Why Elon Musk’s SpaceX launch is utterly depressing

Elon Musk is right: silly and fun things are important. But some of them are an indefensible waste of resources


Falcon Heavy, world’s most powerful rocket, successfully launches – video

On Wednesday, two things happened. In Syria, 80 people were killed by government airstrikes. Meanwhile in Florida, Elon Musk fired a sports car into space. Guess which story has dominated mainstream news sites?

The much-anticipated launch of Musk’s Falcon Heavy rocket, the most powerful every launched by a private company, went off without a hitch. Musk successfully sent his cherry-red Tesla roadster hurtling toward Mars, launching what a CNN commentator called “a new space age”.

Musk expects the rocket and car to orbit the sun for hundreds of millions of years, though some experts have speculated that it will disintegrate within a year. The event attracted phenomenal publicity: at one point, 2.3 million viewers were watching the event’s livestream, making the rocket launch a masterstroke of advertising for Tesla.

Meanwhile, in Syria, where hundreds of thousands of refugees may be forced to return to unsafe homes amid “global anti-refugee backlash”, an anti-government activist said despondently that he is no longer sure why he bothers to videotape the effects of bombing, since nobody ever pays attention: “I don’t know what the point is.” The UN human rights coordinator for Syria pondered what level of violence it would take to make the world care, saying that they are “running out of words” with which to try to describe the crisis.

There is, perhaps, no better way to appreciate the tragedy of 21st-century global inequality than by watching a billionaire spend $90m launching a $100,000 car into the far reaches of the solar system.

Musk said he wants to participate in a space race because “races are exciting” and that while strapping his car to a rocket may be “silly and fun … silly and fun things are important.” Thus, anyone who mentions the colossal waste the project involves, or the various social uses to which these resources could be put, can be dismissed as a killjoy.

But one doesn’t have to hate fun to question the justification for pursuing a costly new space race at exactly this moment. If we examine the situation honestly, and get past our natural (and accurate) feeling that rockets are really cool, it becomes hard to defend a project like this.

A mission to Mars does indeed sound exciting, but it’s important to have our priorities straight. First, perhaps we could make it so that a child no longer dies of malaria every two minutes. Or we could try to address the level of poverty in Alabama that has become so extreme the UN investigator did not believe it could still occur in a first-world country. Perhaps once violence, poverty and disease are solved, then we can head for the stars.

Many might think that what Elon Musk chooses to do with his billions is Elon Musk’s business alone. If he wanted to spend all his money on medicine for children, that would be nice, but if he’d like to spend it making big explosions and sending his convertible on a million-mile space voyage, that’s his prerogative.

But Musk is only rich enough to afford these indulgent pet projects because we have allowed gross social inequalities to arise in the first place. If wealth were actually distributed fairly in this country, nobody would be in a position to fund his own private space program.

Yet even on the theory that there’s no moral problem with frittering away hundreds of millions of dollars, and inequality is fine, there’s another reason we are permitted to care about what Musk does. A great deal of his fortune is not actually his own: it’s ours.

Musk’s empire is fueled by billions of dollars in government subsidies. The Los Angeles Times revealed in 2015 that Musk’s companies benefit from “grants, tax breaks, factory construction, discounted loans and environmental credits”, plus the tax credits and rebates that are granted to consumers for buying his products.

The average household income of a Tesla purchaser is in the multiple hundreds of thousands, yet the federal government pays people $7,500 to buy them through tax credits, and many states offer their own cash handouts. Because we’re all giving Elon Musk money, what he chooses to do with that money is very much our business.

Elon Musk is right: silly and fun things are important. But some of them are an indefensible waste of resources. While there are still humanitarian crises such as that in Syria, nobody can justify vast spending on rocketry experiments. That point was made plain in 1970 by poet Gil Scott-Heron, in his record Whitey On The Moon, which criticized the US for spending millions to send men on a pointless moon adventure while the country’s inner cities languished:

“I can’t pay no doctor bills

But whitey’s on the moon

Ten years from now I’ll be payin’ still

While whitey’s on the moon.”

Whitey may not have gone back to the moon recently. But his sports car is now in space.


The infertility crisis is beyond doubt. Now scientists must find the cause. 

News last week that sperm counts in western men have halved confirmed what experts already knew. The real problem is that no one knows why.

 Life begins … but for western couples the process is becoming more and more difficult.
 Life begins … but for western couples the process is becoming more and more difficult. 

The topic has become the mainstay of dystopian science fiction. Our world is afflicted by widespread infertility and childless civilisations are left hovering on the brink of collapse. Children of Men and The Handmaid’sTale provide perfect examples of these unsettling narratives.

