Poor pregnant women missing out on free vitamin D, health officials claim

Senior government health advisers say takeup of vitamin supplements under NHS Healthy Start scheme is low

GPs, midwives and health service officials have been told to ensure pregnant women and those with young children in low-income families know of their right to free vitamin D supplements.

Takeup of vitamins under the NHS’s Healthy Start scheme is low, according to Sally Davies, the UK government’s senior medical adviser, and chief medical officers in Scotland, Wales and Northern Ireland.

Up to a quarter of the population are at risk of vitamin D deficiency, according to national nutrition surveys. This has led to concerns about the health of bones, particularly in older people and young children.

Those at risk include people who have low or no exposure to the sun, for example those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods.

People who have darker skin may also need supplements because their bodies may not be able to make as much vitamin D.

The medical officers say the NHS must ensure those who need supplementation are offered it, in the form of tablets for adults and drops for children.

Women qualify for Healthy Start from the 10th week of pregnancy or if they have a child under four years old, or if they or their family receive income support, jobseeker’s allowance, employment and support allowance or child tax credit. Pregnant women under 18 also qualify, even if they do not get any of those benefits or tax credits.

The letter adds: “NHS organisations can choose to sell the vitamins or supply them free of charge to those who are not eligible for Healthy Start, and we encourage this. Alternatively, vitamin D supplements are available for purchase or can be prescribed for those who are not eligible for the scheme.”

Hospital trusts offered £1.5bn emergency fund to pay PFI bills

Andrew Lansley says some trusts can no longer afford to honour PFI deals that were ‘badly negotiated’ by Labour ministers

Seven hospital trusts struggling with crippling private finance initiative debts are to receive £1.5bn in emergency funding from the government to help them avoid cutting patient services to pay their bills.

The Department of Health is making the £1.5bn available – in grants, not loans – to the seven hospital trusts in England with some of the heaviest PFI debts through a “stability” fund. Trusts will be able to use the money to meet PFI repayments, rather than their usual budgets, as long as they meet four conditions set out by the department.

The move will help trusts such as South London Healthcare NHS trust, which is facing a PFI repayment in 2012-13 of £66.8m under the terms of a deal agreed in July 1998, in the early days of Tony Blair’s government. They will be able to access the £1.5bn over the next 25 years, until the PFI contracts end.

Andrew Lansley, the health secretary, said he had been forced to use taxpayers’ money because certain NHS organisations could no longer afford to honour PFI deals that had been “badly negotiated” by Labour ministers.

“Labour left some parts of the NHS with a dismal legacy of PFI, and made them rely on unworkable plans for the future. They swept these problems under the carpet for a decade and left us with a £60bn postdated PFI cheque to deal with,” Lansley said.

“The problems facing some parts of the NHS left to us by Labour now have to be sorted out. Tough solutions may be needed for these problems, but we will not let the sick pay for Labour’s debt crisis.”

The six other NHS trusts are Barking, Havering and Redbridge; Peterborough and Stamford Hospitals NHS foundation trust; St Helens and Knowsley; North Cumbria; Dartford and Gravesham; and Maidstone and Tunbridge Wells.

Without the fund, there was a danger that services would be put “at severe risk” because of the weight of their PFI deals at a time of tightening NHS budgets, according to Department of Health sources.

South London faces the largest annual repayment in 2012-13. The Barking, Havering and Redbridge trust has to find £49.8m on its deal, agreed in January 2004, and the St Helens and Knowsley trust’s payment will be £42.5m under the terms of its contract, signed in June 2006.

Lansley acted after 22 hospital trusts told him their PFI debts were endangering their financial or clinical future. Department of Health research established that PFI payments were one of the reasons for trusts’ problems.

The department set four conditions for trusts to use the fund:

• The problems they face must be exceptional and beyond those faced by other organisations.

• The problems must be historic and they have a clear plan to manage their resources in the future.

• They must show they are delivering high levels of annual productivity savings.

• They must deliver clinically viable, high quality services, including delivering low waiting times and other performance measures.

Andy Burnham, the shadow health secretary, who was health secretary during Labour’s time in office, has previously admitted in relation to the deals: “We made mistakes. I’m not defending every penstroke of the PFI contracts we signed.”

The money will be available over the remaining lifetime of the seven trusts’ PFI contracts. It will come from underspends over that time in different Department of Health budgets.

In December a report into NHS finances by the public accounts committee flagged up looming problems with PFI debt. It concluded: “The cost of private finance schemes is an additional challenge for a limited number of hospitals. Analysis commissioned by the department has identified six trusts that are unviable largely because of their PFI charges. Long-term private finance initiatives deals reduce the department’s ability to establish a level playing field of financially sustainable, autonomous trusts.

“In many cases efficiency savings alone will not be enough to make unviable trusts financially sustainable. The department faces a particular dilemma about how to manage the debt of these hospitals as their long-term financial commitments make reconfiguration more difficult,” it added.

Three Britons die in legionnaires outbreak at Spanish resort

British holidaymakers aged between 73 and 78 were among more than 20 people to contract disease at hotel in Calpe, Spain

Three British holidaymakers have died in an outbreak of legionnaires disease at a hotel in the Spanish resort of Calpe.

The three unnamed Britons, aged between 73 and 78, were among more than 20 people to have contracted the disease at the Diamante Beach hotel.

The deaths were confirmed over the last 24 hours, almost three weeks after Saga holidays was first informed of the outbreak at the four-star spa and convention centre.

The regional government of Valencia confirmed on Friday that the first death had been on 26 January and another had come five days later. The latest death happened at the Clinica Benidorm hospital on Thursday.

“The three dead were British and aged between 73 and 78,” a spokesman said. A further 14 other people, ten of them British, were being treated for the disease.

Confusion surrounded the date on which the legionella outbreak had been confirmed, with Saga saying it was first told about it on 14 January.

The regional health department, however, said a preliminary test had failed to locate the bacterium that causes the disease. It did not publicly inform of the outbreak, which was confirmed by a second test, until Friday.

Authorities ordered the disinfection of the hotel’s water system, but said Diamante Beach had not broken maintenance rules.

Saga said a further three people remain in hospital in Spain. Five other people who recently stayed at the Diamante Beach had been treated in hospital in the UK though all but one have been discharged.

“It was reported to us on Saturday 14 January that a customer who had stayed at the Diamante Beach hotel in Spain was being treated for pneumonia caused by legionella,” a Saga spokesman said.

“When that happened we immediately sent out a scientific expert to Spain and informed our guests there and offered to move them to a different hotel.

“We also contacted people who had stayed at the hotel in the previous month telling them to contact their doctor if they were experiencing flu-like symptoms.”

Health authorities said the hotel had now been temporarily closed. “With the closure we have a guarantee that there will be no more contagion and we can then evaluate the measures taken with the rigour required by the situation.”

A spokesman for the hotel said it expected to reopen on Monday.

Saga said the company eventually moved all clients to a new hotel after their expert conducted tests on water samples.

A holidaymaker who died in his hotel room on 31 January had not said he was feeling sick and Saga had not originally known the cause of death, the spokesman said.

“This is clearly a very upsetting time for families and staff. We have sent extra people to Spain to support them in any way we can,” the spokesman added.

Saga will be offering compensation to the holidaymakers who contracted the bacterium and has suspended sending clients to the hotel.

“We have done an inspection of the plumbing and made some recommendations to reduce possibilities of a further outbreak and they will need to make changes before we consider using it again.”

The Foreign Office said it was providing consular assistance to those affected by the outbreak and their families.

Legionnaires’ disease is caused by a bacterium usually found in standing water and can be contracted by breathing contaminated air.

Older people as well as those with weak immune systems or lung problems are most susceptible.

Cancer campaigners say levels of fat, salt and sugar in food must be reduced

Health researchers claim maintaining healthy lifestyle and eating well could prevent as many as a third of all cancers

Foodstuffs and drinks need to contain less sugar, salt and fat in order to help combat the growing number of people developing cancer, campaigners against the disease have said.

The call from the World Cancer Research Fund (WCRF) came as it released fresh estimates that the number of Britons being diagnosed with cancer annually will rise to almost 400,000 by 2030.

The UK will see about 396,000 new cases of cancer a year in 2030 – a 30% rise on the 304,000 seen in 2008 – according to WCRF projections released today to mark World Cancer Day.

Its analysis of the likely increase in cancer cases in all 27 EU member states by 2030 says that the UK will have the 16th biggest proportionate rise and Ireland the biggest with a predicted 72% jump, followed by Cyprus (55%), Luxembourg (53%) and Malta (49%).

The WCRF identified the ageing population as the key factor behind the rise, because cancer affects mainly the over-60s. But it also said improvements in lifestyles, such as eating better, maintaining a normal weight and taking exercise could prevent as many as a third of all cancers.

“Measures to tackle the fat, sugar and salt content of food and drinks and to improve the opportunities for physical activity are the type of developments we need to cut these predictions of future cancer cases,” said Dr Kate Allen, the science and communications director at WCRF International.

