Vitamin pills are a waste of money, offer no health benefits and could be harmful – study


Evidence from the study suggested that ‘supplementing the diet of well-nourished adults…has no clear benefit and might even be harmful’

Vitamin pills are a waste of money, usually offer no health benefits and could even be harmful, a group of leading scientists has said.

A study of nearly 500,000 people, carried out by academics from the University of Warwick and the Johns Hopkins School of Medicine in Baltimore, USA, has delivered a damning verdict on the claims made by the vitamin supplement industry.

Evidence from the study suggested that “supplementing the diet of well-nourished adults…has no clear benefit and might even be harmful”, despite one in three Britons taking vitamins or mineral pills.

According to The Times, scientists involved in the study, which was published in the Annals of Internal Medicine, concluded that companies selling supplements were fuelling false health anxieties to offer unnecessary cures. The industry in the UK is thought to be worth more than £650 million annually.

Researchers declared ‘case closed’ on the vitamin and mineral pills after making their conclusion based on the study of half-a-million people along with three separate research papers.

Evidence from the study suggested that

Evidence from the study suggested that “supplementing the diet of well-nourished adults…has no clear benefit and might even be harmful”, despite one in three Britons taking vitamins or mineral pills.

One of the research papers involved the retrospective study of 24 previous trials. In total 450,000 people were involved in the trials and the paper concluded that there was no beneficial effect on mortality from taking vitamins.

Another examined 6,000 elderly men and found no improvement on cognitive decline after 12 years of taking supplements, while a third saw no advantage of supplements among 1,700 men and women with heart problems over an average study of five years.

The experts said most supplements should be avoided as their use is not justified, writing: “These vitamins should not be used for chronic disease prevention. Enough is enough.”

The scientists argued that the average Western diet is sufficient to provide the necessary vitamins the body needs.

Edgar Miller, of the Johns Hopkins School of Medicine, said: “There are some that advocate we have many nutritional deficiencies in our diet. The truth is though we are in general overfed, our diet is completely adequate.”

He added: “These companies are marketing products to us based on perceptions of deficiencies. They make us think our diet is unhealthy, and that they can help us make up for these deficiencies and stop chronic illnesses.

“The group that needs these is very small. It’s not the general population.”

Dr Miller continued: “There’s something for everything: preventing joint pains, stopping heart disease. If you’re going to spend your money on something every month, is this really the best option?”

The NHS advised recently that other than women taking folic acid to help them conceive and the elderly and children under five benefiting from vitamin D, supplementary vitamins would be surplus to that already gained through diet, The Times said.

The Health Food Manufacturers’ Association said vitamin supplements provided people with “nutritional insurance”.

In July 2011 the Advertising Standards Agency criticised Vitabiotics Ltd for an advert headlined: ‘Advanced Nutrients For The Brain’.

They ruled that the implied claims that “recent research had shown that B vitamins could help maintain brain function and performance’ were not substantiated and were “misleading”.

Wi-fried: do wireless routers really kill plants?


A man using a laptop with wireless router in the foreground
Electromagnetic radiation from a wireless router is unlikely to be strong enough to have any effect on living tissue. Photograph: Denis Closon/Rex Features

You may have seen in the Daily Mail on Monday (well, you MAY read the Daily Mail, who am I to judge?) the headline “What’s wifi doing to us? Experiment finds that shrubs die when placed next to wireless routers”.

Really? This is a bit worrying if so. What shrubs? Well, read a bit further down and the answer may surprise you: cress. I didn’t realise cress was a shrub, but you live and learn eh?

Apparently the researchers (some 15-year-old schoolchildren, in a classroom experiment in Denmark), decided to run the experiment after noticing they had trouble concentrating the morning after sleeping close to their mobile phones.

Quite why wi-fi got blamed for this, I’m not wholly sure, since the wi-fi in their rooms is unlikely to change depending on how close they are to their phones, but anyway, on we go.

