Security fees

What would you do if a supermarket asked you first to make a debit payment on entering the store, and then refunded you the difference when you left the store, or asked you to top up the payment if you went above the deposit? You would probably view this kind of arrangement with some kind of suspicion. After all, it goes against the normal arrangement of things. When you require a product from a store, you pick it out from the store and then take it to the till to pay for it. It is a simple process, one that does not need to be complicated by initial deductions and subsequent resolution.

It might be slightly different if you required a service from someone, such as if you order new windows from your house. You have to give a deposit because while you have ordered a window, you have set someone else on a chain on ordering raw materials and for work to be done, and the deposit that you make is in meeting the person halfway in a binding agreement.

Perhaps binding agreements are what is being sought through this form of pay first, buy later and then get refunded, or top up the difference financial methods. They were trialled at fuel service stations, where car drivers were charged to use the pumps, then paid for their own purchases before getting the initial charge credited back to the them again. And why fuel service stations? It is because fuel theft – driving off the forecourt without paying – costs the economy lost revenues and wastes police time, in having to record, pursue and close investigations which detract from the real job of policing more serious matters.

By another name, this kind of down payment would be known as a security fee. And we do make such payments in our lives. We pay children’s school fees in advance. We pay online for items we have not received. But perhaps this kind of payment method is too radical for the present – but in future, who knows?

How beliefs shape careers

Mathematics is one subject in which many people claim not to be good with numbers. It almost seems acceptable to suggest that there is an inborn, predetermined inability to deal with numbers that , to excuse, to the casual observer, a lack of trying and effort. Is there any truth to this predetermined ability? Or are people shaped and influenced more by society and expectation?

Research shows the latter to be true. In psychological research undertaken by Yale University, the attitudes of two groups of students were studied by psychologists. The students were high school students and they were tracked across the college studies and working careers. The results of the research undertaken in 2008 found that even though the students had been assessed in high school to have similar SATs scores, there were diverse outcomes in their future careers. Those that went on to successful careers were those that displayed a willingness for patience and a willingness to try. Those that did not persist when faced with the initial signs of difficulty were those that ended up with what might be considered less stellar careers.

The results of this research are hardly surprising. We know that hard work allows us to achieve good results. What is less known, however, was that the less successful group was more inclined to quote generalisations to support their lack of effort. When students faced initial difficulty in the subject of Mathematics, some claimed “I’m not good with numbers” or “I’m more of an essay person” or “My family are more artistic and creative types”. The problem is two-fold: these generalisations are made by adults to excuse their own lack of effort, and secondly, younger individuals pounce on them as an immediate knee-jerk reaction to difficulty, and held on to these “axioms”. Few of those who claimed at high school level that they were not good with numbers went on to careers requiring these skills.

It is more the environment that shapes ability. Environment also shapes reaction. To help kids succeed, some measures could include putting them in training environments where they have to develop skills at persistence, trying while manipulating information. One of these environments is in learning a musical instrument. As a piano teacher in Stroud Green  mentions, it is juggling six or seven skills while developing the patience to improve.

Dogs can sense fear – and seek release

What makes some people more susceptible to being bitten by dogs? A recent study suggests that dogs, with a sense of smell keener than humans, can sense fear in us. And this suggests that perhaps the sense of fear trips or triggers the dog into a fright or flight response that results in the human being bitten.

The Daily Telegraph reported that the best form of prevention against a bite from a dog could be to adopt a slight self-confident front, almost seemingly like a swagger, in order to convince the dog of a sense of confidence to override the inner sense of fear. However, this approach does not address how the dog might deal with the presentation of a confident person yet sense the underlying fear. It is like you meeting a person who you know is lying, yet smiling at you. What do you know? You revert to what psychologists might call the memory bank, the “type 2” kind of thinking which is more analytical, and less immediately responsive – but do dogs have that kind of ability to think and fall back on?

The research was carried out by researchers from the University of Liverpool in the form of a survey in a bit to understand why the likelihood of people being bitten by dogs seemed to be in a higher case of incidence for certain individiuals.

The results from the survey said that the likelihood of taking a nip from a four legged friend was almost 2.5 times more common than the current official figure, which estimates that 7.4 in 1,000 people get bitten by a dog every year in the UK. The figure is likely to be higher, because dog owners who get bitten by their own dogs are unlikely to report them for fear of getting their own dogs put down. Dog bites which also happen within the family – where the dog belongs to a family member – are unlikely to be reported for the same reason.

The results also showed that people who are nervous, men and owners of several dogs were more likely to be bitten.

