an unwanted pregnancy can do so, and that obstacles are not put in the way of her accessing supportive services as quickly as possible.
"What matters most is that all women can access the contraception that is most suited to them, and that services are able to accommodate all age groups."
