Someone just shared this video on LinkedIn and it struck me that, say, the local LibDems have no reason not to take similar action here in town, say, once a month. It would show true leadership.
Sex addiction is now formally a mental health condition in the World Health Organization’s International Classification of Diseases (ICD) list. It will take until January 2022, however, for this to kick in in healthcare.
Like alcoholism and drug addiction, it can cost people their jobs and it also tends to lead to a lot of lying to cover up what is going on.
A few years ago, I was contacted by an organization that provides diversity training. Part of its mission was the following:
We seek to be an open, transparent, inclusive non-profit organisation, promoting diversity and equality.
We also firmly believe that individuals should be treated equally regardless of disability, gender, ethnic origin, religion and sexual orientation.
I met with its Chairperson, who asked me to take a look at the organization’s Articles.
I did that and found that they were (a slightly adapted version of) older standard Articles, even though the organization was set up more than half a year after the change in the standard Articles (28 April 2013).
Different in the newer version was that it no longer discriminated against mental health versus physical health. The Mental Health Discrimination Act 2013 had something to do with that.
This is the offending sub-clause in the articles up to 28 April 2013:
18. A person ceases to be a director as soon as—
(e) by reason of that person’s mental health, a court makes an order which wholly or partly prevents that person from personally exercising any powers or rights which that person would otherwise have;
Compare it with sub-clause 18d, which is not discriminatory toward mental health relative to physical health:
18. A person ceases to be a director as soon as—
(d) a registered medical practitioner who is treating that person gives a written opinion to the company stating that that person has become physically or mentally incapable of acting as a director and may remain so for more than three months;
The newer version reads:
18. A person ceases to be a director as soon as—
(e) [paragraph omitted pursuant to The Mental Health (Discrimination) Act 2013]
Even though the fact that the sub-clause in question (18e) was rendered invalid by the Mental Health Act because of its discriminatory nature, I felt that the organization should update its Articles.
- It would reflect the organization’s stated values and objectives.
- Unless the person was familiar with company law, whoever read that sub-clause might not know that it was invalid.
The organization’s Chair didn’t see the need.
While I do wonder what is being done to piglets in the name of academic research, the article makes valid points and I want to share it with you. We need to find a way of living that is much more balanced, not only for the planet, but also for ourselves.
Stress affects most of us to one degree or another, and that even includes animals. My lab studies early-life stress in pigs and how it impacts their health later in life, specifically in the gastrointestinal (GI) tract. Pigs, whose GI tracts are extremely similar to those of humans, may be one of the clearest windows we have into researching stress, disease, and new therapies and preventatives – both in livestock and people.
In my study of how stress makes humans and pigs vulnerable to disease, I have seen the profound impact that stress-related chemical substances, such as hormones and peptides, can have on a body’s tissues. I’m hopeful that our research in piglets could eventually lead to treatments for both people and animals designed to mitigate the adverse effects of stress on the GI health.
How stress can save your life
Not all stress is bad. When we perceive a threat, our hypothalamus – one of our most basic parts of the brain – kicks in to protect us by triggering what many recognize as the “fight or flight” response. It is a primal evolutionary response programmed in our brains to help us first survive and then restore us to a normal set point, or what feels like stability.
What actually is happening has to do with something called the hypothalamic-pituitary-adrenal (HPA) axis, which is at the core of the stress response. During stress, the hypothalamus, a region in the brain, makes and sends out a chemical called corticotrophin-releasing factor, which signals for the pituitary gland to release another chemical, adrenocorticotrophic hormone.
This stimulates the adrenal gland to release adrenalin and cortisol. Adrenalin and cortisol, two of the most well-known stress hormones, power our bodies to react during the fight or flight response. They can heighten our response time in a fight. They can pump blood to our extremities when we flee. They can boost our immune system to protect against pathogens. That stress response gives us what we need to resolve the situation.
How stress can harm your life
Fortunately for many of us, we don’t have to deal with life-threatening situations on a regular basis. However, we still experience stress. This stress can be chronic, due to a specific situation or overall lifestyle.
But, our stress response is meant for short-term resolvable conflict. So, in a way, the stress response is misplaced in today’s world of enduring stressors. Danger comes when we experience repeated elevations of these stress hormones, or when we are exposed to too much of these stress hormones at a young age. Instead of physical threats, many of us experience psychosocial stress, which triggers a similar stress response but is often not resolvable.
For example, stress in the workplace, such as feeling overworked or undervalued, could be perceived as a threat and in turn activate the stress response. However, in these situations, the survival aspects of the stress response, such as increased heart rate and immune activation, is not effective in resolving this threat.
This results in continued production and higher levels of these stress chemicals in the body. They bind to target receptors in many organs, which can have profound effects on physiology and function.
High levels of stress are also especially harmful when they occur at a young age, when many of the body’s important stress regulatory systems – for example, the brain and nervous systems – are still developing. Exposure to stress in early life can alter the normal development and physiology of many organ systems, resulting in increased sensitivity to stress and lifelong health risks in offspring.
Also, a mother’s stress during pregnancy can be “transmitted” to the fetus, resulting in permanent changes to the stress response system and health in offspring.
This early-life stress can fuel a constant stress response inside the body. This can include inflammation, or increased activity of the immune system, or immune suppression as its new “normal.”
Inflammation and immune suppression are unpredictable and can manifest in many parts of our body, with different consequences. For example, stress and inflammation near blood vessels can cause blood vessels to constrict. This causes elevated blood pressure, which can lead to a slew of other conditions like coronary artery disease and heart attack.
Immune suppression can reduce the body’s ability to heal wounds and make it more susceptible to other pathogens. Inflammation and immune suppression can affect anything, including our mental health. Chronic stress can traffic immune cells into the brain, where they can cause neuroinflammation, which can affect our mood and fuel diseases like depression and anxiety.
Your GI tract and you
The GI tract is our largest interface with the outside world. If you think about it, your GI system is “outside” your body; it experiences many of the pathogens and other foreign entities with which we come into contact. If you unfolded your entire GI system, it would cover a tennis court. The GI system also contains just as many neurons as your spinal cord and houses the largest collection of immune cells in the body. A system of that size is as powerful as it is susceptible.
Early-life stress is especially concerning; scientists only now are beginning to understand the long-term consequences. My research demonstrates the impacts of early-life stress on animal health and productivity, as well as human health. In pigs, this stress can result from early weaning and other management practices. In humans, it could be from physical or emotional trauma like abuse or neglect.
What we can learn from piglets
Pigs and humans have similar digestive tracts, making pigs an excellent model for human GI disease. My research team has demonstrated early stress in piglets results in GI symptoms (e.g. diarrhea, GI infections) that are remarkably similar to stress-related GI disorders in people: Irritable bowel syndrome, inflammatory bowel disease and food allergies are examples.
Through my lab’s research of piglets and early-life stress, we have been able to significantly lower the stress and GI disease that they experience through their life by eliminating individual early-life stressors.
Much of their stress is caused through early weaning, social change due to maternal separation and mixing with unfamiliar pigs. These pigs then experience a higher rate of gastrointestinal and respiratory diseases, as well as reduced growth performance and feed efficiency into adulthood.
We also learned that a particular type of immune cell, called the mast cell, becomes highly activated during stress, which in turn causes much of the stress-associated GI disease. By focusing on animal welfare and implementing new management practices to eliminate individual stressors or intervene therapeutically with mast cell blockers, we can lower the overall threshold of stress that the piglets experience.
This basic research could result in future breakthroughs regarding how we combat stress in humans. Maybe with more fundamental research in animal models, we can develop a therapy to help lessen the impact of bad stress on our bodies.