It wants to see mean salt intake fall to 5g a day by 2025, a big drop from the current average in the UK of about 8g, and for total fat intake to make up just 15-30% of people’s energy intake by the same date.

To achieve that it wants action to “encourage nutrient-dense relatively unprocessed foods and discourage sugary and alcoholic drinks”.

Cancer incidence is rising, and experts expect it to keep rising, mainly due to ageing, but also obesity and alcohol misuse. But WCRF’s estimate of a 30% rise by 2030 is lower than Cancer Research UK’s prediction, made last October, of a 45% leap to around 432,0000 cases by the same date.

The trend has prompted concern that the NHS may not be able to keep pace.

“We know the numbers of people getting this disease is increasing and these figures by the WCRF should signal alarm bells for the NHS and how we plan future cancer services. Macmillan Cancer Support’s own research showed that four in 10 people will now get cancer in their lifetime,” said Ciaran Devane, the charity’s chief executive.

On current trends the number of people in the UK who have been diagnosed with cancer will double from two to four million over the next 20 years, added Devane.

Dr Emily Power, health information manager at CRUK, said: “With more cancers being diagnosed, it’s crucial that cancer services worldwide prepare for the growth in demand. It’s also important that we do everything we can to improve the early diagnosis of cancer.”

But medical and scientific advances mean patients diagnosed with cancer are twice as likely to survive it as they were 40 years ago, Power added.

The Department of Health said: “This data shows the challenges we face from an ageing population and the rising burden of cancer. That is why we are investing more than £750m over the next four years to make sure people are diagnosed with cancer earlier and have better access to the latest treatments. This includes a range of public awareness campaigns on the signs and symptoms of cancer.

“Through our investment and modernisation of the NHS, we will save 5,000 more lives every year by 2015 – closing the gap in cancer survival between us and the best-performing countries in the world.

“But we know that up to half of all cancers could be prevented by changing our lifestyles – eating better, doing more exercise, drinking less and stopping smoking.

“That’s why through Change4Life we are encouraging everyone to make small lifestyle changes that really make a difference, like being more active, eating more fruit and veg, fewer calories and less fatty foods. We will shortly launch a campaign to raise awareness of the risks of drinking too much alcohol.”

The Saturday interview: Jo Swinson, Liberal Democrat MP

Lib DemMP Jo Swinson scored another victory this week in her one-woman battle against the beauty industry. But is ‘airbrushing’ really the big issue during an economic crisis?

On the way to meet Jo Swinson I’m still unsure what to make of the Lib Dem MP’s campaign for body confidence. Is this a gutsy, slightly risky move by a young woman on her way up, taking on an issue that proved calamitous for Labour in 2000, when its “body image summit” was widely ridiculed? Is it a subject simply too soft and fuzzy for the political arena? (The YMCA’s website for their part of the campaign features pictures of barely clad people holding hearts saying “I love me” over their genitals, as if recently beset by Gok Wan, Trinny, Susannah and some unruly Care Bears.) Or is it an impressive example of a politician using techniques often associated with grassroots campaigners – the simple, straightforward letter of complaint – to secure surprising results?

Most importantly: is it what politicians should be focusing on right now? There’s no doubt this week saw Swinson notch up another small triumph in her campaign. On Wednesday it was reported that a complaint she had made to the Advertising Standards Authority (ASA) had led to it ruling that an ad for a L’Oréal anti-wrinkle cream could never again appear in its current form. The ad showed a lovely photograph of the actor Rachel Weisz, her skin glassily, fantastically smooth. The ASA decided that although the ad didn’t misrepresent the “luminosity or wrinkling” of Weisz’s face, “the image had been altered in a way that substantially changed her complexion to make it appear smoother and more even”, and concluded it could therefore mislead the public as to the product’s performance. This came after two rulings in Swinson’s favour last year – ads featuring Julia Roberts and Christy Turlington were also deemed to have been digitally enhanced, and potentially misleading – and another in 2009, when an image of Twiggy was pulled.

All perfectly laudable. No one would argue in favour of misleading adverts, few in favour of the over-enthusiastic use of airbrushing – even if trying to stem this last tide seems Sisyphean in a digital age. And yet it still feels slightly odd to see an MP focusing on this issue in the midst of an economic crisis. Body confidence obviously affects both men and women, but primarily the latter, yet when I talk to women’s campaigners it doesn’t seem to be at the forefront of the issues they are worried about. The Fawcett Society, the UK’s leading women’s rights campaign, seems more concerned about the 23-year high in women’s unemployment, and the way cuts to benefits will disproportionately affect women (a fifth of female income comes from welfare payments and tax credits, compared to a tenth of male income).

Others cite this week’s news that local authority cuts to the domestic violence sector have led to women being advised to sleep in Occupy camps or police stations because all the shelters are full. Body image may have seemed a pressing issue before the recession, and it is very necessary, of course, for campaigners, doctors and academics to work together on eating disorders and associated problems. But is it a priority for the political arena?

I meet Swinson in a cafe in Kennington, south London, the area where she lives with her husband, fellow Lib Dem MP Duncan Hames. She bustles in from the cold, and we get straight to talking about the campaign. I ask why she feels so strongly about this issue, and she says she feels strongly about a lot of issues. This is certainly true. There can be no doubting Swinson’s commitment.

In 2005, when she was elected MP for East Dunbartonshire, the area where she grew up, Swinson was 25, the youngest MP in the House. She made a decision, she says, “that I wasn’t going to be afraid of the chamber, and I was going to make sure I spoke regularly and just didn’t get scared of it”. Since her first question at prime minister’s questions – asking Tony Blair if it was time “to say goodbye to the Punch and Judy style of PMQs” – she has spoken up on everything from foreign affairs to the over-packaging of Easter eggs, and is now deputy leader of the Scottish Liberal Democrats.

“So,” she continues, “you know, when I went to Chechnya in 2010, and looked at the human rights situation, I think I arg-u-ably,” she spaces out the syllables to give just the tiniest hint of sarcasm, “felt more strongly about that”. She straightens up in her seat. “But [airbrushing] is a very important issue. It’s important because it has an impact on health. The Royal College of Psychiatrists has said very clearly that they think excessive retouching – and I would talk about this in a much wider context anyway, because it’s not just about retouching cosmetics adverts, it’s about the whole range of body image pressure on men and women – but this kind of culture creates a huge amount of pressure on people, and that can lead to self-esteem problems. At extreme ends, we have rising rates of eating disorders, and we [also] have a much larger section of the population that engages in what they would call disordered eating rather than eating disorders. And then, from an educational point of view, there’s research that shows young people are less likely to participate actively in class on days when they’re not feeling confident about their appearance.”

She started working on this area in 2009, when it was part of a Lib Dem women’s policy paper. She co-founded the Campaign for Body Confidence in March 2010, then became a leader of the all-party parliamentary group on body image in 2011. She says the campaign has “ambitious goals – to change the culture we’re living in”. What does she say to suggestions that body image isn’t an appropriate area for politicians? “Well, it’s not just politicians who are involved. After the policy paper was published … I was contacted by lots of organisations, and so, on the Campaign for Body Confidence, we have Girlguiding, the eating disorders association Beat, Mumsnet, Susie Orbach and her AnyBody team, YMCA, All Walks Beyond the Catwalk, and political representation too.”

The all-party group has been hearing evidence from experts over the past months. One interesting snippet came from an industry voice who said that what had been acceptable in advertising 12-15 months ago was not any longer, due to public pressure, so maybe Swinson’s incremental, small-scale system of complaints is working. I ask what other measures Swinson thinks politicians can take to address body-image problems. There’s a possibility of education on this issue becoming a part of the PSHE curriculum, she says; there’s also the question of “What do you do about parents? So much of what young people perceive about their body image is taken from watching their parents … I think we need to look at ways we can help parents pass on more positive messages to their children, and perhaps some of that can be done through health visitors, for example.”

Another problem for young women, she says, is the paucity of strong women in the public eye. She and some other MPs are meeting with the head of sports at the BBC soon to discuss the fact that 2011′s Sports Personality of the Year shortlist featured 10 men and no women. I ask whether there is any embarrassment in talking about this issue when there are only seven women Lib Dem MPs – just 12% of the party’s total. The representation of women in the Lib Dems has long been disastrous – although not as disastrous as the fact that they have not a single non-white MP – and last year a report suggested they could potentially be left with no women MPs at all after the next election. Five of their women MPs are in marginal seats, including Swinson.

Swinson has opposed all-women shortlists in the past – at the 2001 Lib Dem party conference she wore a bright pink T-shirt saying I Am Not a Token Woman – but it’s these shortlists that led to a sea-change in the representation of women in parliament: the breakthrough moment in 1997 when 101 female Labour MPs were elected. She speaks enthusiastically about the Lib Dem’s leadership programme, which involves mentoring people from under-represented groups, but, speaking to experts in this field, there is scepticism about whether this will make much difference.