Details about what they actually did are sketchy, but what’s been reported is that they put six trays of cress in a room near a wi-fi router, and six trays in a different room without a router. Then they reported what had happened to the cress 12 days later.

This article mentions that the rooms had equivalent light and the seeds were given equal amounts of water, which is great, but it’s unlikely that these students would have had the resources to truly monitor that conditions were equivalent in each room.

I think it’s unkind of me to criticise the experiment too much though. After all, this was a classroom study, and as such is frankly a great design, for that environment. But that certain mainstream media have leapt on this to scaremonger that wi-fi might be damaging our brain is nonsense. This experiment is not controlled enough to give us any evidence for that (and also, I’m not quite sure how similar human brains are to cress anyway).

The suggestion by scientists interviewed about the research is that routers give out heat, and this probably dried out the cress in the rooms with the routers in, so equivalent water was not enough for them.

As for why the girls might struggle to concentrate the day after sleeping with their mobile phones on their bedside, perhaps the lure of late-night Facebook sessions or internet procrastination means they sleep less well? There have been suggestions that the light from mobile phones or tablets just before bed can disrupt sleep patterns, although again there’s not really any strong evidence for this.

Mobile phones, wi-fi and the like are going to cause controversy; almost all new technology does. But wi-fi signals are not strong, you would have to go around with a router strapped to your head for extended lengths of time to be exposed to any meaningful level of electromagnetic radiation.

One thing I’d like to say though to the young women who conducted this experiment, is PLEASE don’t listen to people like me writing critiques of your experiment! I am not criticising what you did at all, because I think it’s great. What I think is dangerous and unhelpful is the media reporting schoolroom science in the same style as well-controlled peer-reviewed research, and claiming it provides the same strength of evidence.

Who next as the world’s elder statesman?


Who next as the world’s elder statesman?
http://www.bbc.co.uk/news/magazine-22389954

Young teens’ weight terror ‘common’


Scales
About 10% of 13-year-old girls are “terrified” about putting on weight, the first UK study looking for warning signs of eating disorders suggests.

Doctors said they were “worried” by the high degree of weight fixation found in 13-year-old girls, years before eating disorders typically start.

Researchers say it might be possible to stop full eating disorders developing.

Their findings, in the Journal of Adolescent Health, came from interviews with the parents of 7,082 13-year-olds.

Eating disorders, such as anorexia, tend to start in the mid-teenage years, although they can begin before then.

“Start Quote

For me the results were particularly worrying”

Dr Nadia Micali

The study, by University College London and the London School of Hygiene and Tropical Medicine, looked at the years before those disorders tend to start.

Interviews with the parents of 7,082 13-year-old schoolchildren showed:

  • Nearly 12% of girls and 5% of boys were “terrified” by the thought of getting fat
  • 52% of girls and a third of boys said they were “a little worried” about getting fat
  • One in three girls and one in five boys were “distressed” by their body shape
  • 26% of girls and 15% of boys had “eating disorder behaviours” such as fasting
  • Some habits, such as uncontrolled bingeing, were linked to higher weight two years later

One of the researchers, Dr Nadia Micali, told the BBC she was surprised children were so concerned about weight at such a young age.

“For me the results were particularly worrying, I wouldn’t have thought they’d be so common at this age.

“Part of me thinks it’s a shame we didn’t ask earlier, we don’t know when this behaviour starts.

“Quite a large proportion will develop full-blown eating disorders, maybe more than half.”

However, she said there might be an opportunity to help children before they develop an eating disorder if a reliable set of warning signs could be developed for parents and teachers.

In a statement the eating disorder charity Beat said it was an interesting and important study.

“This is the first time a study like this has been carried out so we have nothing to compare it to and therefore don’t know if the problem is increasing or getting worse.

“However it is striking and worrying how many young people had concerns about their weight from such a young age.

“It does not mean that they will all go on to develop eating disorders, but they could be tempted by unhealthy ways to control their weight and shape.”