In the meantime, those of us experiencing stress can take action. If you experience a lot of stress on a daily basis, focus on what you can and cannot control, and then apply your energy to the things within your control while taking care of your body by eating properly, getting enough sleep, and maintaining some level of physical activity. Then, learn to cope with the things you cannot control through therapy, meditation and other stress management practices.
The annual Uehiro lectures will take place in Oxford next week. This year, they are by Richard Holton, Professor of Philosophy at the University of Cambridge. Their topic interests me because I feel strongly that we need to start looking differently at various forms of illnesses. Continue reading
I just ran into the case of KW, a 52-year-old woman who suffered a brain haemorrhage during an operation at age 34. A complicated matter. Am still reading and mulling it all.
Want to know how? Watch this TED Talk.
People are currently focusing on Trump and his silly comments, but perhaps they should be focussing on Britain.
A few days ago, British newspaper The Guardian reported about a eugenics meeting that allegedly had been convened in secret, involving someone who has previously advocated child rape. This meeting is supposed to have taken place at University College London and white supremacists supposedly were present at this meeting. Continue reading
Interview with Mark Easton, BBC. Date unknown, but near the end of Tony Blair’s premiership.
Keep in mind that “hooliganism” and “anti-social behaviour” are often labels used to indicate (and reject) people from a lower socioeconomic class in Britain and that this “hooliganism” for example gets expressed in graffiti.
Of course, causing (increased) financial hardship for parents by taking any benefits away is most definitely not “in the best interest of the child”.
Tony Blair did consider graffiti “anti-social behaviour”. During a photo-op as part of his crusade, he hosed down graffiti and said that older generations of his family would have abhorred such behaviour. It then turned out that his own grandmother had been a “commie” graffiti vandal.
There probably is a work by Banksy somewhere in response to all of this.
Tony Blair also criminalized a lot of behavior that is essentially merely human behavior. That too was in nobody’s best interest and probably did nothing toward decreasing inequality in Britain.
It did not enable (more) people to flourish.
A designer baby is any baby who is preferred over another baby, the way one might pick a handbag or a rug.
The only exception should be when the resulting baby ends up having a life not worth living. In my book “We need to talk about this“, I give a definition of “a life not worth living” that has held up so far. This definition does not represent what I feel, but what could be doable to work with in practice.
This also means, however, that parents should get all the assistance they need. This means that the baby (and child) should get all the assistance he or she needs to enable him or her to FLOURISH.
Society creates so many hindrances for anyone who isn’t mainstream. We should embrace diversity as it enriches society and we should address the artificial impairments so that they disappear.
I also believe that techniques like CRISPR should be used first to help remedy these “lives not worth living”. Why? Because it is a logical approach, based on the application of (generally globally accepted) principles instead of personal preferences.
Model and former Miss Great Britain Danielle Lloyd is flying to Cyprus for a designer baby:
I am wrapping up the much improved version of “We need to talk about this“. There is now a chapter on euthanasia, for instance, with a discussion of the Groningen Protocol.
I didn’t write this book to convince you that my views are the right ones, even though I hope you will agree with many of them. I wrote this book to encourage as many people as possible to develop their own opinions in these areas, to go beyond impassioned exclamations like “this is so wrong” or “this is very good” and to make their opinions known to their governments and academics, and to discuss these issues with their friends, relatives and colleagues. Continue reading
Well, okay, as long as you start with Juan’s talk.
As a psychiatrist, I find that one of the hardest parts of my job is telling parents and their children that they are not to blame for their illness.
Children with emotional and behavioral problems continue to suffer considerable stigma. Many in the medical community refer to them as “diagnostic and therapeutic orphans.” Unfortunately, for many, access to high-quality mental health care remains elusive.
An accurate diagnosis is the best way to tell whether or not someone will respond well to treatment, though that can be far more complicated than it sounds.
I have written three textbooks about using medication in children and adolescents with emotional and behavioral problems. I know that this is never a decision to take lightly.
But there’s reason for hope. While not medically able to diagnose any psychiatric condition, dramatic advances in brain imaging, genetics and other technologies are helping us objectively identify mental illness.
Knowing the signs of sadness
All of us experience occasional sadness and anxiety, but persistent problems may be a sign of a deeper issue. Ongoing issues with sleeping, eating, weight, school and pathologic self-doubt may be signs of depression, anxiety or obsessive-compulsive disorder.
Separating out normal behavior from problematic behavior can be challenging. Emotional and behavior problems can also vary with age. For example, depression in pre-adolescent children occurs equally in boys and girls. During adolescence, however, depression rates increase much more dramatically in girls than in boys.
It can be very hard for people to accept that they – or their family member – are not to blame for their mental illness. That’s partly because there are no current objective markers of psychiatric illness, making it difficult to pin down. Imagine diagnosing and treating cancer based on history alone. Inconceivable! But that is exactly what mental health professionals do every day. This can make it harder for parents and their children to accept that they don’t have control over the situation.
Most important of all is making sure your child is assessed by a licensed mental health professional experienced in diagnosing and treating children. This is particularly important when medications that affect the child’s brain are being considered.
Seeing the problem
Thanks to recent developments in genetics, neuroimaging and the science of mental health, it’s becoming easier to characterize patients. New technologies may also make it easier to predict who is more likely to respond to a particular treatment or experience side effects from medication.
Our laboratory has used brain MRI studies to help unlock the underlying anatomy, chemistry and physiology underlying OCD. This repetitive, ritualistic illness – while sometimes used among laypeople to describe someone who is uptight – is actually a serious and often devastating behavioral illness that can paralyze children and their families.
Through sophisticated, high-field brain imaging techniques – such as fMRI and magnetic resonance spectroscopy – that have become available recently, we can actually measure the child brain to see malfunctioning areas.
We have found, for example, that children 8 to 19 years old with OCD never get the “all clear signal” from a part of the brain called the anterior cingulate cortex. This signal is essential to feeling safe and secure. That’s why, for example, people with OCD may continue checking that the door is locked or repeatedly wash their hands. They have striking brain abnormalities that appear to normalize with effective treatment.
We have also begun a pilot study with a pair of identical twins. One has OCD and the other does not. We found brain abnormalities in the affected twin, but not in the unaffected twin. Further study is clearly warranted, but the results fit the pattern we have found in larger studies of children with OCD before and after treatment as compared to children without OCD.
Meanwhile, the field of psychiatry continues to grow. For example, new techniques may soon be able to identify children at increased genetic risk for psychiatric illnesses such as bipolar disorder and schizophrenia.
New, more sophisticated brain imaging and genetics technology actually allows doctors and scientists to see what is going on in a child’s brain and genes. For example, by using MRI, our laboratory discovered that the brain chemical glutamate, which serves as the brain’s “light switch,” plays a critical role in childhood OCD.
What a scan means
When I show families their child’s MRI brain scans, they often tell me they are relieved and reassured to “be able to see it.”
Children with mental illness continue to face enormous stigma. Often when they are hospitalized, families are frightened that others may find out. They may hesitate to let schools, employers or coaches know about a child’s mental illness. They often fear that other parents will not want to let their children spend too much time with a child who has been labeled mentally ill. Terms like “psycho” or “going mental” remain part of our everyday language.
The example I like to give is epilepsy. Epilepsy once had all the stigma that mental illness today has. In the Middle Ages, one was considered to be possessed by the devil. Then, more advanced thinking said that people with epilepsy were crazy. Who else would shake all over their body or urinate and defecate on themselves but a crazy person? Many patients with epilepsy were locked in lunatic asylums.