In many ways, Swinson is impressive, and the Lib Dems could do worse than to promote her – she is articulate, loyal, always willing to put her head above the parapet, and in a way that draws the focus to the issues rather than her as an individual. She is confident, a comprehensive school pupil who loved debating and went on to study management at the London School of Economics. But her devotion to politics can sometimes make it difficult to find out if there’s much beneath the rhetoric. I ask about growing up in Milngavie, part of the area she now represents, and rather than any insight into her childhood, she talks about it being a middle-class, affluent area, with “a lot of community spirit and social capital, so the list of groups doing fantastic things is as long as your arm”. This analysis goes on for some time.

Her family wasn’t particularly political, she says – her mother is a primary school teacher, father was in economic development – but she realised she was passionate about politics, and about the Liberal Democrats, when she stayed up all night during the 1997 election, months before she was actually eligible to vote. She joined the party at her university’s freshers’ fair, spurred, she says, by two key issues: education and proportional representation.

It must have been a bruising experience in government so far, given the rise in university tuition fees (Swinson was one of 28 Lib Dem MPs who voted in favour) and the disastrous vote on AV? “Well, do you know what, I’m a democrat as well,” she says, “so I campaigned hard on AV, but the people have the say at the end of the day … And as Vince [Cable]‘s PPS [principal private secretary] I was very involved in seeing how we improved the situation [regarding tuition fees]. We made sure that there was a cap on fees, which there wouldn’t have been without us.” In some ways, she just seems thrilled to be in government, to be able to make changes to policy, however small – rather than battling from the opposition benches.

I put it to her that some people would see the focus on body confidence as an easy way for the government to appeal to the women’s vote without actually spending money – a cheap sop for the ladies. She is unruffled, and points out she has been campaigning on the issue since 2009, and never expected to be doing so within government. “Yeah, much of the action we’re taking isn’t going to cost a lot, because there isn’t a lot of money around. It would be great [if there was] – you could propose all sorts of things, but there’s a point in being realistic about it and saying, ‘Well, if there isn’t loads of money, then what can we do that isn’t going to cost a lot?’”

It’s a practical approach, I suppose, and frustrating, too. I hope Swinson’s campaign causes a shift in the culture, and I’m glad she’s working with such great organisations. But with so few women in government, it can’t help but feel a slightly odd time to be prioritising this above so many other concerns she could be pouring her undisputed energies into. Feeling good about your body is a boon, but it rarely beats a steady job.

Dirty little secret: the loo that saves lives in Liberia

Diarrhoea kills more children than HIV/Aids, tuberculosis and malaria combined – and its main cause is food and water contaminated with human waste. Liberia’s president is trying to change all that

For the worst country in the world, Liberia looks lush. All along the long road to Fish Town, the sumptuous rainforest on either side is a comfort, a green bath to soothe the dreadful red dust that is constant and the potholes that cause nose-bleeds, head-bumps and nausea even in this well-cushioned Toyota Land Cruiser belonging to WaterAid. We are scrunched into this car for days, because that’s how long it takes to get to Fish Town, only a few hours from Liberia’s capital Monrovia if you’re a crow, but 36 hours otherwise, because the country has only one decent main road.

To get there, we must loop north, brushing the border with Guinea, before swooping back down to a town that isn’t much of a town, the joke goes, and doesn’t have much fish. But it’s busy these days because NGO 4x4s such as ours are zooming through on their way to help refugees escaping from Ivory Coast, the latest poor sods in this region to be kicked out of their country by war.

We, though, are not zooming towards refugees but towards something far less newsworthy. It is my sixth visit to Liberia. The first was in 2004, six months into the country’s first peace in 20 years. Liberia had suffered years of stunningly brutal civil wars, orchestrated largely by Charles Taylor, now on trial in the Hague for war crimes (a man who once sued a journalist for saying he had eaten a human heart, and lost); and by other warlords with names such as General Butt Naked, General Peanut Butter and Devil. And this war’s stories were more horrific than most: mass rape; boy soldiers kept going by drugs, looting and raping; parents killed by their own boys; checkpoints made from intestines. Imagine the worst and, if you looked, you’d find it here doubled.

By 2003, when the Economist called Liberia the worst country in the world, it was wrecked. Yet it hadn’t always been that way. Founded by freed American slaves in the 19th century, Liberia had had good times. Its ex-slave colonists built graceful mansions, installed themselves as rulers over local tribes and instituted a Liberian English that still has the infectious drawl of the American South. They named their capital after US president James Monroe; they called their currency the dollar; they let the US use them as a listening station in the second world war. Liberians – flying a US-lite flag of stripes and one star – thought they lived in the 51st state, or “Bitty America”. But it was a one-way relationship: during battles so terrible that they were called world wars I, II and III, a US warship holding 2,000 marines anchored itself on the horizon and did nothing to help. Only when rebels attacked Monrovia was Taylor persuaded to leave and a UN force brought in.

The receding war left ugly tides. At least 70% of women raped. Nearly the entire population refugees of one sort or another. A huge brain drain. No functioning electricity grid. A decimated healthcare system. And, thanks to the plundering Taylor, a national debt of $4.9bn. In 2004, when I first visited, all Liberia seemed to have was 9,000 UN peacekeepers and some cautious hope.

But the world’s worst country has been busy. In 2006, it elected Ellen Johnson Sirleaf to be its president. A Harvard-trained former World Bank economist, Sirleaf is Africa’s first female head of state, Ma Ellen to three million or so Liberians and a president with a dizzying to-do list. Eighty-five per cent of Liberians have less than a dollar a day to spend. A dollar goes further in Liberia, but not that far, when rice costs $45 a bag. You can always find a decent Club Beer in Monrovia, but you won’t find a post office, electricity grid, sewage treatment, taxes or decent road system. One suburb of the capital is called Red Light, because it used to have a traffic light. It doesn’t any more.

How do you fix a ruined country? Start with the money. If you can, get that $4.9bn of debt forgiven. Increase the national budget from $80m a year to $360m. Then figure out how to earn more. Open for business and sell everything you can: oil, gas and mineral rights; timber concessions. Open your ports and improve your roads for all the mining and logging equipment to trundle down. Talk about developing tourism. Invite the Chinese, so that after hours on a road to the remotest part of the country, you’ll find young Chinese lads taking a break from building bridges to take each other’s photograph, as well as new universities and hospitals with suspiciously Chinese-looking roofs.

All that is basic nation-building. But there is also something that’s not on most nation-building lists. Liberians elected a woman who understood that something basic could save millions of dollars, something most people don’t want to talk about. Most people, but not Ma Ellen, the only serving head of state to have written in a major newspaper about the need for toilets. That’s right. Toilets. Because of that, I request an interview with her; and because I am here with WaterAid and have written a book about toilets, she grants it.

We meet in the foreign ministry, where the president moved after the executive mansion caught fire. Ma Ellen’s personal guards, female Indian peacekeepers, stand at the gate like statues. (Someone tells me he saw them beat up rioters one day, then go to church in their saris the next, “looking so sweet and lovely”.) Monrovia’s mayor is also a woman, as is the director of the port, a crucial position. Sometimes I feel as if I’ve landed in a Patricia Cornwell novel, where all positions of authority are held by women. It’s great.

In her spacious office, impeccably dressed in her trademark African cloths and turban, the president is warm and gracious, despite a stern reputation. I have been warned to stick to the agreed topic of sanitation. Stray off it – to accusations of endemic corruption, nepotism and human rights issues, for example – “and you will see her change in an instant”, a Liberian friend tells me.

Sirleaf took a while to understand the place of good sanitation. Like countless Liberians, she grew up on the family farm, where the only toilet was the bush. “It came naturally,” she says, when I double-check that the president has just admitted to open defecation – or, as Liberians say, doing poo-poo in the bush. “That was what it was.”

Like the six out of seven Liberians who still do the same thing, or the 2.6 billion worldwide who have no toilet, Sirleaf didn’t see what was wrong with it. All that forest: what harm can a little poo-poo do? Now she knows better. She knows that diarrhoea – caused largely by people ingesting water or food contaminated by human waste – kills more children worldwide than HIV/Aids, tuberculosis and malaria combined. She knows that even the greenest, widest forest can’t prevent faecal particles being tramped into a village on feet and flies and fingers, to be dipped into food and water, to become diarrhoea, dysentery or cholera. She knows, as an economist should, that good sanitation could reap millions of dollars a year in savings. India, where two-thirds of the population are toiletless, loses $58bn a year in wages and medical bills to the 50 diseases that can travel in human excrement. Half the hospital beds in sub-Saharan Africa are filled with people suffering the consequences of bad sanitation. But, of course, the president sees endless statistics. Only when she looked into why so many Liberian women were dying in childbirth, and why children were dying of something as banal as the squits, did she realise “there is a relationship with water and sanitation. I needed to understand why that was so, and partly it’s because people don’t have access to clean water. That was an eye-opener for us.”

Ma Ellen is amazing, but she is a politician. She is fluent in euphemism. When she says “clean water”, she really means “water without human excrement in it”. That’s what “clean water” means, because that is what dirty water is dirtied with.