The findings came through data collected from the Children of the 90s study.

Bullying

A separate analysis of those children, by a team at the University of Warwick, suggested bullying was linked to an increased risk of psychotic experiences, such as hearing voices, and paranoia.

Lead researcher Prof Dieter Wolke said: “We want to eradicate the myth that bullying at a young age could be viewed as a harmless rite of passage that everyone goes through – it casts a long shadow over a person’s life and can have serious consequences for mental health.

“It strengthens on the evidence base that reducing bullying in childhood could substantially reduce mental health problems.

“The benefit to society would be huge, but of course, the greatest benefit would be to the individual.”

Youngest born ‘perceived as shorter’


girls legs

Mothers perceive their youngest children as shorter than they actually are, a study suggests.

This “baby illusion” applies regardless of the number of children a mother has, Current Biology reports.

Mothers underestimated the height of their youngest child by an average of 7.5cm (3in), yet accurately judged the height of any older children they had.

The study authors believe this is an adaptive mechanism – to nurture and protect most vulnerable offspring.

Always the baby

The Australian researchers surveyed 747 mothers, asking them if they remembered experiencing a sudden shift in their youngest son or daughter’s size immediately after the birth of a new baby.

More than two-thirds (70%) said they did.

This perceptual shift primarily relates to the former “baby” of the family – mothers were less likely to report any height difference in other siblings.

This is not just because the older child looks so big compared with a baby, the researchers say.

It actually happens because all along the parents were under an illusion their child was smaller than he or she really was. When the new baby is born, the spell is broken and parents now see their older child as he or she really is, they say.

The researchers asked 70 mothers to estimate – by putting a mark on a wall – the height of each of their children.

The mothers consistently underestimated the height of their only or youngest children (aged two to six).

Yet many were good at estimating the height of their older children and everyday objects, such as the bathroom sink or kitchen counter.

Lead researcher Jordy Kaufman, of Swinburne University of Technology, said: “Our research potentially explains why the ‘baby of the family’ never outgrows that label. To the parents, the baby of the family may always be ‘the baby’.”

Fungus could control mosquitoes


Fungus could control mosquitoes, research suggests

mosquito
The fungus occurs in soil and kills a whole range of insects

Researchers at Swansea University say a fungus could be the key to controlling mosquitoes.

Fungus Metarhizium anisopliae lives in soil and kills a whole range of insects and researchers say it also affects mosquito larvae if added to the water where the insect breeds.

The insects carry diseases such as yellow fever and malaria.

According to the World Health Organisation malaria causes 800,000 deaths a year world-wide.

The team at Swansea University’s department of bioscience said initial trials are very promising.

“The fungus occurs in soil and kills a whole range of insects but we’ve put it in the water where mosquito larvae breed and it is ingested by the insect and they die,” team member Professor Tariq Butt told BBC Radio Wales.

“Start Quote

It’s quite nice that we’re killing three of the major species of mosquito transmitting a whole range of diseases”

Prof Tariq Butt Swansea University

“Normally what happens is the fungus attaches to its hosts, germinates and penetrates the body of the insect, colonises the insect and in the process the insect dies.

“But, in this case it doesn’t germinate it just stays as spores packed in the body, in the gut, of the insect where it causes stress which activates a number of genes which trigger a whole range of responses leading to the death of the insect.”

Malaria and yellow fever

Further research is now needed to see how the fungus can be introduced as initially it was hoped it would be passed from one insect to another, he added.

 “In the past we were hoping the fungus was going to emerge from the body of the insect then the spores would be carried over to the healthy larvae and create an epidemic, but now what we’re seeing is we’d have to apply the fungus frequently,” he added.

The hope is the research will find a way to control the insect which spreads diseases such as malaria and yellow fever.