Yet the scenarios outlined in these books and dramatisations may be less fanciful than is first supposed. Indeed, reaction to a study of male infertility, published last week, suggests we may already be hurtling towards such a fate.

According to scientists at the Hebrew University of Jerusalem, sperm counts among men in the west have more than halved in the past 40 years and are currently falling by an average of 1.4% a year. Humanity could soon become extinct, it was claimed by some commentators.

It was a chilling and alarming revelation. Western nations – although not developing countries – appear to be facing disaster. But what could be triggering this decline in sperm? And what can be done to counter it?

Answering these questions turns out to be a lot more awkward than was previously realised, and while the most strident apocalyptic warnings that have followed publication of the Jerusalem study are dismissed by experts, most believe its findings suggest we face a major social and biological problem. Worryingly, there is little evidence that any action is being taken to address the coming crisis.

In fact, there was nothing new in the study, Temporal Trends in Sperm Count, by Hagai Levine and others, which was published in Human Reproduction Updatelast week. The work was an analysis of more than 100 previous studies in the field, and most reproductive health experts have reacted positively to it. Professor Chris Barratt, at Dundee University, described it as a landmark study “that should ring alarm bells”, while Manchester University’s Professor Daniel Brison said its “shocking” results should act as “a wake-up call to prompt active research in the area”.

Nor are they alone in declaring their worries about declining sperm counts in the west. Earlier this year, the World Health Organisation described current knowledge of male infertility as “very low”, a relative ignorance that has since been acknowledged by the UK Medical Research Council, which has issued a call for scientists to put forward projects in the field for funding. “We are still relatively ignorant about the causes of male infertility, and as a matter of urgency we need to increase, substantially, our research effort into male reproductive health,” said Barratt.

The dangers of this ignorance were highlighted by Professor Richard Sharpe at Edinburgh University – though he was also quick to dismiss the more outlandish claims that current dwindling sperm counts could doom humanity.

“The end of humanity is not approaching,” said Sharpe. “But at the individual level, for affected people, this trend could be tragic. We have no treatments for improving sperm production in infertile men, and we have no idea about what is the cause of the condition. We cannot remedy it. So we are completely hamstrung.”

The problem is particularly urgent in the west, where couples are having families much later in life, he said. In 2014, 52% of all live births in the UK were to mothers aged 30 and over (67% of fathers fell into this age group). However, when a woman reaches the age of 32 her chances of conceiving start to decrease gradually but significantly until, by 40, they have fallen by half. At the same time, more and more men now have sperm counts low enough to impair their fertility.

“This creates a double whammy for fertility in modern western societies,” said Sharpe. “Couples wait until they are over 30 and then find that one or both have reproduction problems. In some cases, they may not discover these problems until they are in their late 30s – by which time they have little time left to take advantage of assisted reproductive techniques such as IVF. Couples like these are more and more likely to end up childless – as mothers get older and sperm counts continue to drop – and that is a tragedy. The problem is that the only effective way to treat infertility caused by a man’s low sperm count is to treat his partner, invasively, using assisted reproductive techniques. That may not always be seen as an acceptable approach. We are sailing into a storm.”

The issue is further complicated because the underlying cause of these declining sperm counts remains a mystery. “Almost every aspect of modern life – from mobile phones to smoking and oral contraceptives [contaminating drinking water] – has been blamed for declining sperm counts, but no convincing evidence has emerged to link any of them to the problem,” said Professor Allan Pacey of Sheffield University.

In addition, there have been criticisms of some of the retrospective studies that suggest dramatic falls in sperm counts. Some of the studies were based on men attending fertility clinics who were therefore more likely to have low sperm counts.

Different techniques were used in different studies to count sperm in samples, and this variation could also have skewed results.

Neither set of these kind of studies was included in the meta-analysis by Levine and his team, however, and for this reason, several scientists – including Pacey – who had remained cautious about the extent of the problem, have said that they are much more convinced by the new work.

“This new analysis has gone a long way to get round the flaws of previous studies, so I am much less sceptical about the reality of declining sperm counts in the west,” Pacey said.

The reality of the problem is also supported by the rise in cases of testicular cancer that has taken place in recent years, he added. This also suggests that problems appear to be occurring as the male foetus develops in the womb. In some way, it is becoming more and more vulnerable to changes in conditions there.

Whether these have come about because of alterations to a mother’s diet, or to the drugs she is taking, or chemicals in the environment and other factors, it is hard to say. And why do men outside the western world appear not to be affected?

Scientists are anxious to find an answer, but are unlikely to do so in the short term, they admit. “We should have funded large epidemiological studies of healthy males 25 years ago and this would – by now – have given us a clear answer one way or the other,” said Pacey.

“Unfortunately, it seems as though we might have to wait another 25 years before we might get to know the real answer.”