At the end of a long, red road, a bone-shaking hour’s ride from Fish Town, we arrive at Jaytoken, an ordinary village like thousands of others, with huts grouped around a green football pitch and surrounded by that ever-so-green forest. Women do chores; men are at the farm or the illicit gold-mine nearby. The closest clinic is a four-hour walk away. The road is so bad only motorbikes or 4x4s can negotiate it in the dry season; hardly anything can pass in the rains. People walk and walk and walk. The only fat bellies here are the ones filled with worms. Why? Because of the creek.

The creek is everything. It carried dead bodies in times of war. It still carries animal carcasses. Boas swim in it. It carries the excrement of upstream villagers who use it as a toilet. It provides drinking and washing water. And it brings death – it is the water into which hopeful mothers with diarrhoea-afflicted children mix oral rehydration salts, dispensed for free by that clinic four hours away, without boiling it. I don’t know why they do that – they have had countless hygiene lessons.

They tell me their dirty water causes “running stomach” and that running stomach sometimes causes death, such as that of Marie Saylee, nine months old, who got sick last November. I ask her father, Pastor Saylee, why she wasn’t taken to the clinic. There was no time, he says. He goes to fetch the country medicine he would have given her, had she been older. It is a leaf called wudirrubu, or “goat-eat leaf”, because goats eat it. You pound it, mix it with creek water – again, unboiled – and drink it. Marie’s mother gave her pepper soup, coconut milk, clean water from the hand-pump. Nothing worked. Marie took three days to die from something most of us consider a stomach bug.

The people of Jaytoken, like people in countless other villages, knew that creek water was deadly water. And still they didn’t boil it. They had soap for sale cheaply in the local shop, along with affordable water-purification sachets, but nobody bought them. They could build their own houses; they crafted chairs and lovely bamboo window shutters – but they would not build latrines. Like the president, going for poo-poo 60 years ago, they didn’t see the necessity. They had other things to think about, such as not having a decent road or clinic or money. Sanitation was a luxury. So along came WaterAid, trying to reshuffle those needs into a list that puts sanitation near the top. Jaytoken’s green fields are atop rock, so they brought rock-breaking equipment to sink water pumps. But the villagers kept going to the goal-pole latrine in the bush – so-called because it is formed of a perch that looks like a goal – so WaterAid brought in a Liberian NGO to perform a process known as community-led total sanitation (CLTS). That jargon hides a fascinating concept: that people are stubborn and so must be shocked out of their wrong behaviour. The NGO does this with tricks. By dipping a hair they say has been dipped in shit into a glass of water and then asking people to drink it. No? How is that different from the water they drink every day? Or by putting food next to a piece of excrement and watching the flies jump from one to the other. Are they different flies? No? By that point, the penny is supposed to have dropped. “The basic assumption,” says the CLTS handbook, “is that no one can remain unmoved once they have learned that they are ingesting other people’s shit.”

Liberians don’t use that word. “Poo-poo” is bad enough. But not bad enough for the president to be shy about it when I ask what language she uses to talk about sanitation. “I say poo-poo,” she says. “Of course. If you tell people ‘defecate’, they won’t understand.”

CLTS is wildly popular in the world of poo-poo activists. It has been hugely successful in many parts of the world. When it works, it works dramatically. People rush off to build latrines, then they clean up the rest of their villages. They are encouraged with prizes and – in India – awards handed out by the president and covered on national TV. WaterAid is one of dozens of NGOs currently using the technique.

But it doesn’t always work. The trouble with sanitation is that it involves human nature. People don’t usually respond well to health messages or nagging – many doctors smoke when they know they shouldn’t, for example. At Jaytoken school, the blackboards are covered with appropriate hygiene messages, written especially for our visit. A young woman named Grace puts up her hand when I ask if anyone has ever been bitten by a snake while going to the latrine. She is a 24-year-old in a primary school, because her school years were swallowed by war. She was bitten by a snake because the school was built by a Liberian charity that gave up before providing toilets. Snake bites are one risk; sexual assault is another. None of the women of Jaytoken admits to being raped, but it is endemic, and using latrines in the bush leaves them vulnerable. Water may be life, goes the slogan, but a decent toilet is dignity.

Dignity doesn’t get the attention that clean water does, though. The people of Jaytoken and nearby Nyonken – a three-hour walk away – are proud of the new pumps provided by WaterAid. But, like seven out of 10 other Liberians, they still haven’t built latrines. Far too many NGOs rush to provide a clean water supply without bothering to install sanitation along with it. If there is a better method for polluting a clean water supply than having little fingers covered with faecal particles, I don’t know what it is.

I ask the president about this disparity. Sanitation makes economic sense, after all. CLTS, for example, is cheap – no expensive concrete latrines, no sewerage systems, just some clever persuaders changing people’s hearts and minds.

“The problem is,” she answers, “these public services don’t have a high profile. People want to see their footprint – a building that everyone can see, or a road. No one pays attention to the three-room latrine in the back yard. There has to be a whole change of consciousness.”

And not only by donors. In the welcome meetings, villager after villager stands up with a petition. Thank you for the water, they say, but give us more. Give us roads. Give us a clinic. They don’t ask for latrines. A man from the ministry of works expresses what I’m thinking: “You can build your houses. Why don’t you build latrines? If a hinge falls off a door, will you expect an NGO to come and fix it?”

The president would be unimpressed, but unsurprised. “People say they want health clinics,” she says, “but they don’t ask for sanitation. They say their children get malaria or dysentery, but they don’t ask for sanitation. We have to bring to their consciousness that sanitation is linked to health.”

On the way back to Monrovia, with the roof of the truck now holding a live chicken that the villagers of Nyonken gave us to honour us (and which ends up in a pot in a Fish Town restaurant), we pass more 4x4s zooming towards the border and the refugees. I feel frustrated. In Monrovia, ministers and NGOs hold a weekly crisis meeting about refugees, but not about the 18% of Liberians who die because they have no toilets or clean water.

Towards the end of our interview, I ask the president why that is. We had followed in her footsteps to Fish Town because she had also gone to see the state of the Ivorian refugees, most of them welcomed by Liberians who had to think back only a few years to a time when they were themselves refugees. Ma Ellen is too polite to shrug, but her words do. “The humanitarian system responds to these things that get sensational,” she says. “They want to be seen as responsive. The ordinary village, that no one is taking care of, that doesn’t come to mind.” And with that she takes her leave, to get back to the job of fixing her country, one latrine at a time.

DIY science: should you try this at home?

When Richard Handl was arrested for attempting to split the atom on his stove, he joined a growing band of home experimenters cooking up all kinds of trouble behind the kitchen door

Ängelholm is a pretty southern Swedish town, famed for its clay cuckoo manufacturing, a clay cuckoo being a kind of ocarina, which is a kind of flute. The crime rate here is practically zero. Except one of its residents was last year arrested for trying to split the atom in his kitchen. His name is Richard Handl and he buzzes me into his first-floor flat.

I wanted to meet Richard because I keep seeing reports of home science experimenters clashing with the authorities. There’s been a spate of them this past year or two.

I glance into Richard’s kitchen and recognise his cooker from the news. It was horrendously, alarmingly blackened then, but it’s clean now.

“So, you aren’t currently doing any experiments?” I ask him.

“I’m banned,” he says.

“By whom?” I ask.

“My landlord,” he says. “And the Swedish Radiation Safety Authority.”

Then we sit on the sofa and he tells me his story.

When Richard was a teenager, everything, he says, was fine. “I had friends. We’d go partying. I have Asperger’s, so I was a bit of a nerd, a geek. My interests were chemical experiments. I’d make solutions that changed colour. When I was 13, I made some explosives in the garden, using gunpowder, stuff I got from a paint store and from my father’s pharmacy. He had sulphuric acid, nitric acid. Visiting my father in his pharmacy was very exciting.”

His father assumed Richard would grow up to be a pharmacist, too. He was, Richard says, happy and proud of his son, as it was his dream to raise a boy to follow in his footsteps. But something unexpected happened to Richard 14 years ago, when he was 17: “I became very aggressive to people,” he says.

“In what way?” I ask.

“It was towards my father,” Richard says. “Sometimes I hit him.”

“In response to what?”

“Very small things. Like if he was late and didn’t call.”

“Was he worried about you?”

“Yes, he was quite worried about me. He took me to the hospital, so I could talk to psychiatrists. They said I was depressed. And I had some paranoid disorder.”

“And all this just came from nowhere?”

“It just happened,” he shrugs.

Richard worked in a factory for four years, but his disorder meant he spent most of his time in his flat. His love of chemistry continued undimmed, but the possibility of him becoming a pharmacist had practically gone. So, instead, he decided one day to start a collection – he would scour the internet and buy an ampoule of every chemical element. He quickly realised he had to downgrade his ambition. “There are some very unstable radioactive elements, like polonium and francium, that last just a couple of minutes and then decay. They’re impossible to get.”

But he persevered with the others.

“Do you have any of them still here?” I ask.

“Sure,” he says. “Would you like to see them?”

He disappears into his bedroom and returns holding a basket filled with ampoules of gold and silver and platinum and thallium and beryllium. Some are solid blocks, some glittering shards, others shining slivers. The basket looks like a treasure chest.