Then in 1924, psychiatrist Hans Berger discovered something called the electroencephalogram (EEG). This showed that epilepsy was caused by electrical abnormalities in the brain. The specific location of these abnormalities dictated not only the diagnosis but the appropriate treatment.
That is the goal of modern biological psychiatry: to unlock the mysteries of the brain’s chemistry, physiology and structure. This can help better diagnose and precisely treat childhood onset mental illness. Knowledge heals, informs and defeats ignorance and stigma every time.
A world mental health survey shows that about 5.2% of people who lose loved ones suffer from PTSD. But how do you know who suffers from PTSD after a traumatic loss so that you can give them the care they need?
Unfortunately, in Africa most people go undiagnosed. This is because only two countries on the continent have carried out national surveys on mental health – South Africa and Nigeria. Concerning trauma and PTSD, the only significant data emanated from the South African Survey, since the Nigerian one did not have a high enough prevalence rate to enable detailed analysis.
The recent global survey identified a number of predictors that significantly increase the risk of PTSD after a loss. These include: whether the deceased is either a spouse or child, being female, believing that one could have done something to prevent the death, prior exposure to a traumatic event and having a previous mental disorder before the trauma.
Using these predictors it was possible to construct a model that can be used to determine those with the highest risk of developing PTSD after the unexpected death of a loved one. This model makes it feasible for clinicians helping people who have suddenly lost loved ones to develop interventions that are evidence-based and with high probability of success. This should provide opportunities for affected people being able to be provided with the appropriate care after this traumatic event.
PTSD and death
PTSD happens after a person is exposed to an event that poses a threat to their life. It is a group of symptoms that include re-experiencing the event, changes in emotions and cognitive functions. Irritability, reckless or self-destructive behaviour, sleep problems and low concentration are common.
Families and caregivers can recognise PTSD in a loved one because the symptoms are a change from their usual behaviour. These signs and symptoms begin within a month of experiencing the traumatic event like the unexpected death of a loved one.
The person may experience nightmares or flashbacks, will avoid distressing memories, thoughts, or feelings associated with the traumatic event.
Due to the trauma, the person may also develop memory problems and feelings of detachment from friends, colleagues and family are common. The person may also display exaggerated negative beliefs about themselves, others or the world. In some cases, depression and drug abuse is noted.
People who have unexpectedly lost a loved one are at a higher risk of getting PTSD so they should be identified early enough and appropriately counselled.
The high prevalence and meaningful risk of PTSD makes the unexpected death of a loved one a major public health issue. Due to a collaborative initiative under the World Health Organisation (the World Mental Health Surveys Initiative) it is now possible to predict the occurrence of PTSD after a traumatic event such as the unexpected death of a loved one.
The resulting screening assessments will be useful in identifying high risk individuals prone to PTSD for early interventions.
Raising relevant data is one of the biggest challenges to tackling the issue of PTSD in Africa.
African countries should carry out national mental health surveys because they provide information that can be used for planning care and rationally allocating resources in mental health. They also provide information necessary in policy formulation and mental health interventions.
Without a national survey, countries often misallocate resources, ending up with situations in which they neglect the most important problems and intervene disproportionately in low priority areas. This is responsible for the current situation in which what is probably a silent mental ill-health epidemic which is sweeping across the continent.
(But not really.)
Another example of what Ms May’s reign is resulting in:
I have a hospital appointment next month and I will likely cancel it and go to an optician instead, and pay for my examination. My eyes require an examination every six months, and my eye condition (pigment dispersion syndrome) makes me very angry and powerless because it really hampers what I can do with my life. It tethers me to fridges, pharmacies and hospitals. (It makes me particularly angry because I was finally free from having to have periods and I was so enjoying that freedom.)
I hate that stupid class system that only the British have and that classifies human beings into lesser and higher humans. I too will never be anything but fourth-rate in Britain. I have tick marks in so many “negative” boxes against me. I will never even be second-rate here and this is currently actively driven by the government here.
After reading what it says in that Metro article, I will definitely cancel my hospital appointment. I have had plenty of state-driven hatred and human rights violations in Britain and am sick of it. I won’t put up with any more of it. Enough is enough.
And I’ll get my eye meds some other way too. (That’ll be the modern variety that does not require refrigeration, by the way.)
Yes, of course, there are worse things than having a stupid eye condition that in itself is quite interesting/funny. But I don’t get to choose whether I have it or not.
So Theresa May wanting to subject me to discrimination on account of it is something I will not stand for. If I put up with abuse without protesting, I become a party to it and just as guilty of my own abuse.
Appointment cancelled. Strangely enough, the message I received in response was “We are grateful for this questionnaire response based on your experience of our services. All completed questionnaires are completely anonymous. Thank you for your support.” The form I used requested many personal details.
For those of you who don’t know that, we foreigners go through an interview process before we get our national insurance number and card. We need it for all sorts of things. It is also on our tax papers, for instance. (But apparently, I can cut the thing in two and throw it out now.)
Could a diet high in refined sugars make children and adults more susceptible to opioid addiction and overdose? New research, from our laboratory of behavioral neuroscience at the University of Guelph, suggests it could.
Approximately 20,000 people died of fentanyl-related overdoses in the United States last year and in Canada there were at least 2,816 opioid-related deaths. During 2017 so far, over 1,000 people have died of illicit drug overdoses in British Columbia. High schools are stocking up on the overdose-reversing drug naloxone and universities are training staff to administer the drug.
Nobody is talking about sugar.
And yet there is substantial experimental evidence that refined sugar can promote addictive behaviours by activating the brain’s rewards centres in much the same way as addictive drugs. Opioid abuse is also associated with poor dietary habits, including preferences for sugar-rich foods, as well as malnutrition. These connections have led to questions of whether excessive consumption of refined sugar may affect vulnerability to opioid addiction.
To explore the possible role of a sugar-rich diet in opioid addiction, we investigated whether unlimited access to high fructose corn syrup (HFCS) altered rats’ neural and behavioural responses to the semi-synthetic opioid, oxycodone.
Our findings suggest that a diet high in corn syrup may dampen the reward associated with oxycodone and may therefore encourage consumption of higher quantities of the drug.
Opioids, high fructose corn syrup and addiction
High fructose corn syrup is a refined sugar that typically includes more fructose than glucose. It is a commonly used food additive in North America, produced by chemically processing corn. Although it is employed in many processed foods, its use in soft drinks appears to have the biggest impact on health. In fact, there is a significant relationship between increased consumption of sugar-sweetened beverages and weight gain, metabolic syndrome and hypertension.
Recently, our laboratory has been exploring the impact of HFCS on behaviours and brain markers of addiction in laboratory rats. In one study conducted by my PhD student Meenu Minhas, animals had unrestricted around-the-clock access to bottles containing a water solution sweetened by HFCS. After about a month of voluntary drinking, the bottles were removed and, after a few sugar-free days, animals’ behavioural and neural responses to oxycodone were assessed.
Similar to other opioids, oxycodone induces pharmacological effects that include analgesia, euphoria and feelings of relaxation. Some common street names include: “hillbilly heroin,” “perc,” and “OC.” Oxycodone is the active ingredient in a number of formulations which include intravenous injections, immediate release solutions/capsules (Percocet, Percodan, OXY IR, OXY FAST), and extended release preparations (OxyContin).
Oxycodone is also highly addictive and has impacted the lives of numerous North Americans. There are estimates that its consumption increased by almost 500 per cent from 1999 to 2011. The U.S. National Survey on Drug Use and Health revealed that approximately 27.9 million people aged 12 or older used oxycodone products. Moreover, 4.3 million people aged 12 or older reported misusing oxycodone-containing products in the past year.