This study was dependent on the date from questionnaires. This sort of information collection is a good way to obtain responses quickly. However, the limitations of this study include the fact that in this particular instance an assessment of behaviour is difficult, both in a recollection situation – having to do it in hindsight. Also there was the earlier reported case of perhaps dog owners not wanting to get their dogs taken in, and amending their queries.

The current guidelins for dog bit preventions suggest the following:

Never leave a young child unsupervised with a dog – regardless of the type of dog and its previous behaviour.

This is of course a good point, especially with attack dogs or more aggresive breeds. Even if the child is known to the dog, there have been many cases where dogs left alone with toddlers have seized the chance and attacked them. It is almost as if the removal of an adult boldens the dog into an attack it would not normally make, and being left alone with a young child heightens the fright or fight syndrome within a dog.

Another guideline is to treat dogs with respect – don’t pet them when they’re eating or sleeping. Dogs dislike being disturbed when they are meeting their basic needs, and the disturbance awakes and breeds aggressive responses that may evolve later.

A third guideline is to avoid stroking or petting unfamiliar dogs – when greeting a dog for the first time, let it sniff you before petting it. A good idea is to actually converse with the owner first so that the dog has already established you are friendly.

This study was carried out by researchers from the University of Liverpool and was funded by the Medical Research Council Population Health Scientist Fellowship. While the media reporting of the study was fairly accurate, The Guardian pointed out that people’s emotional stability was self-rated. In other words, if respondents were asked to rate their feelings, this may not be an accurate assessment – one person’s level of anxiety may not be the same as another’s.

So can dogs actually sense fear and anxiety? How does this explain the incidence of people being bitten by dogs? The answer to these questions can be answered best perhaps in two parts.

The first is the level of aggression in the dog. This depends of course on the genetic makeup, but also how it is treated. If its needs are met then it is likely that the level of aggression is typically lower than what it would be than if it were harrassed or disturbed persistently, which can build up latent aggression.

The second is the dog’s sense of fear. If a dog is often emotionally angered and there is opportunity to release this tension, even in a moment of madness, then this may result in biting as an emotional release.

So can dogs sense fear? Possibly. Does this explain their tendency to bite? Well, dogs that are treated well and genetically not prone to attacking will be less prone to nipping. Dogs that are not attack dogs but mistreated, or dogs that habitually have their attack responses nurtured, are more prone to biting, when the opportunity presents itself in the form of a less defensive target.

Going herbal? Switch with caution

Do you use herbal remedies rather than traditional medicines? If you belong to the former group, you may find yourself part of a growing number of individuals who may be increasingly opting for the herbal medicine route in favour of the traditional medicine route.

What makes people resort to traditional medicine? There are many reasons. One may be that they have been on a particular type of medication for a long period of time, and have seen no improvement, and are keen to try something that might bring about change. For example, if you have been suffering from migraines for quite a long time, and the medication does not appear to alleviate the severity of the frequency of the headaches, then would you not be tempted into trying something else that might work? After all, you might think that if you do not try, you might miss out of the potential benefits. Hence, the search for a better treatment might be a motivating reason for going herbal.

But seeking products that might work better because they are more naturally occurring and possibly more readily adopted by the body may only be one reason for switching to or trying herbal remedies. Traditional medicine also carries risks of adaptation and addiction, which is why some individuals consider switching.

Take for example pain relief medicines such as ibuprofen. If taken consistently for a long period of time, the body adapts to this increased level and the benefit of ibuprofen is gradually neutralised and minimised. It does not bring pain relief if taken on a prolonged basis because the body has adapted. But because the body has acclimatised or become accustomed to this, it now depends on this level of ibuprofen. The medicine has now bred dependency, and an individual is now addicted to it. It is possible that something more potent in terms of pain relief may be prescribed by doctors but again with prolonged use there is the danger of adaptation and addiction, but this time to a higher dose.

Medicines also produce side effects if used for long term. We have already examined for example the effect of aspirin in the elderly – it can cause bleeding and other complications.

Hence it is unsurprising that individuals look to the herbal medicine route as a means of avoiding greater dependency on drugs, to avoid tampering with the body’s natural ability to heal itself, and in the hope that herbal remedies could provide a quick alternative resolution to medical issues that they have had long term treatment for.

The herbal medicine world is not as regulated as the traditional medicine world although there is increasingly a tightening on the controls, especially on the advertising and promotion of products to make sure that products cannot make claims to curing certain illnesses.