“This is the most amazing one,” Richard says, picking up an ampoule marked “Cesium“. It looks like solid gold. “Watch,” he says. “If you warm it up…”

He closes his fist around it for 30 seconds. Then he shows it to me again. It has melted. We both look at it, amazed, as if we’ve just witnessed a magic trick.

“And then,” Richard says, “I began to collect radioactive elements like radium and uranium and americium.”

Richard was Googling “americium” one day when he found a story, in Harper’s magazine, chronicling the life of a Michigan boy named David Hahn who grew up in the 1990s. There was something about Hahn with which Richard identified. Both boys spent their childhoods blowing things up in the garden. Hahn once turned up at a Boy Scouts meeting in Golf Manor, Michigan, with a bright orange face due to an accidental overdose of canthaxanthin. Hahn got expelled from camp for dismantling a smoke detector (he was trying to extract the americium – pretty much everything you need to split the atom you can find on eBay or in smoke detectors and antique luminous dial clocks).

Those were the days before the internet, so getting hold of information about how to build a nuclear reactor was more complicated for Hahn than it would turn out to be for Richard. He learned how to do it by writing to the US Nuclear Regulatory Commission and pretending to be a physics teacher. Did they have any pamphlets on how to split the atom?

“Nothing produces neutrons as well as beryllium, Professor Hahn,” they wrote back.

And that’s how David Hahn managed to turn his potting shed into a nuclear reactor.

It wasn’t long before the Michigan police cottoned on, and in June 1995, 11 men in protective suits descended on the dangerously irradiated shed. He was shut down.

Sixteen years later, in Ängelholm, Richard read the Hahn story and felt inspired to try it out himself. This is how Richard went about trying to split the atom. First, he got a saucepan. Into it he put his radioactive elements – the americium and radium. He mixed them up with sulphuric acid and beryllium, and turned on the stove. The mixture bubbled up crazily, splashing all over the cooker and the floor. He quickly turned off the hob and posted a picture of the carnage on his blog, with the caption “The Meltdown!”.

His plan, he says, was to repeat the experiment, but this time collect into a test tube the neutrons that were emanating from the concoction. Then he’d have fired the “neutron ray” at a chunk of uranium sealed in a glass marble.

“What does the neutron ray look like?” I ask.

“It doesn’t look like anything,” Richard says. “You can’t see it.”

“How do you know it’s there?”

“You have to measure it with a Geiger counter,” he says.

“So what you’re saying is, you’d point the test tube filled with neutrons at the uranium marble, and that’s what would split the atom?”

“Yes,” Richard says.

Richard never did collect the neutrons into a test tube. After the meltdown, he decided to email the Swedish Radiation Authority to double-check that what he was doing was above board.

“Hello!” read his email of 18 July 2011. “I’m very interested in nuclear physics and radiation. I have planned a project to build a primitive nuclear reactor. Now I’m wondering if I’m violating any laws doing so?”

They emailed him back on 11 August: “Hi. The short answer to your question is that if you build a nuclear reactor without permission, you are violating strict laws. It is a criminal offence and can lead to fines or imprisonment for up to two years.”

Richard was surprised. “The amount I had was very small,” he says, “so far away from the amount needed to make a dirty bomb or something like that. To get it to explode, you must have something called a critical mass, which is 50kg of radium or 6kg of plutonium. I had 5g. The worst that could have happened was I might have got radiation in me.”

“And got cancer years later?” I ask.

He shrugs. “Yes.”

Even though it took the radiation authority three weeks to respond to Richard’s email, everything moved very quickly after that. Within days, they’d turned up at his flat with the police.

“They told me to get out with my hands up. They scanned me with Geiger counters. There was nothing. They measured the whole apartment. They said I was arrested for a crime against the radiation safety law.”

And that’s it, so far. Sixteen weeks have passed and nothing has happened to him, besides making headlines all over the world.

“I don’t regret it,” he says, “because it was exciting. I’m sad I can’t do it any more.”

We glance at his basket of elements. “There are no other experiments you could do with these?” I ask.

“I can,” he says, “but I don’t want to.”

“What could you do?” I ask.

“I could…” Richard pauses. “This thallium is very, very poisonous. If you break the ampoule, it would start to react with the air and oxidise. Thallium oxide. Very poisonous. If you get it on your fingers, you can die.”

“But you would never consider…”

“No, no,” Richard says. He pauses. “Actually, I’m thinking of trying again to become a pharmacist. I’m going to read up some courses from the high school and begin to study in the university.”

Back home, I remember the moment Richard shrugged, unconcerned, at the possibility of developing cancer from his experiments. This happens a lot with home experimenters. Something clicks in them and their science becomes more important to them than their safety. It happened to the Brazilian priest Father Adelir de Carli, who in April 2008 strapped 1,000 helium party balloons to a chair and lifted off from the port city of Paranagua.

He’d been inspired by a truck driver named Larry Walters who in 1982 had attached 45 weather balloons to a chair and soared to 16,000ft, waving at passing Delta and TWA pilots before landing 20 miles away in Long Beach. “The more I look at it, the more I’m glad I did it,” Walters told the New York Times at the time. “It’s  something for when I’m an old man. So many people have dreams and they never follow through on them.”

Twenty-six years later, Father de Carli was so captivated by the experiment, he reportedly forgot to check the weather forecast, and to learn how his GPS worked. He was blown off course and drowned.

Then there were the two racing car drivers who, in the summer of 2010, poured four gallons of methanol into a barrel in a parking lot in Washington State, sat on top and lit the fuse. They were envisaging a “barrel ride”. It was supposed to slide across the parking lot. Instead it exploded. One of them, a former American Sprint Car Series national champion called Travis Rilet, suffered 70% burns. The other, an Australian crew member called Tyson Perez, died.

In Enniskillen, Northern Ireland, a man named Paul Moran was jailed for three months last October for accidentally setting fire to his block of flats while trying to turn his faeces into gold. He had left the stuff on an electric heater and it caught light.

“It was an interesting experiment to fulfil the alchemist’s dream, but wasn’t going to succeed,” the judge said when sentencing him.

But no home experiment has gone wrong quite so heartbreakingly as that of the Pambakian family. The Pambakians live in a cottage very close to my own house, so one day I stop on my way home to have a look. There’s a Volvo parked in the driveway. In the boot is a bag filled with medical supplies, bandages, some Brasso, some old wellies, a duvet, all jumbled up. The wing mirror is stuck together with tape. There’s stuff here that would save your life if administered by a medical professional, but it’s all quite haphazard.

Dr Yvonne Pambakian won’t talk to me about the tragedy that occurred inside the cottage. So instead I sit on the press bench of her General Medical Council fitness to practice hearing and listen to her testimony and cross-examination.

Five years ago, on 20 June 2007, she made an emergency call from the cottage. Her 22-year-old sister, Yolanda Cox, had gone into anaphylactic shock. When the paramedics arrived, they asked Pambakian what had happened.

“I gave her a drug for her asthma,” she told them.

Yolanda was rushed to the Royal Free hospital where a doctor, Alexander Mackay, asked her and her mother to explain exactly what they’d injected into her.

“They wouldn’t say,” he later told the coroner. “They said I didn’t need to know anything and the drug was extremely safe.” It seemed they were trying to protect some secret ingredient they’d been developing. “Some time later,” Mackay told the coroner, “they brought in paper information in two files.” The family were, in fact, injecting each other in their kitchen with an experimental drug of their invention, which they’d called B71.

Yolanda died a week later, on 27 June 2007.

Pambakian and her mother, she tells the hearing, began their experiments back in the mid-90s, pooling their areas of expertise (she’s a GP, her mother an immunologist). One day, they had a kind of eureka moment. To summarise it: some diabetes sufferers have an autoantibody that’s responsible for their resistance to insulin, and the Pambakians supposed that, as insulin resistance is so uniquely destructive, if they could derive a peptide from the autoantibody, it would be uniquely curative. So they did, and they called it B71. They began posting patent applications. B71 would treat – and this is just a small sample – asthma, diabetes, psoriasis, eczema, Alzheimer’s, schizophrenia, depression, Parkinson’s, migraines, multiple sclerosis, premature baldness in men, obesity, inflammatory bowel disease, asthma, cystic fibrosis, insomnia, cancer and HIV.

They managed to persuade some Dutch money people to bankroll the business and embarked on two clinical trials in the Netherlands. That was in 2005. For two years after that, nothing happened. The whole thing seemed stuck in limbo.

And then one day in April 2007, they got an email. A woman called Caroline, a friend of one of the Dutch backers, had just been told she was dying of cancer. She was 33, with four children and – according to doctors at the Royal Marsden hospital – had only three months to live. “If there’s the remotest chance the drug might prove beneficial…” the backer emailed.

So on Good Friday 2007, Pambakian travelled to Caroline’s home, with a vial of B71 in her bag.

“You wanted to try out a theory,” GMC prosecutor Stephen Brassington says at the hearing.

“I wanted to offer her a treatment,” Pambakian snaps back.