Dampening drug’s reward may increase use
At the neural level, HFCS exposure decreased oxycodone-induced release of dopamine, which is a desire-promoting neurotransmitter active in the brain’s reward circuits.
Furthermore, at low doses, sedative drugs like opioids and alcohol normally interfere with inhibition and stimulate a variety of “psychomotor” behaviors — such as sociability, extroversion, talkativeness, sensation seeking and interest in novelty. Our study in rats found that exposure to the high fructose corn syrup reduced this psychomotor stimulation induced by oxycodone.
Our experiments show that chronic exposure to high fructose corn syrup had an impact on both the neural and behavioural responses to oxycodone, resulting in changes likely to affect drug-taking and drug-seeking behaviour. They suggest that a high sugar diet may dampen the reward associated with a given dose of oxycodone. And that this may cause people to consume more of the drug.
These results suggest that nutrition, and high fructose corn syrup intake in particular, can influence responses to opioids — a finding that may be relevant both to clinical uses of opioids and to treatment of addiction.
We can win the war on opioid addiction only if we tackle the problem from multiple angles. Our findings, and those of other laboratories, strongly suggest that prevention of unhealthy diets may not only help reduce the obesity epidemic, but also reduce environmental factors that may predispose to opioid addiction.
“IMF research has shown that excessive inequality hinders growth and hollows out the country’s economic foundation. It erodes trust within society and fuels political tensions.”
In the past three decades, economic inequality between countries has declined sharply, said Christine Lagarde at her recent public speech at Harvard’s Kennedy School of Government.
“But if we look at inequality within countries, especially some advanced economies, we see widening gaps and an increased concentration of wealth among the top earners.”
There are no lesser human beings and higher human beings. That idea is a fallacy. Greater equality brings greater happiness, particularly if it lifts everyone who is in deep poverty out of it, and even benefits those at the top.
In 1981, the average top marginal tax rate in advanced economies was 62%. In 2015, it was 35%. New IMF research (which will be published next week) suggests that some advanced economies could raise their top tax rates without slowing growth. “Worth considering.”
“What is not yet done is only what we have not yet attempted to do.” – Alexis de Tocqueville
It was a woman in Sarasota who e-mailed me a few years ago at the recommendation of someone else in Florida who made me aware of the problem with foie gras.
Essentially, it is the product of disease and torture, which is why its sale as well as its production is against the law in many countries. The disease is called hepatic lipidosis. Fatty liver disease. It is deliberately inflicted on geese and duck for the production of foie gras.
Many celebrities have spoken out against it and actively campaigned against it. The woman in Sarasota – not a celebrity – was campaigning to stop its use in local restaurants.
I made a (semi-mock) campaign for a course I was taking in 2010, and I also boycotted Amazon until Amazon banned its sales.
Since then, I’ve been boycotting eBay UK. Ebay is stubborn and still allows its sales, although it depends on the country. I’ve never seen foie gras offered from the Netherlands, but eBay.nl does accept offers from the UK, France and Germany.
Occasionally, sellers still try to sneak it in on Amazon by calling it a book, when they sell tins of the stuff packaged in cardboard, I later saw. When I spot it, I report it.
In Britain, Viva! is a very active campaigner against foie gras.
The town of Los Algodones in Mexico is nicknamed “Molar City”. It has a population of just 6,000 people and, shockingly, it has more than 500 practising dentists. This has produced an intense clustering of dental clinics within a four block radius.
Many of these dentists chose to work in this town because of the tourist traffic, given its proximity to the Mexico-United States border. Thousands of Canadian and American tourists park their cars and walk across the border into Los Algodones to spend the day souvenir shopping, eating and drinking in the local restaurants, and purchasing alcohol, prescription drugs and dental care at lower costs than available back home.
In 2015 and 2016, I spent four months living in Los Algodones conducting interviews and participating in local events for a doctoral research project in health sciences at Simon Fraser University. My work investigates dental travel as part of the wider phenomenon of “medical tourism” — an industry that is growing rapidly as more and more patients seek access to new or more affordable medical treatments outside of their countries of residence.
My research raises concerns about exploitative industry practices in Los Algodones, Mexico. These include poor working conditions and discriminatory practices for employees in dental clinics, harassment of Indigenous street vendors and lack of access to dental care for local residents.
Inside ‘Molar City’
Most of the residents and employees I met during my research in Los Algdones were grateful for the much-needed economic benefits of the dental tourism industry. But I also heard concerns and frustrations from members of the local population. They felt that many of the industry activities were unfair and difficult to change.
One interviewee explained how dental tourists often come with prejudiced assumptions about Mexico, stating: “We see a lot of racism […] people trying to come here and saying, okay it is Mexico, I can ask for anything and pay you less.”
Local residents and industry employees felt that dental tourists’ perceptions of Mexico as unsafe and underdeveloped are driving poor working conditions and discriminatory practices.
For example, employees work long hours to promote Los Algodones’ reputation for their employers as an ideal site to purchase dental care. Some also said they had experienced harassment from dental tourists negotiating lower prices and faster care.
Harassment of Indigenous vendors
Clinic employees and local residents also experience stressful interactions in the industry to meet the expectations of clinic owners. Some owners encourage employees to minimize their Mexican accents. This is done to distance Los Algodones from prejudiced perceptions of Mexico as an underdeveloped place with inferior medical care.
One participant described how a dental clinic owner offered to pay him to dump buckets of water on the heads of Indigenous souvenir vendors working near his clinic. Along with harassment, clinic owners also encourage Indigenous vendors to “stay cool, sell stuff cheap, and smile to people.” Many owners worry that the presence of Indigenous vendors might deter tourists by representing the underdeveloped Mexico of tourists’ imaginations.
Local residents struggle to access dental care
My research also revealed that dental clinic owners’ concerns about reputation can decrease access to dental care for local residents. Clinic owners suggested they’re too busy marketing their services and treating foreign patients to treat many locals. Some owners are using free X-rays to entice tourists, who shop around for their ideal care.
Most of the dental services in Los Algodones are also focused on the provision of major restorative treatment rather than preventative care, given the needs of dental tourists. Most local residents cannot afford this type of care. This is concerning as there are limited publicly funded dental care options available in this region of Mexico.
Overall, the “dental Shangri-la of the Mexican desert” is only an oasis for those able and willing to travel and pay for dental care. For many, the industry provides much-needed employment. But this might be stressful, unfair work for individuals unable to use the dental oasis for their own health needs.
The need for global regulation
Participation in the global medical tourism industry is increasing and research shows that this growth raises serious ethical challenges, at least in the industry’s current form. Researchers have raised concerns about the negative impacts on the health of local people who live and work in these medical tourism destinations.
My in-depth investigation of industry practices in the town of Los Algodones provides more evidence to support these concerns. It suggests the need for better global regulation of dental tourism and medical tourism more widely.
This regulation is needed to avoid competition between industry sites driving down labour standards in the global industry and diverting health resources away from populations in need. This regulation could enforce acceptable work conditions to avoid a race-to-the-bottom effect as industry sites try to attract customers to lower-cost, desirable medical care.
More information about these concerns could also help individuals participating in the industry to avoid harmful practices. It could remind medical tourists that cost savings for care might come at a cost to fair labour standards — and that they should allow sufficient time for treatment and be prepared to pay fair prices.
- Crops for livestock feed damage ecosystems and threaten wildlife, says WWF UK.
- The conservation NGO estimates that just the UK’s livestock industry has caused the extinction of 33 species worldwide.
- However, if people lower their protein intake to recommended amounts, farmers would need 13 percent less land to produce feed for livestock and farmed fish, saving an area 1.5 times the size of the EU.