This point was backed by Sharpe, who warned that the field is still bedevilled by a lack of research investment. “We need a critical mass of scientists trying to find out what is happening and why it is happening. Unfortunately, we still do not have that. Not enough research is being done. Yet I believe the problem is getting worse.”


Umbilical cord blood could slow brain’s ageing, study suggests.

Scientists hope protein infusion which rejuvenated brains of aged mice could combat mental decline in older people

CT scans of a patient with Alzheimer’s disease. If the protein therapy is effective in humans it could be a potent weapon against neurodegenerative diseases such as Alzheimer’s.
CT scans of a patient with Alzheimer’s disease. If the protein therapy is effective in humans it could be a potent weapon against neurodegenerative diseases such as Alzheimer’s. 

Scientists have reversed memory and learning problems in aged mice with infusions of a protein found in human umbilical cord blood.

The striking results have raised hopes for a treatment that staves off mental decline in old age, but researchers stressed that more studies, including human trials, are needed before the therapy can be considered for clinical use.

Tests on frail rodents found that the protein therapy rejuvenated an area of the brain called the hippocampus, which is crucial for memory formation, and one of the first and most important regions to deteriorate in old age.

Older mice that received the treatment reacted like younger animals in a series of behavioural tests, according to researchers at Stanford University in California. They escaped from a maze faster than before, had better memories, and started building nests again, a skill the animals tend to lose in old age.

Researchers led by Tony Wyss-Coray made the discovery after they noticed that human umbilical cord blood had unusually high levels of a protein called TIMP2 when compared with blood from older people. When injected into mice, the protein ramped up the activity of a group of genes that revitalised the hippocampus, and made it more able to adapt to new information. Details of the study are reported in Nature.

The work is the latest in a string of studies that suggest molecules found in young blood may be able to rejuvenate old brains and other tissues. If the therapies are effective in humans, they could become a potent weapon against the cognitive decline that comes with old age, and also neurodegenerative diseases such as Alzheimer’s.

But until the treatment has proved itself in humans, scientists are roundly cautious of the work. The lesson from Alzheimer’s research on mice is that almost everything works in the animals, and so far nothing works in humans, said Rob Howard, professor of old age psychiatry at University College London. “Having taken that on on board, this is a really interesting way to understand how we might help people who are aged or in the early stages of the disease,” he said. The protein therapy might not reverse brain ageing, or halt Alzheimer’s, but it might boost what remains of the healthy brain to at least offset some of the decline that accompanies old age.

Jennifer Wild, a clinical psychologist at Oxford University, said that while the results were interesting, it was too early to consider it as a therapy for humans. “It’s exciting for mice who have cognitive ageing, but it’s way too early to start extrapolating that to say we can help humans,”, she said.


Canadian river vanished in just four days

First ever observed case of ‘river piracy’ saw the Slims river disappear as intense glacier melt suddenly diverted its flow into another watercourse

A view of the ice canyon that now carries meltwater from the Kaskawulsh glacier, seen here on the right, away from the Slims river and toward the Kaskawulsh river.
A view of the ice canyon that now carries meltwater from the Kaskawulsh glacier, seen here on the right, away from the Slims river and toward the Kaskawulsh river. 

An immense river that flowed from one of Canada’s largest glaciers vanished over the course of four days last year, scientists have reported, in an unsettling illustration of how global warming dramatically changes the world’s geography.

The abrupt and unexpected disappearance of the Slims river, which spanned up to 150 metres at its widest points, is the first observed case of “river piracy”, in which the flow of one river is suddenly diverted into another.

The continental-scale rearrangement was documented by a team of scientists who had been monitoring the incremental retreat of the glacier for years. But on a 2016 fieldwork expedition they were confronted with a landscape that had been radically transformed.


“We went to the area intending to continue our measurements in the Slims river, but found the riverbed more or less dry,” said James Best, a geologist at the University of Illinois. “The delta top that we’d been sailing over in a small boat was now a dust storm. In terms of landscape change it was incredibly dramatic.”

Dan Shugar, a geoscientist at the University of Washington Tacoma and the paper’s lead author, added: “The water was somewhat treacherous to approach, because you’re walking on these old river sediments that were really goopy and would suck you in. And day by day we could see the water level dropping.”

The team flew a helicopter over the glacier and used drones to investigate what was happening in the other valley, which is less accessible.

“We found that all of the water that was coming out from the front of the glacier, rather than it being split between two rivers, it was going into just one,” said Best.

The Kaskawulsh River, seen here near its headwaters, is running higher now thanks to the addition of water that used to flow into the Slims River.
 The Kaskawulsh River, seen here near its headwaters, is running higher now thanks to the addition of water that used to flow into the Slims River. Photograph: Jim Best/University of Illinois

While the Slims had been reduced to a mere trickle, the reverse had happened to the south-flowing Alsek river, a popular whitewater rafting river that is a Unesco world heritage site. The previous year, the two rivers had been comparable in size, but the Alsek was now 60 to 70 times larger than the Slims, flow measurements revealed.