While some may protest into the regulation of the herbal medicine market as the clamping down on civic liberties by an over protectionist nanny state, there are actually valid medical reasons for these interventions.

Herbal remedies may interact with traditional medicines and cause conflicts. They may either neutralise the potency of the traditional drug, or enhance it to dangerous levels above recommended limits.

The most often reported drugs that can come into conflict with traditional drugs include the blood-thinning drug warfarin, cholesterol-lowering statins, anti-cancer drugs, antidepressants, immunosuppressant drugs for organ transplants and antiretroviral drugs for people with HIV. The most common result of a drug herb interference was that of cardiovascular disease, involving medicine such as statins and warfarin. Other unwanted spheres of influence include cancer, kidney transplants, depression, schizophrenia, anxiety disorders and seizures.

The most commonly used herbal remedies included ginkgo biloba, St John’s wort, ginseng, sage, flaxseed, cranberry, goji juice, green tea, chamomile and turmeric, while those most likely to cause interactions with drugs appear to be sage, flaxseed, St John’s wort, cranberry, goji juice, green tea and chamomile.

In some cases herbal remedies can lead to death or secondary death. One man died after a herbal remedy prevented his anti-seizure medication from working properly, resulting in him drowning.

These facts highlight the need for patients to inform their doctors if they are taking other forms of herbal medication apart from the medication that the doctors are prescribing, so that the doctors can examine if there might be interference in the interactions. This need is particularly important if among the drugs are those that have been identified as being likely to be affected by herbal remedies.

But what stops people from mentioning they are trying herbal remedies? One main reason is embarrassment. Alternative remedies still have a reputation for being outside the periphery of the mainstream and carry with them the stigma of being unconventional, flaky and based on superstitious beliefs. Some might question their unscientific basis as a whole load of quackery, akin to snake oil or elephant powder. Subscribing to herbal remedies in some circles in seen as being illogical. And no one wants to be perceived as a nutter.

There is also the perception of owning up to being a failure for whom traditional medicine has not worked for.

The crossover group is the one most at risk as they are most likely to continue taking the doctor’s medication while trying herbal remedies at their prescribed doseages. In other words, they are most likely to take double of what is recommended in a bid to get the best of both worlds.

Herbal remedies may prove their worth in time. But in the meantime, while we move towards a scientific study, regulation and understanding of non-pharmaceutical medicines, it is best to be cautious of interference and their crossover effect.

Ibuprofen and the fertile imagination

There is an astounding variety of painkillers available for purchase both in supermarkets, chemists, and corner shops. Just take a look at the shelf of your nearest Tesco or Sainsbury. You have various types of paracetamol, both made by pharmaceutical companies as well as in house versions of the supermarkets.

What is the difference between them and why are there so many varieties?

When pharmaceutical companies take on the decision to manufacture a new drug, they are given a twenty-year patent which covers the research into the product, testing and manufacturing, and sales. The period of twenty years, a monopoly as such, is to reward them for the time invested into the research. In the course of the research into the product, pharmaceutical companies must publish various forms of medical evidence and put it into public domain, so that if there is any medical evidence that points to the contrary, these can be debated both by the medical community and the pharmaceutical world.

The problem, if we can call it that, is that business is a very competitive world, and if research is put out in the open without any form of intellectual protection, any manufacturer can pounce on the research undertaken by someone else who has taken the effort and trouble to do it, and produce their product off the back of it. They would have saved the time and cost investment.

Imagine if a writer has taken the time to research a topic, organise his thoughts succinctly, and find a publisher. And when his book is published, someone else photocopies it, binds the copied pages and subsequently peddles it as their own.

Within the period of twenty years, a pharmaceutical company has to research, market and sell enough of the product to recoup the investment costs and profit. It is after the twenty period has expired that the other sharks enter the fray. This is where you get the supermarket brands of the product, which are cheaper because they don’t need to pay for research.

What is the difference between brand names and generics? They essentially do the same thing. But if the original company has done a good job in making the product synonymous with its own brand, then you might think they are better. If you take Neurofen for headaches, then you might think it better than Tesco ibuprofen, even though they both contain the same active ingredient.

But pharmaceutical companies have to reinvent themselves, to make varieties of the same product, otherwise they will lose their market share and eventually die out. If you realise that Neurofen is matched in ability by the cheaper Tesco ibuprofen, you would buy the latter, unless you are persuaded that Neurofen for Flus and Colds, or Neurofen Muscle Pain has something clinically formulated for that specific purpose.

So the shelves of supermarkets are stacked with different priced products with the same active ingredient, as well as different varieties of the same product.