“It is reported that 300 children die each hour in Africa because of Malaria, but other diseases which are emerging such as dengue (fever) results in thousands of deaths reported across the world and also some of these diseases have been reported in Europe,” said Prof Butt.

“We’ve done a number of trials and it looks very, very promising. Also, it’s quite nice that we’re killing three of the major species of mosquito transmitting a whole range of diseases.”

Test ‘may predict altitude sickness’


Mountaineers in the French Alps

Scientists say they have developed a way of predicting who will develop altitude sickness.

The condition, otherwise known as acute mountain sickness, occurs when people have difficulty adapting to low oxygen levels at high altitude.

Most cases are mild – but in rare cases there can be a potentially fatal build-up of fluid on the brain and lungs.

Altitude sickness often affects skiers and mountaineers.

It affects people only when they go above 8,000ft (2,500m).

Around 30% experience a mild form of the condition. Between 1%-2% develop the more severe form of the disease.

It is not possible to get altitude sickness in the UK because the highest mountain – Ben Nevis in Scotland – is only 4,406ft (1,344m) high.

The condition usually causes relatively mild symptoms such as headaches, nausea and dizziness. But it can in rare cases cause fluid to build up on the lungs or brain.

Current advice is to aim to acclimatise slowly to higher altitudes to give the body a chance to adapt.

Drugs which can reduce the severity of symptoms are also available, but can have side-effects.

Ultrasound check

Details of the new test are being presented to the EuroEcho-Imaging conference in Istanbul.

The researchers looked at how the heart responds to hypoxia – low oxygen levels.

They studied cardiovascular function, using non-invasive, ultrasound-based techniques, in 34 healthy volunteers once at sea level and again after going by cable car up Aiguille de Midi, a mountain in the French Alps, to a height of 12,600 ft (3,842m).

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An increasing number of people of all ages go to high altitude, mainly for recreational purposes but also for working without being conscious of the potential risks”

Dr Rosa Maria Bruno, Researcher

Around a third of them had experienced severe altitude sickness previously.

Participants had oxygen saturation levels monitored and had an ultrasound check of their heart function, using a portable device, after four hours on the mountain.

After 24 hours at high altitude, 13 out of 34 volunteers developed moderate to severe symptoms.

They had lower oxygen saturation levels and the ultrasound showed poorer function in the systolic (pumping) ability in the right ventricle.

The changes were not seen in people who did not display altitude sickness symptoms.

Susceptibility

Dr Rosa Maria Bruno, who led the study, said: “If these results are confirmed by larger studies, it will be possible to identify vulnerable individuals and suggest particular behaviours and drugs.

“Thus we can limit drug use (and side-effects) only to those who will really need them, and give them special advice and recommendations such as avoiding high altitudes or spending more time ascending to allow time for acclimatisation.”

She added: “At the moment we don’t know exactly why some people can adapt successfully to high altitude and other people cannot, or how to identify susceptible individuals in whom preventative strategies may be applied.

“This can be an important problem since an increasing number of people of all ages go to high altitude, mainly for recreational purposes but also for working without being conscious of the potential risks.”

The test can now only be done once people have spent at least four hours at high altitude but the team hope it can be developed so it can work sooner.

How to deal with job rejection


man ripping up paper
Rejection can be a chance to hone your approach to job hunting

Technology has made firing off multiple job applications easier – but as well as more opportunities for success, there is also more chance of rejection.

We wanted to know how experts suggest we turn rejection around so that it helps a job search be successful in the long run.

“Don’t take rejection personally,” says Los Angeles-based business coach Joanna Garzilli.

“Often there are a number of factors at play including timing, circumstances, office politics and budgets. Just because someone says no today doesn’t mean it’s a no in the future.”

And About.com job-search expert Alison Doyle says: “The best way to deal with rejection is to consider why you were rejected, and then move on.”

“Start Quote

Alison Doyle

Spending time volunteering will help you feel better about yourself”

Alison Doyle About.com

But analysing rejection is easier said than done. It may be tempting to follow up a rejection email or letter by asking an employer how they reached their decision, but you won’t always get a response.