The data also showed how abrupt the change had been, with the Slims’ flow dropping precipitously from the 26 to 29 May 2016.

Geologists have previously found evidence of river piracy having taken place in the distant past. “But nobody to our knowledge has documented it happening in our lifetimes,” said Shugar. “People had looked at the geological record, thousands or millions of years ago, not the 21st century, where it’s happening under our noses.”

Prof Lonnie Thompson, a paleoclimatologist at Ohio State University who was not involved in the work, said the observations highlight how incremental temperature increases can produce sudden and drastic environmental impacts. “There are definitely thresholds which, once passed in nature, everything abruptly changes,” he said.

Between 1956 and 2007, the Kaskawulsh glacier retreated by 600-700m. In 2016, there was a sudden acceleration of the retreat, and the pulse of meltwater led to a new channel being carved through a large ice field. The new channel was able to deliver water to the Alsek’s tributary whose steeper gradient resulted in the Slims headwater being suddenly rerouted along a new southwards trajectory.

In a geological instant, the local landscape was redrawn.

Where the Slims once flowed, Dall sheep from Kluane National Park are now making their way down to eat the fresh vegetation, venturing into territory where they can legally be hunted. The formerly clear air is now often turned into a dusty haze as powerful winds whip up the exposed riverbed sediment. Fish populations are being redistributed and lake chemistry is being altered. Waterfront land, which includes the small communities of Burwash Landing and Destruction Bay, is now further from shore.

Sections of the newly exposed bed of Kluane Lake contain small pinnacles. Wind has eroded sediments with a harder layer on top that forms a protective cap as the wind erodes softer and sandier sediment below. These pinnacles, just a few centimeters high, are small-scale versions of what are sometimes termed “hoodoos.”
 Sections of the newly exposed bed of Kluane Lake contain small pinnacles. Wind has eroded sediments with a harder layer on top that forms a protective cap as the wind erodes softer and sandier sediment below. These pinnacles, just a few centimeters high, are small-scale versions of what are sometimes termed “hoodoos.” 

A statistical analysis, published in the journal Nature Geoscience, suggests that the dramatic changes can almost certainly be attributed to anthropogenic climate change. The calculations put chance of the piracy having occured due to natural variability at 0.5%. “So it’s 99.5% that it occurred due to warming over the industrial era,” said Best.

Thompson, who has documented glacial retreat on Mount Kilimanjaro, predicts that there will be an acceleration in the observations of river piracy events as glaciers retreat globally.

“I think we could see similar divergence in streams in the Himalayas as well as throughout the Third Pole region, the Andes of Peru, other sites in northern Canada and Alaska,” he said. “Often these events occur in remote and poor parts of our planet and thus go largely unnoticed by the larger population but greatly impact the livelihood of many families downstream.”


If general practice fails, the whole NHS fails

GPs are the bedrock of the health service, but practices have been brought to their knees by unprecedented funding cuts and rising demand

Female doctor treating patient
GP services have become an under-resourced, over-stretched shell of their former self, struggling to keep pace with patient demand despite the efforts of their staff. 

Anyone who has visited their GP recently will be aware of the pressures: the struggle to get an appointment, the difficulty of seeing the same GP more than once, the rush to get you out of the door for the next patient.

The crisis in general practice is unprecedented. The health secretary, Jeremy Hunt, fails to understand the seriousness of the situation facing general practice in England.

There are now 8,000 GP practices in England – one in 20 has disappeared since 2010. The rate of loss of local surgeries has increased. There has been a fivefold rise in the number of GP surgeries approaching senior NHS managers for advice about shutting their doors or merging with nearby practices. Furthermore, a freedom of information request by Pulse magazine revealed 58 practices closed in 2016, with a further 34 shutting because of mergers.

The failure to acknowledge the crisis facing GP services – an under-resourced, over-stretched shell of their former self, struggling to keep pace with patient demand despite the efforts of their staff – could finish off the general practice, “the jewel in the crown of the NHS”, in next few years for good. Hunt never tires of saying GPs are central to his vision for the NHS. But the gap between policy rhetoric and reality has never been starker.

The NHS has the most stressed GPs by western standards, as a result of relentless workloads, endless bureaucracy and the shortest time spent with patients. We have been squeezing the lemon for all sorts of healthcare needs for years. But it is getting to the stage where there is nothing left to squeeze.

The government is asking GP practices to provide more services, including many involving the transfer of hospital care into the community, without the resources required to successfully deliver them. And now, NHS England wants 12 hours a day, seven days a week opening in general practice.