So she prayed, and then she injected Caroline with a mammoth 6mg of the drug – a dose four times higher than they had given the Dutch trial volunteers. Caroline survived the injection, but later died of her cancer.

Brassington is incredulous. This is not how science works, he says. Science is all about assiduously gathering data, about treading gently, about conducting delicate clinical trials.

“I didn’t have safety data in thousands of people, that is true,” Pambakian admits. The way she says “thousands” is fierce, irritated, superior, as if the GMC panel live so far inside the box, they can never understand the kind of maverick thinking that changes the medical world.

When Pambakian arrived back at the cottage, they decided to make themselves test subjects. Of course, they were far from the first doctors to self-inject at home. For centuries, scientists have been deliberately infecting themselves with gonorrhoea and yellow fever; they’ve become morphine addicts and cocaine addicts in their hunt for new anaesthetics. The doctor who discovered in 2003 that stomach ulcers came from a bug and not from stress did so by drinking a potion containing the bug. So the Pambakians mixed up some more gigantic 6mg doses. And they injected themselves. And that’s when Yolanda said she didn’t feel well, and she slumped on the sofa.

“When the ambulance crew arrived, you told them that it was a treatment for asthma,” Brassington says.

“When the ambulance crew came, there was no time to sit and discuss the workings of the drug,” Pambakian replies. “I just wanted them to concentrate on getting the tube down her lungs. On giving her a chance to live. I’d have told them anything.” She pauses. “Anaphylactic shock is extremely rare. We’re talking about a few people a year in the whole country. It was not in my mind. Perhaps it should have been, but it wasn’t.” She falls silent for a moment. “Now it’s on my mind all the time. Now I don’t take a Nurofen without thinking about it. Now it’s on my mind all the time.”

And at that she seems to diminish, like a balloon losing its air.

“Your judgment entirely deserted you,” the prosecutor says.

“I think ‘entirely’ is a bit…” She trails off.

“Doctors who ignore the proper, ethical process of clinical research expose their patients to unnecessary risk,” he says.

“I suppose so, yes,” she says, quietly.

“You fell seriously short of the standards expected from a registered medical practitioner,” the prosecutor says.

There’s a short silence. “Yes,” she says.

A few days later, the GMC gives its judgment: “Your name will be erased from the Medical Register.” And she leaves the hearing, no longer Dr Yvonne Pambakian, but Yvonne Pambakian.

Soon after I watch her hearing and meet Richard Handl, I receive a slightly alarmed email from Jason Bobe, who runs DIYbio.org, an online community for home science experimenters. I’d emailed him as part of my research. He says he’s worried my article may discourage home science. Maybe, he suggests, I should talk to Victor Deeb, whose experiments in his basement went disastrously wrong in a very different way and whose story might offer a counterbalance.

Deeb lives in a small Massachusetts town called Marlborough. He’s retired, in his mid-70s, and although he’s lived in the US almost all his life, he still has a strong Syrian accent, which gets stronger as he becomes more incensed down the phone.

Three years ago, on 5 August 2008, a policeman happened to be driving past Deeb’s house. “He saw smoke billowing from the air conditioner in an upstairs room, so he called the fire department.” Deeb speaks in short, exact phrases, as if he considers our conversation to be like a chemical experiment, requiring complete precision.

A plug had shorted in the bedroom. The fire department put out the fire, glanced into the basement and immediately called for emergency reinforcements.

“The whole fire department came,” Victor says. ”The FBI. Even the CIA was here. It couldn’t have been any more crazy. They went into the sewer system to see if I was dumping anything down the toilet.”

What they had found in the basement was 100 bottles of chemicals. None was hazardous. There was nothing poisonous. “I was working on a coating for the inside of beverage cans containing no Bisphenol A,” Deeb says.

BPA, he explains, is standard in beverage can coatings. The problem is that it can seep into the drink and play havoc with our hormones, causing men to grow breasts and girls as young as seven to have periods. Back in 2008, he says, “there were few references in the media to the negative effect of BPA. Currently, there is a deluge of articles. So my desire to eliminate BPA was ahead of its time.” He pauses. “I spent an enormous amount of time with the authorities, trying to explain what I was working on, but they had no perception. No concept.”

And so he watched as they hauled away all the chemicals and test tubes in a truck. “I had a box full of files and notes and comments,” he says. “Twenty years’ work. They hired two PhD chemists to go through the box, looking for confirmation that there were hazardous materials in the basement. When they couldn’t find anything, they left the box out in the rain. It destroyed all my notes. Twenty years of my life and work and efforts to help others down the drain.”

“When they realised their mistake, I presume they apologised and paid you a settlement,” I say.

“The opposite!” he says. “They’re suing me for the cost of emptying my basement.”

For America’s online community of home science experimenters, the most outrageous moment of all came when the enforcement officer, Pamela Wilderman, explained her decision-making process to the local paper: “I think Mr Deeb has crossed a line somewhere,” she said. “This is not what we would consider to be a customary home occupation.”

“Allow me to translate Ms Wilderman’s words into plain English,” wrote Robert Bruce Thompson, the author of Illustrated Guide To Home Chemistry Experiments. “‘Mr Deeb hasn’t actually violated any law or regulation that I can find, but I don’t like what he’s doing because I’m ignorant and irrationally afraid of chemicals, so I’ll abuse my power to steal his property and shut him down.’ There’s a word for what just happened in Massachusetts. Tyranny.”

Before I hang up, Victor Deeb says he wants to remind me of something. He says that for every David Hahn and Richard Handl, there’s a Steve Jobs and a Charles Goodyear. “They started at home. Goodyear developed the vulcanisation process by mixing sulphur with virgin rubber on his wife’s stove in their kitchen.”

And then he is gone, to do – he says – what he spends every day doing. He’s going to try to remember what he’d written on the pages in the box that was left out in the rain.

How Planned Parenthood won Susan G Komen’s ‘race for the cure’ | Amanda Marcotte

Planned Parenthood’s huge public relations win shows the deep support for women’s healthcare – defeating the shame-mongers

This week’s headline-grabbing fight between Planned Parenthood and the Susan G Komen Race for the Cure has one very important takeaway for pro-choice activists and organizations: if you put up a fight, you will win. By getting in front of the story about Komen cutting grants to Planned Parenthood for mammograms under a barrage of anti-choice pressure, Planned Parenthood tapped a well of feminist rage, and neatly demonstrated how much the country believes that women should have access to comprehensive healthcare that includes contraception, STD prevention and treatment, and yes, abortion.

For the past year, anti-choice activists have set their sights on Planned Parenthood, determined to wipe out the behemoth provider of low-cost reproductive healthcare. The strategy? A massive propaganda effort aimed at painting Planned Parenthood as a dirty, criminal organization, instead of the efficient provider of quality care that it is. This strategy involved making false accusations of abetting sex traffickers, opening nuisance congressional investigations and throwing the word “abortion” around a lot to justify attempts to eliminate federal funding for contraceptive service.

As part of this strategy, anti-choicers mounted a pressure campaign on Komen, trying to get them to cut ties with Planned Parenthood in order to create the impression that Planned Parenthood has cooties. Anti-choicers had every reason to believe a shaming campaign would work. After all, this fight is fundamentally about female sexuality, a traditional site of much shame and secrecy.

But as Planned Parenthood demonstrated, shaming campaigns have a major weakness as a tactic: they don’t work if the target refuses to be shamed.

Instead of slinking away in shame when Komen cut ties, Planned Parenthood went on the offensive, shooting off press releases, publishing a snarky public letter for supporters to sign, and exhausting their representatives with television appearances. The message was simple: there’s nothing wrong with comprehensive reproductive healt care. On the contrary, those who should be ashamed are those who let their prudery and misogyny drive them to hate Planned Parenthood so ferociously.

Throwing anti-choice shaming tactics in their face worked, probably exceeding all of Planned Parenthood’s expectations. The story has dominated the news cycle for an entire week, and Komen’s efforts at damage control kept backfiring. The attention allowed Planned Parenthood to remind the public that while they unapologetically provide abortions to those in need, 97% of their services are not abortion but, instead, contraception services, STD prevention and treatment, and other sexual healthcare.

Planned Parenthood also trumpeted the fundraising that resulted from the dust-up, clocking in at least $680,000 – even before Mayor Michael Bloomberg of New York City pledged $250,000 in matching funds.

The mind-boggling numbers sent a strong message, that Americans don’t appreciate conservative grandstanding on women’s healthcare. Even some anti-choicers had to admit that Planned Parenthood took the upper hand during this skirmish. Komen removed all doubt, Friday morning, about who had won the battle, by caving and restoring their grants to Planned Parenthood.

The past week has erased months – years, really – of work on the right to build a cloud of suspicion around Planned Parenthood. Now, a new narrative is forming: if you attack Planned Parenthood, be prepared to meet massive resistance, as well as a ton of negative press. And it’s not just because so many people have affection for Planned Parenthood, though considering how many women the organization has served, that does play a role. It’s because the public increasingly understands that attacks on Planned Parenthood are a proxy for a larger war on sexual healthcare. The anti-choice strategy of flinging the word “abortion” around in order to attack contraceptive services – or, in this case, access to affordable mammograms – is losing its impact.