“Many employers won’t disclose any information to applicants they rejected, because they are concerned about legal issues like discrimination,” says Ms Doyle.

“That said, it can’t hurt to ask, and if you do get feedback, consider how you can use it enhance your chances in the future.”

If you can’t get feedback, you should spend some time asking yourself what might have gone wrong.

Ms Garzilli says: “Do a self evaluation on what went well, what didn’t and why? This will help you to be well prepared for the next job interview.”

Re-focus

In the relatively anonymous world of online job searching, where the number of applications and rejections can mount up very quickly, it it easy to lose focus on the ultimate goal.

Ms Doyle says: “Do consider how effective your job search is – or isn’t.

“Are you applying for the right jobs? Jobs that are a strong match for your qualifications? If not, you are wasting time because there are so many applicants for each position, only the most qualified candidates will be considered.”

Sheri Bennett
Sheri Bennett has applied for more than 200 jobs but won’t give up

‘Disappointing, disillusioning and discouraging’

Since May, Sheri Bennett, from California, has applied for more than 200 jobs online, but she is still looking for work.

“I have not had many call-backs at all, and a lot of the companies don’t even send a courtesy email that you’ve not been selected,” she says.

“Not even an acknowledgment, not even a thank you for applying. Nothing.”

The former teacher says it can be very “disappointing” and “disillusioning.”

Emotional toll

Ms Bennett, who says she is “discouraged” at times, responds by simply “trying harder.”

Dan Sparks, vice-president of sales at Hire Live, which stages career fairs, says: “There are very qualified candidates out there and sometimes it just takes a little time to find that right position. says .

“Don’t just talk to one company and say, ‘That was it, that’s all I need to do, I already got that job.’ Keep an open mind, don’t be disappointed if they say no or don’t be disappointed if they move forward with somebody else.”

how to get a job now branding

Being out of work for a prolonged period takes its toll emotionally. Relationships suffer, and unsuccessful candidates can find themselves on a downwards spiral into depression.

Ms Doyle says: “One way many job seekers have dealt with lethargy or depression is to not focus all their time and energy on job seeking.

“Spending time volunteering, for example, will help you feel better about yourself. It may also help you make valuable contacts who can help your job search.”

GSK to stop doctor incentive schemes


GSK to stop paying doctors to make speeches

Editor of the British Medical Journal Fiona Godlee: “Doctors need independent, unbiased information about drugs”

GlaxoSmithKline (GSK) is making major changes to its incentive schemes following a damaging corruption scandal in China.

The pharmaceuticals firm will stop paying doctors to promote its products through speaking engagements.

Members of its sales force will also no longer have individual sales targets.

Earlier this year, Chinese police said GSK had transferred 3bn yuan ($489m; £321m) to travel agencies and consultancies to help bribe doctors.

But the company says the latest measures are not related to that continuing investigation. Instead, it says, they are part of a wider effort to improve transparency.

‘Greater clarity’

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There is a long way to go if we are truly to extricate medicine from commercial influence”

Fiona Godlee Editor, British Medical Journal

In a statement, Sir Andrew Witty, chief executive of GSK, said: “Today we are outlining a further set of measures to modernise our relationship with healthcare professionals.

“These are designed to bring greater clarity and confidence that whenever we talk to a doctor, nurse or other prescriber, it is patients’ interests that always come first.”

As well as stopping payments to doctors for making speeches, GSK is also ending payments to healthcare professionals for attending medical conferences.

A spokesperson told the BBC that there were “perceived conflicts of interest with that way of working”.

GSK plans a new system under which independent organisations, such as universities, can approach GSK for a grant if they want a particular doctor to attend a medical conference.

Doctors ‘satisfied’

In a statement, Dr Vivienne Nathanson, head of science and ethics at the British Medical Association (BMA), which represents doctors, said: “Whilst we agree that GSK should not directly sponsor doctors going to meetings, we are satisfied that they will continue to financially support education.