There are not enough GPs to cover current working hours. The colleges want 10,000 more GPs to service the present demand. The promise of 5,000 new GPsnot only ignores the fact that the pressures of the profession are putting medical graduates off joining, but also that it takes a good eight to 10 years to train. Practically, it’s not possible to pull so many GPs out of the hat.

Despite all this, Hunt talks of more care in primary care, more access, initiatives and ideas – ignoring the workforce crisis, a funding disaster and the committed GPs facing burnout. General practice’s share of the NHS budget has fallen progressively in the past decade, from a high of 11% in 2006 to less than 8.5% now. Many practices will see further reductions over the next three years, forcing further closures. A combined financial and staffing crisis could cause chaos in primary care for years and ultimately kill off general practice for good.

 The root cause of the crisis is this unprecedented combination of rising patient demand and declining resources. Practice incomes have been frozen for several years and this has led to real net incomes dropping by more than 20% since the introduction of the GP contract in 2004. Practices are being brought to their knees by this unprecedented fall in money for primary care and rising demand for GP services. Primary care is imploding faster than people realise and patients are already bearing the brunt of the problem.

General practice is the bedrock of many NHS services and the gatekeeper to the rest. We can either confront the realities facing practices and make plans now to meet growing challenges – or we can bury our heads in the sand and watch this key part of the health service slide into terminal decline. If general practice fails, the whole NHS fails.

Source: www.theguardian.com

Five Pacific islands lost to rising seas as climate change hits.

Six more islands have large swaths of land, and villages, washed into sea as coastline of Solomon Islands eroded and overwhelmed.

The remains of one of six partially eroded islands in the Solomons.
The remains of one of six partially eroded islands in the Solomons. 

Five tiny Pacific islands have disappeared due to rising seas and erosion, a discovery thought to be the first scientific confirmation of the impact of climate change on coastlines in the Pacific, according to Australian researchers.

The missing islands, ranging in size from 1 to 5 hectares (2.5-12.4 acres) were not inhabited by humans.

But six other islands had large swaths of land washed into the sea and on two of those, entire villages were destroyed and people forced to relocate, the researchers found.

Many of the Solomon Islands are low-lying and prone to flooding from rising seas.
Many of the Solomon Islands are low-lying and prone to flooding from rising seas. 

One was Nuatambu island, home to 25 families, which has lost 11 houses and half its inhabitable area since 2011, the research said.

The study is the first that scientifically “confirms the numerous anecdotal accounts from across the Pacific of the dramatic impacts of climate change on coastlines and people,” the researchers wrote in a separate commentary on an academic website.

The scientists used aerial and satellite images dating back to 1947 of 33 islands, as well as traditional knowledge and radiocarbon dating of trees for their findings.

The study raises questions about the role of government in relocation planning, said a Solomon Islands official.

Map of Nuatambu Island.

“This ultimately calls for support from development partners and international financial mechanisms such as the Green Climate Fund,” Melchior Mataki, head of the Solomon Islands’ National Disaster Council, was quoted as saying in the commentary.

The Green Climate Fund, part of United Nations Framework Convention on Climate Change, was founded to help countries deal with climate change.

Ad hoc relocation has occurred on the islands, the study said. Several Nuatambu islanders moved to a neighbouring, higher volcanic island, the study said. Other people were forced to move from the island of Nararo.

Sirilo Sutaroti, 94, is among those who had to relocate from Nararo. He told researchers: “The sea has started to come inland, it forced us to move up to the hilltop and rebuild our village there away from the sea.”


Smoking causes one in ten deaths globally, major new study reveals.

Efforts to control tobacco have paid off, says study, but warns tobacco epidemic is far from over, with 6.4m deaths attributed to smoking in 2015 alone

 Students wearing masks with no smoking signs attend an anti-smoking lecture in Fuyang, China. More than a million deaths a year in China are from smoking related diseases.
Students wearing masks with no smoking signs attend an anti-smoking lecture in Fuyang, China. More than a million deaths a year in China are from smoking related diseases. 

One in 10 deaths around the world is caused by smoking, according to a major new study that shows the tobacco epidemic is far from over and that the threat to lives is spreading across the globe.

There were nearly one billion smokers in 2015, in spite of tobacco control policies having been adopted by many countries. That number is expected to rise as the world’s population expands. One in every four men is a smoker and one in 20 women. Their lives are likely to be cut short – smoking is the second biggest risk factor for early death and disability after high blood pressure.

The researchers found there were 6.4m deaths attributed to smoking in 2015, of which half were in just four populous countries – China, India, USA, and Russia.

