Aidan Semmens
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Put that in your pipe... and vape it

13/4/2017

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How times change. My daughter, who’ll be off to university this year, has never known a world without the internet. She can barely remember life without smartphones and social media. She’d struggle to see, breathe – or believe – in the kind of atmosphere that was normal in every pub not so very long ago.

And not only in pubs either. It was 30 years ago this week that I gave up smoking at work. My colleagues in a new job made it clear they’d prefer me not to bring the pipe with which I’d polluted my previous department.
Not long afterwards I abandoned the habit entirely. I discovered that waking up every morning with sinusitis and a throat tasting of ashes was not a natural or necessary aspect of life.

Half my life ago. Yet a whiff of pipe smoke in the street can still bring a brief pang of nostalgia. Not, I think, that I was ever addicted. But I liked the fiddle and paraphernalia of pipesmoking. I liked the pipe as an object. And yes, I liked the smell and taste of some tobaccos.

Which is why I think if e-cigarettes had been around then, I might have switched from smoking to vaping.
And where would I be now if it had been available and I had? Who knows?

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At this point I should admit a special interest. Among my other jobs I work on a website dedicated to e-cigarettes – every aspect, from marketing to science and health, and the different regulations that apply around the world. It’s all surprising interesting.

In a sense, then, I am in the pay of the vaping industry. But I and the company are strictly independent and impartial. The information we impart to companies, researchers and legislators wouldn’t be much use if we weren’t.

I’ve never tried vaping. Frankly, I’d rather go back to the old pipe. But I do know something about the subject.

I know, for example, that Britain – especially England – is probably the most e-cig-friendly country in the world.
A country which advises: “An expert review of the latest evidence concludes that e-cigarettes are around 95 per cent safer than smoked tobacco and they can help smokers to quit.”

That’s from Public Health England. This is from the Royal College of Physicians: “E-cigarettes are likely to be beneficial to UK public health.”

And this is the British Lung Foundation: “Given half of long-term smokers die as a result of their habit, using vaping to help someone quit smoking could literally save their life.”

Other supporters of e-cigs include Cancer Research and the British Heart Foundation.

Contrast this with countries like Australia, where e-liquids containing nicotine are illegal; India, where four states have banned vaping; or Indonesia, which seems to be heading towards an outright ban.

A cynic might link some countries’ tight regulation to the importance of their tobacco industries, and the tax revenues they get from smokers. But it also fits with the advice of the World Health Organization, which recommends tight restrictions on the sale and promotion of e-cigs, maybe prohibition.

The WHO even calls the things ENDS, which stands for Electronic Nicotine Delivery Systems, but also seems symbolic.

The UK Centre for Tobacco and Alcohol Studies doesn’t think much of Dr WHO’s advice. In a long list of charges, it concludes: “The WHO report does not acknowledge that significant restrictions on e-cigarettes could lead to unintended consequences, including increases in smoking.”

Vaping, of course, can be a trendy lifestyle choice as well as a way to quit fags. No one, as far as I know, ever chased the dragon with Embassy Regal.

And support for e-cigs should come with this reservation. They may not bring the same dangers as smoking – in fact, they clearly don’t – but of the long-term effects of inhaling flavoured, nicotine-loaded vapour, there is only one thing we can say with confidence. It’s too early to tell.

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Sweetness and bite – how sugar got humanity hooked

6/4/2017

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Interesting fact of the week: cigarettes contain added sugar. In the case of “American blend” cigarettes, it can make up 20 per cent of the weight.

This may be one of the reasons people often pile on the pounds when they give up smoking. Their bodies are finding a different way to get a constant hit of the drug they really crave. Sugar.

Interesting fact number two: in 1715, when Britain’s sugar habit was starting to cause concern, consumption in this sweet-obsessed land was about 5lb per person per year. Today it’s normal to consume 20 or 30 times that much.

No wonder Public Health England is challenging businesses to cut sugar by five per cent this year and 20 per cent by 2020. Though this may be a bit like switching to low tar cigarettes – or jumping from the 30th floor instead of the 31st.

I don’t have a very sweet tooth. I can’t stand sugary drinks like Coke or lemonade, I don’t take sugar in tea or coffee, and I try to limit my intake of cakes, biscuits and chocolate. We eat toast, not sugary cereals, for breakfast. And I’m never hungry enough to fob my body off with the sugar-and-fat concoctions of fast-food outlets. I try in general to avoid “processed food” of all kinds – that stuff the writer Michael Pollan memorably dubbed “edible foodlike substances”. Oh, and I don’t smoke either.