But above all, Planned Parenthood won this battle by going on the offense. The lesson learned here should not be forgotten. Instead of slinking away to nurse your wounds when anti-choicers call you a slut, throw it back in their faces by calling them prudes. Pro-choicers have nothing to fear by being loud and proud about what we believe. When they dish out shame, respond with pride – and you will win.

Susan G Komen in U-turn over Planned Parenthood funding cut

Nancy Brinker, cancer charity’s CEO, apologises for ‘recent decisions’ and says Komen will honour existing grants

America’s largest breast cancer advocacy group has been forced to make a self-abasing retraction of its plan to cut funding for Planned Parenthood following a huge outcry against the decision.

Susan G Komen for the Cure, a Dallas-based organisation, has announced that it will honour existing grants to Planned Parenthood and allow the organisation to continue to apply for future funding – a U-turn from its earlier decision to cut its annual $650,000 provision.

Nancy Brinker, who set up Komen as a pledge to her dying sister to work to end breast cancer in the US, together with the foundation’s board of directors, put out a statement in which they apologised to the American public “for recent decisions that cast doubt upon our commitment to our mission of saving women’s lives”.

Although the statement insisted that the move to sever Planned Parenthood’s funding had not been political in nature, the board did admit that it had left itself open to the charge that it was vulnerable to political persuasion within America’s highly-charged debate over abortion. It said that it would amend a new rule under which the funding cut had taken place to make clear that political considerations had no place in its decision making.

“The events of this week have been deeply unsettling for our supporters, partners and friends and all of us at Susan G. Komen,” the statement said. “We have been distressed at the presumption that the changes made to our funding criteria were done for political reasons or to specifically penalize Planned Parenthood. They were not.

It added: “We do not want our mission marred or affected by politics – anyone’s politics.”

The newly-adopted rule under which Komen made its controversial decision to cut ties with Planned Parenthood, the largest reproductive and sexual health service provider in the US, stated that no body should be funded should it be under official investigation. Planned Parenthood is indeed under congressional investigation – the problem, though, is that the investigation was launched against it by overtly politically motivated individuals who are opposed to abortion. The organisation is a favourite target of anti-abortion lobbies because some of its clinics offer abortions.

“Our original desire was to fulfil our fiduciary duty to our donors by not funding grant applications made by organizations under investigation,” Komen said in its statement. “We will amend the criteria to make clear that disqualifying investigations must be criminal and conclusive in nature and not political. That is what is right and fair.”

In a statement, Cecile Richards, Planned Parenthood’s president, described the support she had received since Tuesday as astonishing and “a testament to our nation’s compassion and sincerity”.

She said: “In recent weeks, the treasured relationship between the Susan G Komen for the Cure Foundation and Planned Parenthood has been challenged, and we are now heartened that we can continue to work in partnership toward our shared commitment to breast health for the most underserved women.

“We are enormously grateful that the Komen Foundation has clarified its grantmaking criteria, and we look forward to continuing our partnership with Komen partners, leaders and volunteers. What these past few days have demonstrated is the deep resolve all Americans share in the fight against cancer, and we honour those who are at the helm of this battle.”

The reversal was welcomed by local Komen affiliates, many of which had publicly denounced the funding decision. “We are elated,” said Michele Oftrander, executive director of Komen in Denver. “We opposed the decision from the very beginning. Planned Parenthood is an essential partner in breast health care.”

However, Republican candidate Rick Santorum, campaigning in Missouri on Friday, said he was “very disappointed” by the reversal. “It’s unfortunate that public pressure builds to provide money to an organisation that goes out and actively is the No 1 abortion provider in the country. That’s not healthcare. That’s not healthcare at all.”

There have been suggestions that Komen’s new rule was pushed through the foundation by the organisation’s recently appointed senior manager for public policy, Karen Handel, who had been quoted as saying: “I am staunchly and unequivocally pro-life … Let me be clear: since I am pro-life, I do not support the mission of Planned Parenthood.”

Komen’s statement leaves some room for ambivalence, however. Though it says that existing funding for Planned Parenthood will be reinstated, it puts a question mark over future funding by saying only that the group will continue to have “eligibility to apply for future grants”.

Whether those applications will be received favourably is left unresolved.

Since Komen announced on Tuesday that would pull the funding, it has faced a massive barrage of criticism. Social media protests appeared instantly, including a Tumblr blog entitled Planned Parenthood Saved me, which saw 216 posts in just two days.

Komen’s own local offices went public with their disapproval. Paula Birdsong, spokesperson for Komen’s Sacramento affiliate which opposed the national office’s decision, said the chapter believed Planned Parenthood should not be penalised for being under investigation.

“Normally we are in complete support of decisions that are made at our national level but this issue is one we could not support,” she said. “We believe until someone has been found to have been guilty of a charge, funds should not be pulled just because someone is under investigation. It’s innocent until proven guilty.”

Prominent individuals associated with Komen also resigned in protest, including the group’s top health official, Mollie Williams, the executive director of its Los Angeles chapter, Deb Anthony. A member of its medical advisory board in New York, Dr Kathy Plesser, had also announced that she would resign if the decision were not reversed.

The fury directed at Komen was matched by an outpouring of support for Planned Parenthood. Michael Bloomberg, the mayor of New York, led the charge, pledging $1 for every equivalent dollar donated to Planned Parenthood up to a total of $250,000.

In addition, $400,000 was raised online from 6,000 donors in the first 24 hours after the announcement. Within hours of the controversy breaking, the $650,000 cut had been more than compensated.

Yet Komen continued to defend the decision, with chief executive Nancy Brinker appearing in a video published on the organisation’s website to explain the decision. She also told MSNBC that Komen wanted to focus on giving grants direct to service providers, whereas Planned Parenthood sent people to other facilities. “The investigation isn’t the only issue … Our issue is grant excellence.”

Now Komen hopes that its policy reversal will temper the storm that has raged around it. “It is our hope and we believe it is time for everyone involved to pause, slow down and reflect,” its statement said.

NHS reforms already taking their toll on GPs

Chris may want to get a second opinion on his latest test figures

Health bodies reject NHS reforms

Physiotherapist leaders have joined the Royal College of GPs in calling for the health bill in England to be scrapped, increasing pressure on the government.

PFI hospitals ‘get bail-out fund’

Seven English NHS hospital trusts with debts caused, in part, by PFI repayments are to have access to a £1.5bn government bail-out fund.

Our NHS bill amendments represent a major concession by the government | Shirley Williams

The changes proposed by the Lords go some way to securing a sustainable health service, safeguarded from marketisation

The government’s proposed amendments to the health and social care bill prior to the report stage, which begins on 8 February, represent a major concession, the outcome of efforts by representatives of all parties and the crossbenchers in the Lords.

The original amendment on the secretary of state’s powers and accountability was tabled last year by Lady Margaret Jay, chair of the Lords constitution committee, and me (I began the campaign to restore the constitutional authority of the secretary of state in spring 2010, with the support of the Liberal Democrat spring conference). Lord Mackay of Clashfern, the former Conservative lord chancellor, had tabled a separate amendment on the accountability of the secretary of state to parliament for the health service. The government negotiated with peers of all parties and the crossbenches.

We have managed to persuade the government that the secretary of state must continue to be fully accountable to parliament and to the public for a universal, comprehensive health service free at the point of need, and that clinical commissioning groups (CCGs) must be accountable to the secretary of state in fulfilling this duty. The clause in the bill on autonomy has also been fundamentally changed. The autonomy of providers will now be subsidiary to the overriding duty of the secretary of state. Alternatively, there may be amendments to eliminate clause 4 altogether.

A further crossbench amendment requires the secretary of state, in exercising functions in relation to the health service to have regard to the NHS constitution.

What these constitutional amendments add up to is a cross-party agreement that the comprehensive health service will continue, a solid foundation for the health service after the upheavals and uncertainties of recent years.

Other changes already conceded by the government include the role of Monitor, which has been changed from the pursuit of competition to acting in the interest of patients, and will now have to ensure that competition in the health service is limited entirely to competition on quality and not on price. Monitor will also now be responsible for making sure that every foundation hospital must use any profit made from income from private patients for the benefit of NHS patients.

At report stage, further significant amendments will be tabled. Liberal Democrat amendments would require the National Commissioning Board and the clinical care groups to ensure that no one is left out of comprehensive healthcare, including homeless people, travellers and other vulnerable groups.

Other amendments we are putting forward promote transparency in the health service by making sure that anyone responsible for commissioning or providing healthcare services is legally obliged to declare any material interest to prevent any conflict of interest.

We also want a health service based on quality not price, and so we have proposed changes to the bill designed to limit the application of competition law. In certain circumstances, competition based on quality not price can encourage innovation and best practice. We propose that CCGs must ensure that the interests of patients are always paramount in their commissioning decisions. These changes include enshrining in law that provision of healthcare is a “service of general economic interest”.

We propose to remove the Competition Commission as the adjudicator of Monitor and the body responsible for reviews.