Major efforts to control tobacco have paid off, according to the study published by the Lancet medical journal. A World Health Organisation treaty in 2005 ratified by 180 countries recommends measures including smoking bans in public places, high taxes in cigarettes and curbs on advertising and marketing.

Between 1990 and 2015, smoking prevalence dropped from 35% to 25% among men and 8% to 5% among women. High income countries and Latin America – especially Brazil which brought in tough curbs on tobacco – achieved the biggest drops in numbers of smokers.

But many countries have made marginal progress since the treaty was agreed, say the authors of the study from the Institute of Health Metrics and Evaluation at the University of Washington in the US. And although far more men smoke than women, there have been bigger reductions in the proportions of men smoking also, with minimal changes among women.

Senior author Dr Emmanuela Gakidou said there were 933m daily smokers in 2015, which she called “a very shocking number”. The paper focused only on those who smoke every day. “The toll of tobacco is likely to be much larger if we include occasional smokers and former smokers and people who use other tobacco products like smokeless tobacco. This is on the low end of how important tobacco is,” she told the Guardian.

There is much more that needs to be done, she said. “There is a widespread notion that the war on tobacco has been won but I think our evidence shows that we need renewed and sustained efforts because the toll of smoking in 2015 is much larger than most people would think, so we absolutely have a lot more to do. We need new and improved strategies to do it and a lot of effort and political will.”

Traditionally there have been far fewer women smoking around the world than men, but it was a huge problem for both, she said.

“There are some really worrisome findings – for example in Russia female smoking has increased in the last 25 years significantly. There are also some western European countries where about one in three women are smoking. So it is true globally that a lot fewer women smoke than men but there are some countries where it is a big problem for women,” she said.

Dr Kelly Henning of Bloomberg Philanthropies, which is committed to tobacco control and co-funded the study with the Bill and Melinda Gates Foundation, said: “I think the study highlights the fact that the work is not finished on tobacco. The good news is the decline in daily smoking among men and women … however there are still many smokers in the world and there is still a lot of work to do. I think we have to keep our eye on the issue and really do more.”

Countries with some of the highest death tolls such as China and Indonesia “really don’t need those health problems – they have so many other issues they are trying to address. But tobacco control is critically important in those places,” she said.

“China has more than a million deaths a year from smoking related diseases and China is only beginning to see the effects of their high male smoking rate. That is only one instance of what is expected to become an extremely major epidemic,” she said.

Writing in a linked comment, Professor John Britton from the University of Nottingham said: “Responsibility for this global health disaster lies mainly with the transnational tobacco companies, which clearly hold the value of human life in very different regard to most of the rest of humanity.” British American Tobacco, for instance, sold 665bn cigarettes in 2015 and made a £5.2bn profit.

“Today, the smoking epidemic is being exported from the rich world to low-income and middle-income countries, slipping under the radar while apparently more immediate priorities occupy and absorb scarce available human and financial resources,” he writes. “The epidemic of tobacco deaths will progress inexorably throughout the world until and unless tobacco control is recognised as an immediate priority for development, investment, and research.”


How long should you stay on antidepressants? 

As many as 5.4 million people in the UK may be taking pills to help with anxiety and depression, but does that mean they are hooked?

Doctor in discussion with patient
It’s important to discuss a plan for coming off antidepressants with your doctor. 

According to reports last week, hundreds of thousands of people are hooked on prescription drugs for not only depression but also pain and anxiety. The Daily Mail quoted a recent report from the all party parliamentary group for prescribed drug dependence, saying that in 2013 about 11% of women and 6% of men were on antidepressants – 5.4 million people nationally.

But are they really hooked? The Royal College of Psychiatry says that antidepressants are not addictive, on the grounds that you do not have to increase your dose to get the same effect or get cravings when you stop the drug. But the college’s own survey of 817 people found that 63% had withdrawal symptoms after stopping antidepressants – mostly they were on SSRIs (the most commonly prescribed antidepressants).

The solution

The symptoms of withdrawal – stomach upsets, flu-like symptoms, anxiety, dizziness, nightmares and electric shocks to the head – can last for two months. Dr James Davies, an academic in social and medical anthropology at the University of Roehampton and member of the all parliamentary group says that people on antidepressants can certainly feel dependent on their drug. “Dependence can be physical or psychological,” he says. “People may feel they are only better because they take the drug.”

In a letter to the BMJ last year, Prof Peter C Gøtzsche of the Nordic Cochrane Centre in Denmark said that half of people on antidepressants become addicted. Out of 260,322 people in Finland who were taking an antidepressant in 2008, 45% were still on them five years later.

When you stop antidepressants should be the result of a discussion between you and your doctor – it is an individual decision and depends on how long and how severely you have been depressed. A precipitating cause may have gone, or talking therapy may have helped. But you should never stop taking them suddenly because the side-effects can be horrible. Instead, it is recommended that you taper your dose by a quarter every four to six weeks.