Painkillers are a common medicine because there will always be a demand for pain management.

The availability of pain relief medicine means it is easy for the average individual to obtain them. There is the possibility of overdose, and while this may be a rarity, there is a higher likelihood that the greater availability may mean individuals are taking more doses than they should.

What are the long term health impacts of taking ibuprofen for prolonged periods?

One problem is that the body adapts and so the long-term resistance is affected. In certain groups such as the elderly, aspirin also increased the risks of stomach bleeding.

A clinical trial seemed to suggest it may impact on testosterone production and hence affect fertility.

Test subjects were administered 2 x 600mg doses of ibuprofen daily for six weeks, much higher than the average dose. The sample size was only a small group of 30, and half received ibuprofen, while the others received a placebo. It would have been better if the subject group had been greater, so that there could be more confidence in the test results, but because a test of such nature is to examine human resistance to what is essentially toxicity, it would have been unethical to involve a large group of participants. The research findings found that there was no impact on testosterone already in the body, but the pain relieving nature of ibuprofen, as a relaxant of sorts, had impact on the production of testosterone and appeared to slow down production.

How did these reports end up in the media? The tabloids had a field day, and you would undoubtedly have found one with the usual wisecracks about balls and other man-related genitalia, along the lines of “Ibuprofen shrinks your balls” or “Ibuprofen smalls your balls”.

Maybe instead of Ibuprofen for colds or fast relief, we need Ibuprofen for Dummies.

Your daily sausage roll may exact its revenge on you in good time

Ever wonder why people go on a vegetarian or a vegan diet? There are many reasons I can think of.

The most common one is that people are very much against animal cruelty. People who avoid eating animal-based products are against the farming of animals, because they are convinced that animals are treated inhumanely. For example, battery hens are kept in small cages in large densities. Imagine if you and your fellow co-workers were put together in a small room, without any desks, and told to make the most of it. You’d all be up in arms about the way you were treated. The only difference between you and hens is that hens can’t protest about it.

The transition to a vegan diet is not just about not eating animals, although this can be a factor too. Vegans are against the eating of animal meat because of the way farm animals are killed. Cows, pigs and chickens, the main farm animals that are killed to provide the common English foods such as the English breakfast comprising sausages, bacon and eggs, are – in the opinion of vegans – inhumanely killed, despite the best of measures.

Do you know how a chicken is killed before it ends up deep fried in bread crumbs and served with your chips and bottle of cola? There are two main ways. The first is by electric methods. First of all, the birds are shackled to a conveyor belt by their legs, upside down. Needless to say, they don’t willingly walk to the machine and pick their positions. There is a lot of fluttering about, human exasperation, and rough handling of the birds which may result in broken bones – who cares, right? After all, the bird is going to be dead soon – before the conveyor belt brings the birds upside down into a water bath primed with an electric circuit. The moment the bird’s head touches the water, it is electrocuted to death.

The second method involves gassing to death. Birds are transported in their crates and exposed to suffocation. This method is arguably more humane, supporters say, because the birds are not manhandled. But don’t be fooled into thinking the bird’s welfare is under consideration. It is a faster, less human-intensive way of killing the birds. Sling them in the box and gas them to death. No messing around trying to catch the flapping things. Avoiding the need to shackle them also saves time.

There is a third reason often quoted for going further in being a vegan. Cows produce vast amounts of methane and if everyone stopped eating beef, it would be better for the enviroment. In this instance, it is not so much for the animal’s welfare, but more for the sake of avoiding the environmental pollution by the animal.

There may soon be another fourth reason for avoiding meat. Processed meats – which have been preserved using methods such as salting, curing, smoking or adding preservatives – have been linked with cancer.

A study involving 262,195 UK women showed links of breast cancer and processed meat. Postmenopausal women who ate processed meat had a 9% higher chance of getting breast cancer than women who ate no processed meat. Those who consumed more than 9g of processed meat had a 21% chance of getting cancer in comparison to those who avoided it altogether.

The study is significant because the sample size is large – not just 100 women, or a small negligible figure whose results may bias findings, but over 250,000 women; more than enough to be taken seriously.

The women were all between the ages of 40-69 and free of cancer when they were recruited for the study before 2010. They were followed for a period of seven years and the results examined.

Process meats are thought to possibly cause cancer because the methods involved in processing the meat may lead to the formation of cancer-causing compounds called carcinogens.