We also seek a requirement on each provider of healthcare services to co-operate with other providers of health and social care services and other services which contribute to patient wellbeing.

Working with the crossbenchers in particular, Phil Willis and others have secured commitments from the government on future research, medical education and training.

We will also seek to maintain Monitor as the regulator of foundation trusts beyond 2016, thereby minimising the threat that foundation trusts would be deemed “undertakings” and be open to the applications of EU competition policy.

We believe these changes uphold Liberal Democrat aims of securing a comprehensive and sustainable health service. Our proposed amendments also aim to safeguard the NHS from the loopholes left in Labour’s 2006 and 2008 legislation, which left the health service open to marketisation.

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Icy weather warning issued to older people

Chief medical officer warns elderly and ill people to wrap up warm and keep an eye on forecasts as cold weather grips UK

The UK’s chief medical officer, Sally Davies, has warned older people and those with underlying health problems to take extra care as below-zero temperatures continue.

She reminded them to wrap up warm, prepare hot drinks to help ward off the cold and keep an eye on local weather forecasts after winter finally arrived and an icy spell across Europe caused dozens of deaths.

Temperatures during Thursday night fell as low as -11C (12F), and the Met Office warned of snow showers in eastern England on Friday, with light and patchy falls in coastal areas of East Anglia and Kent. Temperatures were likely to remain barely above freezing all day, it said, even though many areas could expect dry and sunny conditions.

It was expected to be cold on Saturday, with rain moving into the south-west of England, turning into sleet and possibly slow on higher ground. But there could be significant falls of snow with 5-10cm (4in) on the ground in central and eastern areas.

Temperatures in some parts of the country will be around -5C on Saturday night, leading to the possibility of severe ice on roads.

Davies said: “During a cold spell, older people and those with underlying health problems, such as heart disease or respiratory conditions, can all be at higher risk of becoming ill. Icy conditions can make surfaces extremely slippery and older people should take extra care to avoid slips and falls.

“If you do not want to brave the cold outside there are simple ways to keep warm at home, such as drawing curtains to block out draughts, drinking plenty of hot drinks, and wearing lots of light layers of clothing.”

However, the generally mild weather before this cold snap has helped create a UK first – an all-round tea harvest. The Tregothnan estate near Truro, Cornwall, reported that pickers were out earlier this week for the 12th successive month.

Its garden director, Jonathon Jones, said: “It is quite a novelty to be able to pick outside the normal season and the first time in history in this country. The frost isn’t bad news for tea but it tastes a bit better without it. It has been a really unusual set of weather conditions.”

Record ‘legal highs detected’

A record number of potentially dangerous new legal highs were found in Europe last year, say doctors.

Weekend hospital admission warning

Research which suggests that patients are more likely to die in hospital if they are admitted at the weekend is backed up by a major study.

Malaria cases around the world: how many are there?

What we thought we knew about Malaria deaths is wrong: the reality is much, much worse. See what the new detailed data says
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Malaria causes twice as many deaths as previously believed, according to the latest research out today from the highly respected Institute for Health Metrics and Evaluation (IHME), based in Seattle, and published in the Lancet medical journal.

That figure of 1.2 million deaths for 2010 is nearly double the 655,000 estimated in last year’s WHO World Malaria Report, which we detailed on the Datablog here.

How were the figures so wrong? The assumption has always been that the majority of those who die from malaria are children. In fact, the deaths are much evenly spread than that – adults die too.

Sarah Boseley writes today that

It also raises urgent questions about the future of the troubled Global Fund to Fight Aids, TB and Malaria, which has provided the money for most of the tools to combat the disease in Africa, such as insecticide-impregnated bed nets and new drugs. The fund is in financial crisis and has had to cancel its next grant-making round.

There is some good news in the data. Since the peak of 2004 of 1.8 million deaths worldwide, the number has fallen annually and between 2007 and 2010, the decline in deaths has been more than 7% each year.

The researchers said the key to collecting the new data was the use of verbal autopsy data.

In a verbal autopsy, researchers interview the relatives of someone who has recently died to identify the cause of death. IHME and collaborators around the world published a series of articles in a special edition of Population Health Metrics in August 2011 focused on advancing the science of verbal autopsy. Verbal autopsy data were especially important in India, where malaria deaths have been vastly undercounted in both children and adults. IHME found that more than 37,000 people over the age of 15 in India died from malaria in 2010, and the chances of someone dying from malaria in India have fallen rapidly since 1980.

We’ve extracted the data for deaths and death rates for all ages below. What can you do with it?

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Legionella Britons die in Spain

Three British men die and three more people remain in hospital after contracting Legionnaires’ disease while on holiday in Spain, a tour company says.

Royal College of GPs calls for David Cameron to scrap health bill

UK’s largest medical college says the health and social care bill will ‘damage patient care and jeopardise the NHS’

The UK’s largest medical royal college has called for the prime minister to scrap the health and social care bill, branding it “damaging, unnecessary and expensive”.

The Royal College of General Practitioners (RCGP) has written to David Cameron following the tabling of amendments to the controversial bill in the House of Lords this week.

They said that despite the amendments, they believed the planned reform would “cause irreparable damage to patient care and jeopardise the NHS”.

The RCGP chairwoman, Dr Clare Gerada, said: “This decision was not taken lightly, but it is clear that the college has been left with no alternative.

“We have taken every opportunity to negotiate changes for the good of our patients and for the continued stability of the NHS, yet while the government has claimed that it has made widespread concessions, our view is that the amendments have created greater confusion.

“We remain unconvinced that the bill will improve the care and services we provide to our patients.”

The college, which represents more than 44,000 family doctors, said three-quarters of respondents to a recent poll said they thought it appropriate to seek the withdrawal of the bill.

It wrote to the health secretary, Andrew Lansley, to voice the concerns of their members but decided to take action after receiving his response, and following the government’s tabling of amendments on Wednesday.

Gerada said: “Our position has not changed, and the concerns we expressed when this bill was at the white paper stage 18 months ago have still not been satisfactorily addressed.

“Competition and the opening up our of health service to any qualified providers will lead not only to fragmentation of care, but also potentially to a ‘two-tier’ system with access to care defined by a patient’s ability to pay.”

The 20 colleges that make up the Academy of Medical Royal Colleges have been divided over the strength of the stance they should take against the bill.

Those opposing it include the Royal College of Radiologists, which said it had “grave concerns”, and the Royal College of Psychiatrists, which called the bill “fundamentally flawed”.

The British Medical Association, the Royal College of Nursing and the Royal College of Midwives have also called for the bill to be withdrawn.

The government has been criticised for failing to allay fears over an increased role for private companies in running the NHS.

A critical report from MPs on the health committee last month said the overhaul was hindering the ability of the NHS to make the savings it needs to safeguard its future.

One of the amendments laid out this week said the NHS commissioning board and clinical commissioning groups run by GPs would have new responsibilities to support education and training. Both will also have to report annually on their progress in tackling health inequalities, together with the health secretary.

Lansley said the government had been “carefully listening” to opinions about the bill and that the series of amendments would “address these remaining issues”.

Gerada added: “Our view is that what is required now is to rapidly consolidate the current organisational structure, such that PCT [primary care trust] clusters remain, with GPs placed as the majority of the board so that we may address the serious issues facing our NHS.

“There should be a debate as a matter of urgency to determine what the NHS can provide, how it should be funded, and how we deal with the major health and social care problems facing our population.

“We cannot sit back. Instead, we must once again raise our concerns in the hope that the prime minister will halt this damaging, unnecessary and expensive reorganisation, which, in our view, risks leaving the poorest and most vulnerable in society to bear the brunt.”

She said the college could not support a bill that would “ultimately bring about the demise of a unified national health service”.

Gerada told BBC Radio 4′s Today programme: “This bill is a burden. It makes no sense, it is incoherent to anybody other than the lawyers. It won’t deal with the big issues that we have to deal with, such as the ageing population and dementia.

“It will result in a very expensive health service and it will also result in a health service that certainly will never match the health service that we have at the moment – or at least had 12 months ago.”

She rejected ministers’ claims that GPs were enthusiastic about the reforms: “GPs do want to be part of the planning of services for their patients – absolutely, we have never ever been critical of that.

“But that is one thing. Delivering it through this cumbersome bill is not what GPs want. Over 90% of my members surveyed last month wanted me to ask for withdrawal of the bill.

“It will turn the National Health Service into thousands of different health services, all competing for the same patients, the same knee, the same brain, the same heart.

“Patients will find their care will be fragmented, it will be on different sites, it won’t join up, it will be difficult to hand over care and it will be phenomenally expensive to keep track of all these competing parts of the NHS.”

Gerada said the NHS was “one of the cheapest health services to run and one of the fairest health services” in the world.

“There is absolutely no evidence that opening up the NHS to multiple private organisations is going to result in anything other than a fragmented, expensive and bureaucratic health service for all of us, and one that will be very difficult to sort out and put back into a coherent form,” she said.

GP leaders turn backs on NHS plan

The Royal College of GPs calls for the health bill to be scrapped, heaping more pressure on the government’s controversial reforms in England.