The conservation NGO WWF UK is calling on consumers to cut back the amount of meat they eat. Land used to produce feed crops for livestock and farmed fish threatens biodiversity and delicate ecosystems, the organization argues in a new report released Oct. 3.
“The world is consuming more animal protein than it needs and this is having a devastating effect on wildlife,” Duncan Williamson, a food policy manager at WWF, told the Guardian. “We know a lot of people are aware that a meat-based diet has an impact on water and land, as well as causing greenhouse gas emissions, but few know the biggest issue of all comes from the crop-based feed the animals eat.”
With its conclusions centering primarily on the UK and Europe, the publication’s authors report that the UK’s livestock industry is responsible for driving perhaps 33 species to extinction, as the need for land to grow food to feed chickens, pigs and fish puts pressure on the animals that once called those areas home.
“Feed crops threaten the biodiversity of many of Earth’s most valuable and vulnerable areas,” WWF UK writes, including the Amazon, the Congo Basin, South America’s Cerrado and Asia’s Mekong.
Farmers have ratcheted up soybean production in recent years, and if the trending increase in demand for meat, and by extension livestock feed, continues, they’ll have to produce almost 80 percent more than 2010 levels by 2050.
Poultry production has jumped from 15 percent of global meat production in the 1960s to 32 percent in 2012. As a result, much of that feed — 41.5 percent across Asia, Europe and the United States — is headed for the mouths of hungry birds. Pigs also take a sizeable share at 30 percent of the world’s feed. And fish farming, on the rise as wild stocks struggle to cope with consumer demand, needs another 4 percent.
WWF UK proposes several alternatives to land-hogging feed cropping to provide sustenance to growing flocks, herds and schools of animals destined for the dinner table. Insects could supplement animal feed, as they pack about the same amount of growth-inducing protein as soybeans. Raising them doesn’t emit as much carbon as farming, and they don’t require as much land to produce. Algae, too, could be an alternative livestock food source on a large scale in the future, with the benefits that it can make its own food with few inputs other than nutrients and carbon dioxide.
These potential solutions, however, don’t address the uptick in demand for animal-based protein. Each of us eats on average 25 kilograms (55 pounds) of chicken every year, and our annual fish take is 19.7 kilograms (43 pounds) per person — nearly twice what it was in the 1960s. But WWF UK says we don’t need that much meat.
British health guidelines figure that the average person needs a maximum of 55 grams of protein per day, and yet Britons consume 64 to 88 grams, one-third of which comes from meat.
By notching that intake down to the recommended levels, farmers would need 13 percent less land to produce livestock feed. That translates to an area 50 percent larger than the EU — 650 million hectares (2.5 million square miles) — that could remain undisturbed by agriculture.
Not only is it more sustainable – which I checked with sustainable fisheries expert Edd Hind a few years back – canned / tinned mackerel has all the healthy fish oils. Tuna in cans or tins does not.
Three-quarters of all abortions in Latin America are performed illegally, putting the woman’s life at risk. Together with Africa and Asia, the region accounts for many of the 17.1 million unsafe abortions performed globally each year, according to a new report in The Lancet, published jointly with the Guttmacher Institute, a research and policy group.
Though worrying, this fact is unsurprising in a region where six countries ban abortion under all circumstances: the Dominican Republic, El Salvador, Haiti, Honduras, Nicaragua and Suriname. Such complete criminalization, even when fetal termination is necessary to save a woman’s life, exists in only two other places in the world: Malta and the Vatican.
Numerous studies confirm that restrictive laws do not in any way prevent women from seeking or getting abortions. And in the vast majority of Latin American countries – including Argentina, Bolivia, Colombia, Ecuador, Venezuela and, since August 2017, Chile – this medical procedure is legal, though it generally requires specific justification, such as maternal health or rape.
Not so in Central America, home to three of the eight countries in the world with total abortion bans. As I am a Costa Rican lawyer and feminist, to me, it’s no small matter that women in many neighboring countries lack access to this basic health service.
Why does this region so studiously avoid recognizing women as full individuals entitled to their own human rights? In my view, there’s a clear link in Latin America between the state of a country’s democracy and the reproductive rights of its female citizens.
Honduras: Land of inequality
In Honduras, for example, it was only after the 2009 coup d’état that ousted President Manuel Zelaya – a huge democratic setback that ushered in an era of violence – that the country passed a total ban on abortion.
Despite efforts by human rights defenders and official statements by the United Nations, independent experts and NGOs like Amnesty International, there has been no material progress in advancing the reproductive rights of Honduran women.
In some ways, this is not surprising. In post-coup Honduras, human rights violations – ranging from violence and poverty to impunity – are routine fare for the entire population. Rampant gender inequality is just another symptom of this dismal situation.
Nicaragua and El Salvador: Dangerous setbacks
The situation in Nicaragua, just to the south, is similar. There, “therapeautic abortion” – the common parlance for ending a pregnancy for health-related reasons – was acceptable from 1837 until relatively recently. But starting in 2007, President Daniel Ortega, who has modified the Constitution to end term limits, began passing legal amendments to ban abortions completely, without any exceptions.
Ortega supported abortion rights during his first presidency, in the 1980s. But he has since embraced the Catholic Church’s position of strong opposition, with deadly consequences for Nicaraguan women.
In 2010, for example, a pregnant woman who went by the pseudonym of “Amelia” was refused treatment for metastatic cancer because the state ruled that the regime of chemotherapy and radiotherapy – which her doctor had urgently recommended – might trigger a miscarriage.
The Inter-American Commission on Human Rights ultimately issued injunctions for Amelia, but the damage was already done. She died in 2011.
Impossible though it may seem, women fare worse in El Salvador, a civil war-torn country rife with violence, unpunished crimes and criminal infiltration of the police. In 1999, El Salvador constitutionally mandated that human life starts at the moment of conception.
This legal argument is now used to uphold a full criminalization of abortion, even under the most extenuating circumstances, such as when a woman’s life is at risk, the pregnancy is the result of rape or the fetus is severely malformed.
Anti-abortion sentiment is so virulent in El Salvador today that even miscarriages may be investigated on suspicion that they were self-induced. This persecution has had lethal consequences: Women who’ve spontaneously lost a pregnancy have been accused of murder, sometimes by even their own law-abiding relatives.
In 2016, Sweden offered political asylum to a Salvadoran woman who was sentenced to 40 years of prison for the aggravated homicide of a fetus miscarried before she even knew she was pregnant.
The United Nations Committee on the Elimination of all Forms of Discrimination Against Women has requested that El Salvador decriminalize abortion, saying that the fact that most women prosecuted and sentenced for this crime are among the country’s most vulnerable citizens – young, uneducated, jobless and single – represents a powerful social injustice.
Though there are great economic, cultural and political differences between these three countries, across Central America the connection between the lack of rule of law and women’s restricted reproductive rights is noteworthy.
That’s because denying women the ability to make decisions about their own bodies means that a woman’s life matters only to the extent that she is the custodian of a potential future life, rather than as a life worthy of protection.
The Constitutional Court of Colombia agrees. In 2006, it stated in its legal justification for decriminalizing abortion, “The dignity of women does not permit that they be considered mere receptacles.”
In Chile, which recently legalized abortion after nearly a half-century of its total prohibition, history shows a similar relationship between democracy and women’s rights. In 1931, the Chilean Congress approved the voluntary interruption of pregnancy for medical purposes if the woman’s life was endangered or the fetus was not viable.