Psychiatrists suggest staying on the drug for six months to a year after you feel better. Your response should be checked regularly – at three weeks and then again at three to six monthly intervals. Doctors can sometimes confuse withdrawal symptoms with a return of depression, and restart the drug. Gøtzsche warns that this can keep people trapped on antidepressants for life. If the symptoms occur rapidly after stopping the drug, and stop very shortly after restarting it, then it is likely to be because of drug withdrawal. GPs often advise coming off antidepressants at the start of summer, as it feels a more optimistic time than the middle of winter.


Royals launch campaign to get Britons talking about mental health

William, Kate and Harry recruit celebrities and other individuals for videos discussing depression, anxiety and suicidal thoughts

The Duke and Duchess of Cambridge and Prince Harry help organise the Heads Together charity from Kensington Palace. 

Prince Harry and the Duke and Duchess of Cambridge have enlisted a rapper, a Royal Marine and a Labour spin doctor to try to push stigma about discussing mental health beyond what they believe is a “tipping point” and into public acceptability.

The royals are trying to use their high profile to convince the public that “shattering stigma on mental health starts with simple conversations”. The rapper Stephen Manderson, known as Professor Green, and the comedian Ruby Wax have joined other public figures and individuals who have suffered mental illness to make short films for their mental health campaign, Heads Together, and talk openly about their experiences of depression, anxiety and suicidal thoughts.

“Attitudes to mental health are at a tipping point,” the royals said in a joint statement. “We hope these films show people how simple conversations can change the direction of an entire life.”

In the clips Alastair Campbell, Tony Blair’s former director of communications in Downing Street, discusses his depression and breakdowns with his wife, Fiona Millar, including recalling how he got so low he punched himself in the face repeatedly. In another encounter the former England cricket captain Andrew Flintoff told Manderson: “The hardest thing for me initially was talking. I’m not a big talker. I’m from the north of England. I’m from a working-class family. We don’t talk about our feelings.”

“It was no different for me growing up in a council estate in east London,” replied the rapper. “It is just not something you spoke about.”

The royals also released the largest ever survey of public attitudes to mental health, conducted by YouGov, which found almost half the population had a conversation about mental health in the last three months. Women are more likely to talk about the issue than men and young adults are almost twice as likely to discuss it than people aged over 65.

However, very few of the 5,000 surveyed – just 3% – said they had approached someone from a local support organisation, and a similar amount, 2%, spoke to someone in the human resources department at work about the issue, despite almost 12m working days being lost to work-related stress, anxiety and depression in 2015-16.

Heads Together is a coalition of eight mental health charities, including Mind and the Campaign Against Living Miserably (Calm), organised from Kensington Palace. Prince Harry is championing the issue after fellow servicemen suffered post-traumatic stress disorder and following his time volunteering in the army’s personnel recovery units. Prince William is understood to have been motivated after attending several suicides as an air ambulance pilot, and the Duchess of Cambridge is said to be interested in how mental health affects family life.

By campaigning for people to help each other by talking more, the royals hope to avoid a more politicised issue: claims that funding for NHS mental health services is being effectively cut. Last November an analysis by the King’s Fund thinktank showed 40% of mental health trusts saw their income fall in 2015-16. This was despite the government’s commitment to parity of esteem for mental health and assurances from NHS England that almost 90 per cent of plans submitted by clinical commissioning groups (CCGs) last year included mental health funding increases.

Heads Together will be the London Marathon’s lead charity this year, and the former England footballer Rio Ferdinand and the comedian Stephen Fry have also recorded testimonies set to be released next month.

People from other professions have also contributed. Phil Eaglesham, a Royal Marine who completed tours of Afghanistan and Iraq, is filmed talking with his wife, Julie, about how his struggle with a debilitating illness resulted in him trying to take his own life, although he told no one.

“I was ashamed,” he said. “There’s a stigma around mental health and how that was perceived and at that point I felt I was weak.”

When he finally did speak out, “things improved and I got help”.

“There is no way out without talking,” he said.

The TV journalist and newscaster Mark Austin discusses with his daughter Maddy how he handled her anorexia.

“I couldn’t even come to terms with how to stop it or how to help you,” he told her. “It was like you were determined to kill yourself. I remember at one stage saying if you want to go ahead and starve yourself to death, you go ahead. I obviously didn’t mean it but I was so helpless.”

In the UK, the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here


Cutting-edge theatre: world’s first virtual reality operation goes live.

Medical experts hope surgery live-streamed in VR will make healthcare fairer and boost training

 Dr Shafi Ahmed performs the operation which could be watched online by the public.
Dr Shafi Ahmed performs the operation which could be watched online by the public. 