What is not so clear is whether it was the eating of processed meats in isolation that caused the development of cancer. There are other factors that should be taken into account, of course, such as alcohol, exercise, work stress, lifestyle factors and body mass index. Certain ethnicities may also be prone to developing cancer because of other dietary factors such as cooking with oil, ghee or lard.

The results also did not suggest that the findings would be equally applicable to men.

Nevertheless, it would be a good idea, if you were an older woman, to avoid eating processed meat every day. Instead the consumption could be limited to once every other day, or eating it as an occasional treat. Or cut out the meat completely – a switch to a vegetarian or a vegan diet would not only be good for your health. You would be considering the environment too.

A short history of non-medical prescribing

It had long been recognised that nurses spent a significant amount of time visiting general practitioner (GP) surgeries and/ or waiting to see the doctor in order to get a prescription for their patients. Although this practice produced the desired result of a prescription being written, it was not an efficient use of either the nurses’or the GPs’time. Furthermore, it was an equally inefficient use of their skills, exacerbated by the fact that the nurse had usually themselves assessed and diagnosed the patient and decided on an appropriate treatment plan.

The situation was formally acknowledged in the Cumberlege Report (Department of Health and Social Security 1986), which initiated the call for nurse prescribing and recommended that community nurses should be able to prescribe from a limited list, or formulary. Progress was somewhat measured, but The Crown Report of 1989 (Department of Health (DH) 1989) considered the implications of nurse prescribing and recommended suitably qualified registered nurses (district nurses (DN) or health visitors (HV)) should be authorised to prescribe from a limited list, namely, the nurse prescribers’formulary (NPF). Although a case for nurse prescribing had been established, progress relied on legislative changes to permit nurses to prescribe.

Progress continued to be cautious with the decision made to pilot nurse prescribing in eight demonstration sites in eight NHS regions. In 1999, The Crown Report II (DH 1999) reviewed more widely the prescribing, supply and administration of medicines and, in recognition of the success of the nurse prescribing pilots, recommended that prescribing rights be extended to include other groups of nurses and health professionals. By 2001, DNs and HVs had completed education programmes through which they gained V100 prescribing status, enabling them to prescribe from the NPF. The progress being made in prescribing reflected the reforms highlighted in The NHS Plan (DH 2000), which called for changes in the delivery of healthcare throughout the NHS, with nurses, pharmacists and allied health professionals being among those professionals vital to its success.

The publication of Investment and Reform for NHS Staff –Taking Forward the NHS Plan (DH 2001) stated clearly that working in new ways was essential to the successful delivery of the changes. One of these new ways of working was to give specified health professionals the authority to prescribe, building on the original proposals of The Crown Report (DH 1999). Indeed, The NHS Plan (DH 2000) endorsed this recommendation and envisaged that, by 2004, most nurses should be able to prescribe medicines (either independently or supplementary) or supply medicines under patient group directions (PGDs) (DH 2004). After consultation in 2000, on the potential to extend nurse prescribing, changes were made to the Health and Social Care Act 2001.

The then Health Minister, Lord Philip Hunt, provided detail when he announced that nurse prescribing was to include further groups of nurses. He also detailed that the NPF was to be extended to enable independent nurse prescribers to prescribe all general sales list and pharmacy medicines prescribable by doctors under the NHS. This was together with a list of prescription-only medicines (POMs) for specified medical conditions within the areas of minor illness, minor injury, health promotion and palliative care. In November 2002, proposals were announced by Lord Hunt, concerning ‘supplementary’prescribing (DH 2002).

The proposals were to enable nurses and pharmacists to prescribe for chronic illness management using clinical management plans. The success of these developments prompted further regulation changes, enabling specified allied health professionals to train and qualify as supplementary prescribers (DH 2005). From May 2006, the nurse prescribers’extended formulary was discontinued, and qualified nurse independent prescribers (formerly known as extended formulary nurse prescribers) were able to prescribe any licensed medicine for any medical condition within their competence, including some controlled drugs.

Further legislative changes allowed pharmacists to train as independent prescribers (DH 2006) with optometrists gaining independent prescribing rights in 2007. The momentum of non-medical prescribing continued, with 2009 seeing a scoping project of allied health professional prescribing, recommending the extension of prescribing to other professional groups within the allied health professions and the introduction of independent prescribing for existing allied health professional supplementary prescribing groups, particularly physiotherapists and podiatrists (DH 2009).

In 2013, legislative changes enabled independent prescribing for physiotherapists and podiatrists. As the benefits of non-medical prescribing are demonstrated in the everyday practice of different professional groups, the potential to expand this continues, with consultation currently under way to consider the potential for enabling other disciplines to prescribe.