This exception remained in place until, in 1973, under the dictatorship of Augustin Pinochet, abortion became illegal. In 1980, the Chilean Constitution established that the law protected the life “of the unborn,” indicating that the life of a woman was worth less than that of an embryo.
Even after democracy was restored to Chile, in 1991, this ban remained in place. It was not until August 2017, some 26 years later, that the country adopted a more sensible approach, focused on protecting women’s lives and health. The Chilean case demonstrates that once women lose their value as individuals in the eyes of the state, it is difficult to win back.
What’s at risk in the Latin American regimes where abortion is still forbidden, then, are not only women’s lives but also the political systems of Central American society itself. Can democracy exist in places that don’t recognize women as people?
Okay, that is a slight oversimplification. (Ask any boat refugee, particularly one that is about to drown. Or a child that is being abused.)
But aside from that, it’s true.
Except, it is very easy in some circumstances and very hard in other situations. It is much harder to be happy when you’re cold and hungry, for example. Takes more effort.
British weather isn’t much to write home about. The temperate maritime climate makes for summers which are relatively warm and winters which are relatively cold. But despite rarely experiencing extremely cold weather, the UK has a problem with significantly more people dying during the winter compared to the rest of the year. In fact, 2.6m excess winter deaths have occurred since records began in 1950 – that’s equivalent to the entire population of Manchester.
Although the government has been collecting data on excess winter deaths – that is, the difference between the number of deaths that occur from December to March compared to the rest of the year – for almost 70 years, the annual statistics are still shocking. In the winter of 2014/15, there were a staggering 43,900 excess deaths, the highest recorded figure since 1999/2000. In the last 10 years, there has only been one winter where less than 20,000 excess deaths occurred: 2013/14. Although excess winter deaths have been steadily declining since records began, in the winter of 2015/16 there were still 24,300.
According to official statistics, respiratory disease is the underlying cause for over a third of excess winter deaths, predominantly due to pneumonia and influenza. About three-quarters of these excess respiratory deaths occur in people aged 75 or over. Unsurprisingly, cold homes (particularly those below 16°C) cause a substantially increased risk of respiratory disease and older people are significantly more likely to have difficulty heating their homes.
Health and homes
The UK is currently in the midst of a housing crisis – and not just due to a lack of homes. According to a 2017 government report, a fifth of all homes in England fail to meet the Decent Homes Standard – which is aimed at bringing all council and housing association homes up to a minimum level. Despite the explicit guidelines, an astonishing 16% of private rented homes and 12% of housing association homes still have no form of central heating.
Even when people have adequate housing, the cost of energy and fuel can be a major issue. Government schemes, such as the affordable warmth grant, have been implemented to help low income households increase indoor warmth and energy efficiency. However, approximately 2.5m households in England (about one in nine) are still in fuel poverty – struggling to keep their homes adequately warm due to the cost of energy and fuel – and this figure is rising.
Poor housing costs the NHS a whopping £1.4 billion every year. Reports indicate that the health impact of poor housing is almost on a par with that of smoking and alcohol. Clearly, significant public health gains could be made through high quality, cost-effective home improvements, particulalrly for social housing. Take insulation, for example: evidence shows that properly fitted and safe insulation can increase indoor warmth, reduce damp, and improve respiratory health, which in turn reduces work and school absenteeism, and use of health services.
Warmth on prescription
In our recent research, we examined whether warmer social housing could improve population health and reduce use of NHS services in the northeast of England. To do this, we analysed the costs and outcomes associated with retrofitting social housing with new combi-boilers and double glazed windows.
After the housing improvements had been installed, NHS service use costs reduced by 16% per household – equating to an estimated NHS cost reduction of over £20,000 in just six months for the full cohort of 228 households. This reduction was offset by the initial expense of the housing improvements (around £3,725 per household), but if these results could be replicated and sustained, the NHS could eventually save millions of pounds over the lifetime of the new boilers and windows.
The benefits were not confined to NHS savings. We also found that the overall health status and financial satisfaction of main tenants significantly improved. Furthermore, over a third of households were no longer exhibiting signs of fuel poverty – households were subsequently able to heat all rooms in the home, where previously most had left one room unheated due to energy costs.
Perhaps it is time to think beyond medicines and surgery when we consider the remit of the NHS for improving health, and start looking into more projects like this. NHS-provided “boilers on prescription” have already been trialled in Sunderland with positive results. This sort of cross-government thinking promotes a nuanced approach to health and social care.
We don’t need to assume that the NHS should foot the bill entirely for ill health related to housing, for instance the Treasury could establish a cross-government approach by investing in housing to simultaneously save NHS money. A £10 billion investment into better housing could pay for itself in just seven years through NHS cost savings. With a growing need to prevent ill health and avoidable death, maybe it’s time for the government to think creatively right across the public sector, and adopt a new slogan: improving health by any means necessary.
Dr Nathan Bray, Research Officer in Health Economics, Bangor University; Eira Winrow, PhD Research Candidate and Research Project Support Officer, Bangor University, and Rhiannon Tudor Edwards, Professor of Health Economics, Bangor University
When humanitarian emergencies flare up, what should prompt the U.S. government to “send in the Marines”?
Disasters like Hurricane Harvey’s floods in Houston and Hurricane Maria’s devastation of Puerto Rico’s roads and power grid can quickly overwhelm civilian authorities and emergency responders. Military support can make a life-or-death difference in those emergencies.
As scholars at the U.S. Naval War College and Harvard Humanitarian Initiative, we have seen that the military can have a profound and positive impact on the immediate response to large-scale disasters such as Hurricanes Harvey, Irma and Maria or the Haiti earthquake in 2010.
But soldiers, sailors, marines and aviators are primarily trained to fight, not feed disaster victims. When they report for humanitarian duties, it typically costs far more than when civilians handle them. Does their muscle actually go to good use?
Why deploy the military
Nonprofits like the Red Cross and government agencies like FEMA simply don’t have the equipment required following disasters like the one unfolding in Puerto Rico – where millions of people may lack power and clean drinking water for months.
Only the military can promptly dispatch the ships and planes required to move people, supplies and fuel. It has the electrical generators, water purifiers, bulldozers and lift equipment for search and rescue operations, debris removal and reconstruction.
At the same time, many military personnel also report that aid missions are good for morale, as countless service members take pride in doing disaster relief.
Having soldiers or sailors airlift people from their flooded homes or distribute hot meals is also great public relations at a time when the U.S. military is engaged in several unpopular and protracted conflicts abroad.
While military missions can fill critical gaps in response to large-scale natural disasters like Hurricanes Harvey, Irma and Maria, there are also significant limits to the military’s ability to jump in.
For one, there are laws restricting U.S. military operations on U.S. soil. The Posse Comitatus Act of 1878 prohibits active duty military personnel from engaging in civilian law enforcement, although the National Guard may be deployed in some circumstances.
Also, under a law known as the Stafford Act of 1988, the Department of Homeland Security may request military assistance as a last resort in major disasters and emergencies.
These restrictions have loosened up a little since the 9/11 terrorist attacks, granting the military and National Guard more leeway to support domestic counterterrorism operations. These changes made it easier for the military and National Guard to respond to the recent hurricanes.
But there are no such legal restrictions on how the U.S. military may respond to foreign disasters, as long as host governments request help or consent to it.
A common call
According to the Center for Naval Analyses, a federally funded defense research center, the U.S. military diverted units from “routine” operations to conduct humanitarian assistance operations 366 times from 1970 to 2000, compared with 22 times for combat missions.
Since 2000, the U.S. armed forces have conducted many massive humanitarian operations around the globe, such as responding to the 2004 Indian Ocean earthquake and tsunami and the 2015 Nepal earthquake, as well as Superstorm Sandy and Hurricane Katrina at home.