“It is pleasing to see a large pharmaceutical company like GlaxoSmithKline recognise that it can reduce the possibility of undue influence by rewarding employees for providing high-quality information and education for doctors, rather than for their sales figures.”

GSK says sales representatives will be rewarded for “technical knowledge” and the “quality of the service they deliver to support improved patient care”. Their compensation will also be linked to the overall performance of GSK.

Salespeople in the US have already been working under those conditions since 2011.

A spokesperson from GSK said: “It was always our intent to roll it out globally.”

Paying doctors to make speeches and attend conferences is common in the pharmaceuticals industry, but there is growing demand for reform.

“Where GSK leads we must hope that other companies will follow,” Fiona Godlee, editor of the British Medical Journal and a campaigner against industry influence in medicine, told the Reuters news agency.

“But there is a long way to go if we are truly to extricate medicine from commercial influence. Doctors and their societies have been too ready to compromise themselves.”

‘Non-trivial’

Ben Goldacre, author of the book Bad Pharma, is concerned about the quality of advice received by doctors.

He told BBC Radio 4: “Doctors get a lot of their education about which treatment works best from the pharmaceutical industry itself – from doctors who have been paid to give lectures about which drug is best.

“This free education has been shown to be be biased in research and it’s non-trivial.”

Andrew Powrie-Smith, director at the Association of the British Pharmaceutical Industry, told BBC Radio 4: “A number of companies I think are looking at this area and different models of education are emerging.”

He stressed that by 2016 companies would have to disclose how much they pay individual doctors.

Who next as the world’s elder statesman?


Mandela death: Who next as the world’s elder statesman?

Gandhi, Nelson Mandela and Aung San Suu Kyi

Nelson Mandela was often described as the “world’s elder statesman”, a father figure tackling global problems. His moral authority made him, in some people’s eyes, a successor to Gandhi. Who might play a similar role now?

Lockerbie, Burundi, DR Congo, Lesotho, Indonesia, Israel-Palestine, Kashmir, Stephen Lawrence murder, HIV awareness and World Cup football.

The list of subjects addressed in some way by Nelson Mandela is long and varied.

In some disputes, like Burundi’s long-running conflict, he was a mediator. On other intractable issues, like the stigma of HIV, he was the campaigner and bereaved father who tried to address prejudice.

Not all his contributions were successful or universally welcomed. He opposed intervention in Kosovo in 1999 and often strongly criticised US foreign policy, while his warm relations with Colonel Gaddafi and President Suharto raised eyebrows. Many thought he spoke out too late about the HIV crisis.

But even his critics would concede that he became a figure with unequalled status on the global stage.

“It seems to me that uniquely he negotiated his transformation from prisoner of conscience and iconic human rights leader to practical political leader who became in every single way the father of modern South Africa and then transformed again into elder statesman,” says Simon Marks, global affairs correspondent at Feature Story News based in Washington.

He had unquestioned legitimacy, someone that a very broad array of people looked up to, including pop singers and supermodels, says Marks.

Mandela on…

Mandela and Colonel Gaddafi
  • Lockerbie: Mediated between Libya and UK on transfer of suspects
  • Middle East: Criticised Israel for ‘narrow interests’
  • Lesotho: Ordered troops into country
  • DR Congo: Arranged key summit that led to peace accord
  • Kashmir: Urged India-Pakistan talks
  • Burundi: Closely involved in peace process
  • Indonesia: Visited East Timor politician in prison in Jakarta
  • Stephen Lawrence: Demanded urgency from police, two weeks after killing

Mandela had the capacity to operate as an honest broker in situations where others might not have been able to, says Christopher Alden of the London School of Economics, who points to Indonesia as an example. In 1997, Mandela’s two-hour visit to the imprisoned East Timorese politician Gusmao in Jakarta, against Suharto’s wishes, paved the way for a referendum and Gusmao’s release two years later.