Nevertheless, there’s sugar in that toast. I know just how much, because I put it there myself, in the form of malt, when I bake the bread. In shop-bought loaves, there is probably more. Then I like to smother it in peanut butter (6.2pc sugar) or marmalade (a whacking 63pc).

There’s hardly a tin, a jar or a bottle in the cupboard that doesn’t contain some sugar. It’s the ingredient no food manufacturer can leave out if they want people to keep buying.

David Attenborough once suggested that one way to look at human life was to consider that the “purpose” of our species was to facilitate the spread of grass –lawns, parks and grazing lands, vast fields of wheat, barley and rice.

But grass is not the only type of plant to have made use of humans in this way. Sugar may be a latecomer to the game, but it has done a fabulous job of replicating itself over the past 350 years or so.

Grass did it by feeding us, and enabling us to multiply across the planet. Sugar got us hooked.

Our parents use it to pacify us, we get high, then come down and go wild demanding more. The addictive process is well outlined by science writer Gary Taubes in his book The Case Against Sugar. And as he says: “Once people are exposed, they consume as much sugar as they can easily procure.”

He also quotes Oscar Wilde on “the perfect pleasure”: “It is exquisite, and it leaves one unsatisfied. What more can one want?”

Wilde was writing about cigarettes, but the same applies to sugar. And what better definition could there be of an addictive drug?

The British empire-building rush for coffee, tea and chocolate came only after people started adding sugar. And the link with tobacco goes back to the “triangular trade” which began in  the late 16th century.

British ships carried slaves to the Caribbean, where they worked raising sugar to ship back to Britain and Europe. When the early American colonies joined in, tobacco was added to the eastbound leg of the triangle – and to the slaves’ labours.

Cities like Liverpool and Bristol were built on that 250-year trade. And so, in a sense, was the United States, its history steeped from the beginning in racial exploitation and a kind of drug-trafficking.

Another spoonful of sugar in your tea?

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The doctor who gave up drugs - and why

29/9/2016

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Do you suffer from Walking Deficiency Syndrome, or Hyper Sitting Syndrome? These conditions have been named by Sir Muir Gray, former NHS Chief of Knowledge, as two of the greatest causes of ill health in Britain.

He was on BBC1 last week making his point to Dr Chris van Tulleken, presenter and title character of The Doctor Who Gave Up Drugs. He was dangerously sitting down as he spoke – and so, presumably, were most people watching.

Van Tulleken, who is rapidly becoming one of the most compelling characters on telly, was on a mission. He wants the country’s GPs to provide a real “health service”, not what he calls a “drug-prescription service”. And he wants us all to cut down on the drugs we take – an estimated 100,000 tablets in an average life.

Towards the end of his two-parter he offered a group of chronic pill-poppers a “miracle cure” for just about everything. Well, for obesity, joint pain, heart and stroke risk, type 2 diabetes and depression. Walking. A daily good brisk walk.

Hooray for me. Because I get that already. But most people, it seems, don’t. Most people would rather get a pill from the doctor to tackle their aches and pains.

But here’s the thing Dr Chris and his selected experts found. Painkillers don’t work. Not for long, anyway. Over time they actually make things worse.

In episode one we met Wendy, who had been taking pills for 20 years for shoulder pain. More and more pills – but she still had the pain. Over a two-week trial she took a mix of real and dummy pills. There was no corelation at all between the ups and downs of her reported pain and the fact that after a few days she was taking only placebos. She couldn’t tell the difference. Her drugs were costing the NHS a bomb and doing nothing to help her. After a few weeks off the pills and on a course of exercise she started showing real improvement.

Then there was Sarah, addicted to antidepressants after being on them for eight years from age 16. Still stuck in a grim life of depression. Living, as she put it, “in a chemical fog”. Dr Chris started weaning her off the pills and put her on a course of invigorating wild swimming in cold water. Which is great as long as she can get child care for the delightful toddler who is also a key component of her treatment, as well as a potential impediment to it.

Crystal had a life ruined by unexplained pain. After 20 years of dependency on a 30-a-day pill habit she could hardly walk and had real difficulty with stairs. Dr Chris’s unlikely prescription was a course of kung-fu training – which seemed to be working a treat.

All this miracle-working takes time and attention from the doctor. And when you only have 10 minutes at most for each consultation, that’s not possible. It’s so much quicker and easier just to write out a prescription.

And then there’s the constant advertising pressure from the drug companies, applied both to the GPs and all the rest of us.

Drug research is expensive and it’s done a lot to make our lives longer and more comfortable. But it’s also got us hooked on a massive dose of things we don’t need – at best.

The Doctor Who Gave Up Drugs was first-rate telly, but a tiny prick in the arm against the might of the pharmaceutical industry. It opened such a can of worms that I’ve only scratched the surface in my synopsis here. And I want to know a lot more.