Given how frequently the military undertakes these missions, preparing for them should be a high priority. But that is not the case. With few notable exceptions, soldiers, sailors, marines and aviators spend little if any time training for disaster-response strategies, tactics, policies and procedures.
That is why aid workers for nonprofit organizations like Doctors Without Borders and Oxfam have expressed concerns about what they see as a growing “militarization” of humanitarian relief that endangers their own safety and hinders their effectiveness.
There is also the high cost of having boots on the ground doing civilian work.
Consider what happened when the U.S. military responded rapidly after the 2010 earthquake in Haiti that left 220,000 people dead, 300,000 injured and 1,500,000 people displaced. More than a third of the total of US$1.12 billion in U.S. aid – $453.5 million – covered the costs of military transport, personnel and supplies.
According to estimates by Aruna Apte at the Naval Postgraduate School and Keenan Yoho at Rollins College, the U.S. spent more than $17 million just to operate a single aircraft carrier nearby for 17 days – not counting personnel costs.
Aircraft carriers are essentially floating airfields that make it easier to access otherwise impossible-to-reach areas, facilitating evacuations. Although they can dispatch critical food, water and medicine, there are usually better ways to deliver aid after disasters.
For context, that $17 million could have covered the cost of all of the humanitarian organization Save the Children’s health programs in Haiti between 2010 and 2012.
Finding the balance
Despite the big price tag, military involvement in disaster relief is bound to grow. That’s because global humanitarian organizations are already stretched thin by competing needs.
Conflict-driven migration is growing, and severe storms are becoming more common as a result of climate change – along with the higher sea levels scientists say it is causing.
But we believe it would be a huge mistake for the government to rely primarily on the armed forces in the aftermath of disasters.
The military’s unique capacity can be incredibly useful in the short term. Yet even when its help is most needed, these deployments should be brief and tailored.
Other than in the immediate aftermath of the biggest emergencies, the government should activate civilian emergency responders and humanitarian aid groups instead of sending the Marines.
Julia Brooks, Researcher in international law and humanitarian response, Harvard Humanitarian Initiative (HHI), Harvard University and David Polatty, Director, Civilian-Military Humanitarian Response Program, US Naval War College
The High Court has rejected a judicial review challenging the current law which prohibits assisted dying in the UK. Noel Conway, a 67-year-old retired lecturer who was diagnosed with Motor Neurone Disease in 2014, was fighting for the right to have medical assistance to bring about his death. Commenting after the judgement on October 5, his solicitor indicated that permission will now be sought to take the case to the appeal courts.
Campaigners are often quick to highlight the strength of public support in favour of assisted dying, arguing that the current law is undemocratic. But there are reasons to question the results of polls on this sensitive and emotional issue.
There have been numerous surveys and opinion polls on public attitudes towards assisted dying in recent years. The British Social Attitudes (BSA) Survey, which has asked this question sequentially since the 1980s, has shown slowly increasing public support. Asked: “Suppose a person has a painful incurable disease. Do you think that doctors should be allowed by law to end the patient’s life, if the patient requests it?” in 1984, 75% of people surveyed agreed. By 1989, 79% of people agreed with the statement, and in 1994 it had gone up to 82%.
Detail of the question matters
But not surprisingly, the acceptability of assisted dying varies according to the precise context. The 2005 BSA survey asked in more depth about attitudes towards assisted dying and end of life care. While 80% of respondents agreed with the original question, support fell to 45% for assisted dying for illnesses that were incurable and painful but not terminal.
A 2010 ComRes-BBC survey also found that the incurable nature of illness was critical. In this survey, while 74% of respondents supported assisted suicide if an illness was terminal, this fell to 45% if it was not.
It may not be surprising that support varies considerably according to the nature of the condition described, but it is important. First, because the neat tick boxes on polls belie the messy reality of determining prognosis for an individual patient. Second, because of the potential for drift in who might be eligible once assisted dying is legalised. This has happened in countries such as Belgium which became the first country to authorise euthanasia for children in 2014, and more recently in Canada where within months of the 2016 legalisation of medical assistance in dying, the possibility of extending the law to those with purely psychological suffering was announced.
It’s not just diagnosis or even prognosis that influences opinion. In the US, Gallup surveys carried out since the 1990s have shown that support for assisted dying hinges on the precise terminology used to describe it. In its 2013 poll, 70% of respondents supported “end the patient’s life by some painless means” whereas only 51% supported “assisting the patient to commit suicide”. This gap shrank considerably in 2015 – possibly as a result of the Brittany Maynard case. Maynard, a high-profile advocate of assisted dying who had terminal cancer, moved from California to Oregon to take advantage of the Oregon Death with Dignity law in 2014.
Even so, campaigning organisations for assisted dying tend to avoid the word “suicide”. Language is emotive, but if we want to truly gauge public opinion, we need to understand this issue, not gloss over it.
Information changes minds
Support for assisted dying is crucially known to drop-off simply when key information is provided. Back in the UK, a ComRes/CARE poll in 2014 showed 73% of people surveyed agreed with legalisation of a bill which enables: “Mentally competent adults in the UK who are terminally ill, and who have declared a clear and settled intention to end their own life, to be provided with assistance to commit suicide by self-administering lethal drugs.” But 42% of these same people subsequently changed their mind when some of the empirical arguments against assisted dying were highlighted to them – such as the risk of people feeling pressured to end their lives so as not to be a burden on loved ones.
This is not just a theoretical phenomenon. In 2012, a question over legalising assisted dying was put on the ballot paper in Massachusetts, one of the most liberal US states. Support for legalisation fell in the weeks prior to vote, as arguments against legalisation were aired, and complexities became apparent. In the end, the Massachusetts proposition was defeated by 51% to 49%. Public opinion polls, in the absence of public debate, may gather responses that are reflexive rather than informed.
Polls are powerful tools for democratic change. While opinion polls do show the majority of people support legalisation of assisted dying, the same polls also show that the issue is far from clear. It is murky, and depends on the responder’s awareness of the complexities of assisted dying, the context of the question asked, and its precise language. If we can conclude anything from these polls, it is not the proportion of people who do or don’t support legislation, but how easily people can change their views.
Once known as multiple personality disorder, dissociative identity disorder remains one of the most intriguing but poorly understood mental illnesses. Research and clinical experience indicate people diagnosed with the condition have been victims of sexual abuse or other forms of criminal mistreatment.
But a vocal group of academics and health professionals have claimed dissociative identity disorder, and reports of trauma associated with it, are created by therapists and the media. They say these don’t reflect genuine symptoms or accurate memories.
Media references to dissociative identity disorder are also often highly stigmatising. The recent movie Split depicted a person with the condition as a psychopathic murderer. Even supposedly factual reporting can present people with dissociative identity disorder as untrustworthy and prone to wild fantasies and false memories.
But research hasn’t found people with the disorder are more prone to “false memories” than others. And brain imaging studies show significant differences in brain activity between people with dissociative identity disorder and other groups, including those who have been trained to mimic the disorder.
What is it?
Dissociative identity disorder has been studied by doctors and scientists for well over 100 years. In 1980, it was called multiple personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which outlines the symptoms of psychiatric conditions. Its name was changed in the 1994 edition of the DSM.
Dissociative identity disorder comes about when a child’s psychological development is disrupted by early repetitive trauma that prevents the normal processes of consolidating a core sense of identity. Reports of childhood trauma in people with dissociative identity disorder (that have been substantiated) include burning, mutilation and exploitation. Sexual abuse is also routinely reported, alongside emotional abuse and neglect.