Stretched out on a table in a large, bright operating theatre at the Royal London hospital, a patient is awaiting Shafi Ahmed’s first incision in a procedure that will remove cancerous tissue from his bowel. Around the table a team dressed in blue scrubs and face masks are gathered, exchanging the odd word, while cumbersome machines bearing bundles of wires hum gently in the background. Everyone is focused on the task in hand, getting ready to play their part. Except me.

Scrubless and without so much as a scalpel to pass to the surgeon, I am a mere spectator to this intricate event, a bystander gazing around the room in fascination while others labour at a life-changing task.

Not that the surgeons are bothered. Because although I feel like I am standing at the edge of the operating table, in reality I am sitting in my office chair.

On Thursday afternoon I witnessed the world’s first operation to be streamed live in 360-degree video, allowing medical students, trainee surgeons and curious members of the public like me to immerse themselves in the procedure in real time via the Medical Realities website. A one-minute delay was incorporated into the broadcast in case of any complications in the surgery.

A cancer surgeon at Barts Health NHS Trust, Ahmed said before the operation that he believed the approach could make healthcare more equitable, improving the training of surgeons worldwide. With internet connections becoming better, smartphones getting cheaper and only a pair of lenses and some cardboard needed to make a virtual reality headset, the costs, he said, paled in comparison to the expense of students travelling abroad to train. “It is actually quite cost-effective.”

Shot using two 360-degree cameras and a number of lenses arranged around the theatre, the operation could be viewed through the “VR in OR” app, using a virtual reality headset that can be paired with a smartphone. Those who did not have a headset could watch the feed live online.

It takes a while to get the app up and running so while I wait for the VR experience to start I watch the procedure begin via the website.

The lights are dimmed and, wielding an intimidating device, Ahmed begins to remove a hernia. “This is called a harmonic scalpel,” he says as he gets to work.

A hush descends, punctured only by beeping. Peering down I spot some odd-looking scissors I hope no one will ever use on me. Two large screens on either side of the table show views from the camera inside the patient – a device that resembles an enormous knitting needle. The team prepares to tackle the cancer. “OK let’s have a look, here we go,” says Ahmed.

Fortunately the app boots up. And I am in the room too. “There is a tumour just here,” says Ahmed. “This is what cancer looks like in reality.”

While videos showcasing surgical procedures have been around for years, Ahmed believes the new approach is more than a mere gimmick. The technology, he has argued, brings a valuable new feature to education, allowing viewers to focus not just on what the surgeon is doing, but also on what other members of the team are up to: “There will be noise, there will be the immersive factor – so that will add different layers of educational value.”

George Hanna, professor of surgical sciences at Imperial College, London was cautiously optimistic about the benefits of the approach. “If this technology allows the transfer of knowledge and skills [over] a wider range and in an easier way that would be very beneficial,” he said.

But he was quick to add that, compared with existing approaches for sharing scenes from the operating theatre, the new technology offered more of an upgrade than a revolution. “It is a good video and wide broadcast with interactive [opportunities],” he said, stressing that the operation itself was real rather than virtual.

The procedure continues. Despite my loathing of all medical TV dramas, I am hooked. Suddenly the entire theatre goes dark, except for a spotlight. Someone is making an incision. They pull out a pink, fleshy mass. “Scissors,” says someone. A bundle that I assume is the tumour is removed and dropped into a bowl. The operation has been a success.

It was not the first time Ahmed had led the way in embracing modern technology in healthcare. He co-founded the healthcare company Medical Realities, which streamed the operation in partnership with Barts Health and 360-degree video experts Mativision.

Ahmed said he believes virtual reality, augmented reality and games could all play a role in training medical students. Two years ago he streamed a live operation using the “augmented reality” system, Google Glass, allowing viewers to see the procedure from a surgeon’s point of view.

But the new 360-degree video, Ahmed said, offered a new approach, allowing users to see beyond what the surgeon was looking at. Among future developments he has envisaged, Ahmed said he was keen to add graphics to the raw footage to provide additional information during the operation, as well as taking questions from those viewing the procedure.

“[During an operation] I am teaching people, talking to them, there is communication going on – so it’ll be just an extension of that,” he said. In three to five years, haptic devices – which work off physical contact between the user and computer – could boost the experience further: “Companies are really working on various gloves or bodysuits and devices so that it can replicate touch and feel.”

Such technologies, said Ahmed, could be a boon to healthcare. But, he added, the role of patients in agreeing to take part should not be forgotten. “Ultimately, it is about the operation, about [the patient], about his cancer care and that has to be the priority for everybody.

“The fact that patients have agreed to do this before – with the Google Glass – and again, it is quite reassuring and quite humbling.”