If he’s to do any real good, Van Tulleken needs a series of Bake Off longevity and popularity. Real reality TV. That’d be worth sitting down for.
 
 
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So will Labour now set aside its internal bloodletting and get back to the real job? We can but hope. The need for an effective Opposition has never been greater.

Meanwhile, the view from Scandinavia is interesting. It’s a part of the world renowned for being saner, happier, politically smarter than most others. And much of the Brexit talk has been about whether Britain should follow the Norwegian model.

So here’s Dr Jonas Fossli Gjersø, a historian at the London School of Economics: "From his style to his policies Mr Corbyn would, in Norway, be an unremarkably mainstream, run-of-the-mill social democrat. His policy platform places him squarely in the Norwegian Labour Party from which the last leader is such a widely respected establishment figure that he became the current Secretary General of NATO. Yet in the United Kingdom a politician who makes similar policy proposals is branded an extremist and a danger to society.”

Norway has had 50 years of Labour government in the 71 years since World War II. According to the United Nations it has the highest human development of any country in the world.

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Facing death without fear

2/8/2016

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“I’m tough, aren’t I?” It was almost the first wholly intelligible thing she’d said for about a week, and there was really only one possible answer. “Yes, Mum, you are.”

At the start of that week I’d had the kindly professional chat from the senior consultant. The one about “last days care”. Now it seemed those last days had got longer.

The antibiotics intended to ease the pain of her passing had apparently forestalled it. Against all odds, the sepsis everyone had expected to take her had been cured.

It was not entirely a matter for rejoicing. It was certainly not what she wanted.

The day after she went into hospital she spoke to me at length, and in detail, about what I would have to do after she died. She had thought about it, and we had talked about it, a great deal over a number of years. Now she approached it cheerfully.

Her attitude had always been logical, and consistent. As long as she was able to enjoy life, and to contribute something to others, she was glad to be alive. Once that was no longer the case, she wanted a quick and easy exit.

Which of us, in our right minds, would not want that?

We all need to face death eventually. It would do us all good – individually and as a society – if we faced it more openly before our final curtain falls. And with more of the calm, rational approach my mother showed.

She was not alone in that. A study carried out by researchers at Cambridge University shows what anyone who has spent much time among the very old already knew – that most people in their nineties are not afraid of death.

Indeed, while they might care a great deal about the manner of their dying, the idea of being dead is something many positively look forward to. And not necessarily because life has ceased to be worth living.

Until the last few unwanted, unexpected weeks, my mother generally had a good life. Yet at 94 she still looked forward to its end.

Dr Jane Fleming, who led the Cambridge study, said: “Despite the dramatic rise in the number of people living into very old age, there is far too little discussion about what the oldest old feel about the end of their lives.

“Death is clearly a part of life for people who have lived to such an old age, so the older people we interviewed were usually willing to discuss dying, a topic often avoided.”

Nearly half of all deaths in the UK are of people 85 or older – up from one in five only 25 years ago. The number of people topping 90 has tripled in 30 years. The Cambridge interviewees were all 95 or older.

One told her son, after visiting a friend with dementia: “Gordon, if I ever get like that, for goodness sake put a pillow over my head, will you?”

Which is exactly what our laws and common morals won’t let us do. Yet would the abuses really outnumber and outweigh the benefits?

I'm not sure. And I know some elderly folk who definitely think being allowed – even assisted – to die when they want would be infinitely preferable to being kept alive against their will.

Another of the Cambridge interviewees remembered her parents’ deaths. “They were alive, then they were dead, but it all went off as usual,” she said. “Nothing really dramatic or anything. Why should it be any different for me?”

One 97-year-old said: “I just say I’m the lady-in-waiting, waiting to go.”

Nearly all said that if faced with a life-threatening illness they would rather be made comfortable than simply kept alive. And most said they would rather not go into hospital. In both those respects, my mother was typical.

“Now so many more people have reached a great age before they die, it’s important we know about their views and their concerns, particularly in relation to end-of-life care,” said the study’s other author, Dr Morag Farquhar. “Having these conversations before it is too late can help ensure that an individual’s wishes, rather than going unspoken, can be heard.”

Time, perhaps, to have that conversation now. To let your doctor know the outcome. And, perhaps, to put your wishes clearly in writing, signed by independent witnesses, as my mother very sensibly did a few years ago.
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Though she recovered from sepsis, she had a stroke while in hospital. It took away most of her ability to form intelligible words, though she went on trying. It also severely affected her ability to understand what was said to her. As far as one could tell, it did not impair her ability to think. She died at home eight weeks later, quite comfortable and clearly aware who was around her to very nearly the last.
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