In response to overwhelming trauma, the child develops multiple, often conflicting, states or identities. These mirror the radical contradictions in their early attachments and social and family environments – for instance, a parent who swings unpredictably between aggression and care.
According to the DSM-5, the major characteristic of dissociative identity disorder is a disruption of identity, in which a person experiences two or more distinct personality states (or, in other cultures, experiences of so-called possession).
These states display marked differences in a person’s behaviour, recollections and opinions, and ways of engaging with the world and other people. The person frequently experiences gaps in memory or difficulties recalling events that occurred while they were in other personality states.
The manifestations of these symptoms are subtle and well concealed for most patients. However, overt symptoms tend to surface during times of stress, re-traumatisation or loss.
People with the condition typically have a number of other problems. These include depression, self-harm, anxiety, suicidal thoughts, and increased susceptibility to physical illness. They frequently have difficulties engaging in daily life, including employment and interactions with family.
This is, perhaps, unsurprising, given people with dissociative identity disorder have experienced more trauma than any other group of patients with psychiatric difficulties.
Dissociative identity disorder is a relatively common psychiatric disorder. Research in multiple countries has found it occurs in around 1% of the general population, and in up to one fifth of patients in inpatient and outpatient treatment programs.
Trauma and dissociation
The link between severe early trauma and dissociative identity has been controversial. Some clinicians have proposed dissociative identity disorder is the result of fantasy and suggestibility rather than abuse and trauma. But the causal relationship between trauma and dissociation (alterations of identity and memory) has been repeatedly shown in a range of studies using different methodologies across cultures.
People with dissociative identity disorder are generally unresponsive to (and may deteriorate under) standard treatment. This may include cognitive behavioural treatment, or exposure therapy for post-traumatic stress disorder.
Phase-orientated treatment has been shown to improve dissociative identity disorder. This involves stages (or phases) of treatment, from an initial focus on safety and stabilisation, through to containment and processing of trauma memories and feelings, to the final phase of integration and rehabilitation. The goal of treatment is for the person to move towards better engaging in life without debilitating symptoms.
An international study that followed 280 patients with dissociative identity disorder (or a variant of it, which is a dissociative disorder not otherwise specified) and 292 therapists over time, found this approach was associated with improvements across a number of psychological and social functioning areas. Patients and therapists reported reduction in dissociation, general distress, depression, self-harm and suicidal thoughts.
Controversies and debates
Critics have pointed to poor therapeutic practice causing dissociative symptoms as well as false memories and false allegations of abuse. Some are particularly concerned therapists are focused on recovering memories, or encouraging patients to speculate that they have been abused.
However, a contemporary survey of clinical practice among specialists of dissociative identity found those treating the disorder weren’t focused on retrieving memories at any phase of the treatment.
A recent literature analysis concluded that criticisms of dissociative identity disorder treatment are based on inaccurate assumptions about clinical practice, misunderstandings of symptoms, and an over-reliance on anecdotes and unfounded claims.
Dissociative identity disorder treatment is frequently unavailable in the public health system. This means people with the condition remain at high risk of ongoing illness, disability and re-victimisation.
The underlying cause of the disorder, which is severe trauma, has been largely overlooked, with little discussion of the prevention or early identification of extreme abuse. Future research should not only address treatment outcomes, but also focus on public policy around prevention and detection of extreme trauma.
If this article has raised concerns for you or anyone you know, call Lifeline 13 11 14, Suicide Call Back Service 1300 659 467 or Kids Helpline 1800 55 1800.
Michael Salter, Senior Lecturer in Criminology, Western Sydney University; Adjunct Professor Warwick Middleton, Adjunct Professor, The University of Queensland, and Martin Dorahy, Professor of Clinical Psychology
Genome editing of human embryos broadens ethics discussions
For several years, scientists have experimented on human embryos with a powerful genome editing tool called CRISPR to see if they could correct genetic errors or reduce the risk of disease. In September, Kathy Niakan at the Francis Crick Institute in London and her colleagues reported they had used this tool on human embryos for a very different purpose — to better understand human development.
The use of CRISPR (pronounced “crisper”) to modify human embryos has prompted a healthy debate on the ethics of human genetic technologies. This tool is controversial, in part, because changes that are made to the embryo could be passed down to future generations. Niakan’s recent research is novel, and less ethically fraught than some other genome-editing research.
Research labs around the world are using CRISPR to selectively insert, delete or replace DNA with far greater precision and at a lower cost than other genome-editing techniques. Since 2015, five reports have detailed its use in human embryos to correct disease-causing mutations or create resistance to infectious disease.
Scientists have modified the genes responsible for β-thalassemia (an inherited blood disorder), favism (a reaction to eating fava beans), and a type of heart disease. Another experiment used CRISPR to introduce a mutation into a protein called CCR5 in an effort to prevent HIV infection.
A striking difference
The project led by Niakan had a starkly different aim. It used CRISPR to peek at the earliest stages of human embryonic development by targeting a gene called OCT4, which is active in the cells that go on to form the embryo.
Niakan’s immediate objective was to better understand the early aspects of human development. But her research eventually may help reveal why some pregnancies end in miscarriages and may improve the success of in vitro fertilization.
Much of the global discussion over the ethics of modifying human embryos has focused on whether the technique might be unsafe or used for non-medical purposes. Niakan’s recent project brings other aspects of this debate to light. How do scientists acquire the embryos they use in their research, and how are their projects approved?
So far, these types of experiments have been done in China, the United Kingdom and the United States. With only limited data available on the experiments conducted in China, it makes sense to focus the discussion on the experiments based in the United States and in the United Kingdom.
Who’s taking the risk – and why?
Earlier this year, Shoukhrat Mitalipov, a reproductive biologist at Oregon Health and Science University (OHSU), and his colleagues used CRISPR in human embryos to repair a mutation that causes heart disease. From an ethics standpoint, Mitalipov’s research is more controversial than Niakan’s. The goal of his experiments was to make changes to the human embryo that could be passed on to future generations. Niakan’s research, on the other hand, aimed to develop our understanding of human embryology.
To do the experiments, Mitalipov’s team had to create human embryos from donated eggs and sperm. In contrast, Niakan’s project used embryos that were left over from fertility treatments. This is an important difference.
For Mitalipov’s study, the women who donated their eggs for research were exposed to the risks associated with hormonal stimulation and egg retrieval. These risks include abdominal pain, vomiting, rapid weight gain, shortness of breath, and damage to the organs that are close to the ovaries. A particularly serious risk is ovarian hyperstimulation syndrome that can require hospitalization.
With Niakan’s study, women assumed these risks in connection with their IVF treatment, not their participation in research. These women weighed the potential harms of hormonal stimulation and egg retrieval against the potential benefits of having a child using assisted human reproduction. Embryos remaining after fertility treatment were donated to research.
It’s also worth examining how these studies were approved. Several committees, panels and review boards from OHSU provided input and guidance prior to granting Mitalipov permission to do his experiments. OHSU is Mitalipov’s home institution. This raises the spectre of institutional conflict of interest because OHSU stands to benefit from Mitalipov’s research if his work attracts more research funding or enhances the university’s reputation.
In the United Kingdom, the governance and oversight of human embryo research lies in the hands of authorities that are legally regulated and are at arms length to the institutions conducting the research. Ethics review of human embryo research occurs at both the national and regional level. The Human Fertilisation and Embryology Authority and the regional research ethics committee reviewed Niakan’s proposal before she could begin her experiments.
As genome editing of human embryos becomes more widespread, it is important to understand the differences between one project and the next so that we can meaningfully discuss the range of ethical, social, political and regulatory issues associated with the research.