“He accrued a moral authority that transcended the ordinary politics that guide the worst conduct of political actors.”

The unique feature of Mandela is that he was someone whose moral stature was truly worldwide, says Alden – a reflection of the globalised nature of the anti-apartheid struggle by the 1980s.

There have been other elder statesmen and women in recent years, he says, but they are generally figures whose activities are focused on internal politics or they are asked to act on behalf of a state.

“Jimmy Carter has been ‘deployed’ to North Korea to hold discussions on sensitive issues and has played an important role in democratisation efforts in Africa through the monitoring/training of elections but these are more functional – he lacks the emotive power that Mandela generates.

“Blair’s involvement in the Middle East was an attempt, I suppose, at this – and to burnish his post-Iraq reputation – but notably a failure.”

The Elders
Mandela’s organisation, The Elders, drew together some of the world’s leading statesmen and women

Possibly Mandela’s most noteworthy intervention came early in 2005, following the death of his son, Makgatho. With the Aids epidemic still a taboo subject in parts of Africa, Mandela urged South Africans to be more open about the illness.

Biographer David James Smith believes Mandela’s personality was a key factor in his rise to international father figure – a quality few can match.

“There was a purity about Mandela, a simplicity about him like a farm boy looking after sheep, although he was capable of achieving things in immensely complex situations.

“He talked to commoners and kings in the same way. Everyone loves that he remembered names and took time to talk to everyone. He had all those great human qualities that people admire.”

The EldersFormed by Mandela in 2007, it’s an independent group of leaders working for peace

  • Martti Ahtisaari
  • Kofi Annan (chairman)
  • Ela Bhatt
  • Lakhdar Brahimi
  • Gro Harlem Brundtland
  • Fernando H Cardoso
  • Jimmy Carter
  • Hina Jilani
  • Graca Machel
  • Mary Robinson
  • Ernesto Zedillo
  • Desmond Tutu (honorary)

You could go anywhere in the world and show his face and people would know his name, says Smith, and there’s not anyone alive now who you could say that for.

“I can’t think of anyone else who will set the same example. Aung San Suu Kyi embodies some of the values that he had but you can’t say that she would be recognised in the same way.”

The Burmese prisoner turned politician is a really interesting character, says Marks. “Could she become that person? Maybe, except we don’t yet know how the political story will turn out. She has this amazing moral authority because of her experience as a prisoner of conscience but now playing an active political role and there are a lot of things putting her in a tough position.

“And when you take a leadership role you inevitably rub people up the wrong way. Therefore it’s not axiomatic that she fills those shoes, once the brutal world of politics has finished with her.”

Gandhi, Mandela and Suu Kyi were all political prisoners and this personal sacrifice is an important part of the role, says Marks, but there are other prisoners of conscience, in places like China and North Korea, who are not household names.

“They might at some point emerge as the agent of change in these countries. It requires a combination of personal sacrifice and – cynical though it is to say so – personal sacrifice at the right moment, because when the right moment is there politically, and you can capitalise on it as a result of personal sacrifice, you have more of a chance to effect change.”

But it may be that these extraordinary figures only emerge from time to time, says Marks. In the age of social media, it is perhaps more difficult to establish a long-term reputation because judgments are cast so quickly.

On his 89th birthday, Mandela formed The Elders, a group of leading world figures, to offer their expertise and guidance to – according to their website – “tackle some of the world’s toughest problems”.

“It remains to be seen whether an organisation of senior statesmen and women will be able to do what an individual like this has,” says Alden. “It is a one-in-a-generation person. It may work but it’s a novel experiment.

“Humankind needs this kind of person. Without them, the possibility of descending into brutish conflict we are capable of is accentuated. Hopefully there’s cometh the hour, cometh the man or woman. But I scan the horizon and I don’t see anyone of his ilk.”