The Ultimate Christmas Album for the Existentially Wounded

"It's why, it's why we hang lights so high

and gaze at the glow of silver birches in the snow

Because of the dark, we see the beauty in the spark

We must be alright  if we could make up Christmas night"

-Tracey Thorn, Joy. 

Now, I'll admit that at this time of year, I can get rather annoying.

I love Christmas, I really do. I'm often to be found wearing antlers and tinsel. I put my decorations up at the first opportunity humanely possible, and start on the mince pies in September. This year, I excitedly bought myself a Lego advent calendar, despite the incredulity of the guy behind the counter in the shop. I also have snowman hoodie which yes, I shall wear out in public.

As a child-free, cynical, atheist adult, it might seem like this is a hard time of year to enjoy. And, to be honest, you're probably right. It would be a whole lot easier to throw in the towel and grumble about how commercial it all is, and how I just wish it was over and done with and everything can go back to normal. But I refuse to give into this, and put quite a bit of effort into maintaining my child-like delight at the festive season.

Obviously, its nothing to do with god. And don't get me wrong, I love the presents too (dear parents, if you are reading this, please do take note that I shall never be too old for Lego). But my desperation to enjoy this time of year runs somehow deeper than all that. I don't need to link it to religion, nor do I need to experience it through a child or partner. Christmas reminds me of my own, hard-won personality.

For me, it is about traditions. And these traditions, as they shift and change slightly each year, somehow reinforce my own self to me. Back in what now seems like a lifetime ago, my ex-husband and I took joy in forming new traditions together at this time of year. It was a way of reinforcing ourselves as a couple unit, of forging our own little family ways. Small things, like buying a new special decoration for the tree each year, came to mean a lot to us.

When my marriage broke down on Boxing Day 2010, I had to start again. Everything I had known up until that point fell apart, and my hopes and dreams, which I had been carrying like a shield all my life, shattered in a matter of hours. I had to begin again from scratch, and it was often the smallest of things that seemed to make all the difference to me.

The next year, my new, empty Christmas tree seemed somehow symbolic of how I had to start to collect some traditions of my very own. These traditions would belong to me, and me alone. I started picking up little decorations here and there, and now I have a rather lovely collection of bits and pieces to adorn my home with. And I've done the same with traditions: baking certain things at certain times, (including my beloved Christmas pie), drinking startlingly strong fruit wine in a particular pub on Christmas Eve with my friends, seeing Rare Exports at the cinema, taking part in a gingerbread contest, and many others. Some of us even go so far as to throw ourselves into the freezing North Sea on Boxing Day which not only washes away any vestiges of hangover cobwebs, but also distracts me from the awfully sad memories I would otherwise be thinking about.

Winter is a dark and often terrifying time for many of us. Dark mornings and dark nights make it easy for the sadness and emptiness to creep in. Getting home to a cold, dark, empty, one-bedroomed flat can start to feel like a failure. But then I pop on the tree lights, and I have something to focus on, some little pinpricks of hope that, in the end, the world is full of good people, and I will be able to spend some quality time with those who I love most- my friends and my family. And I will have an excuse to fill my flat with sparkly things, and wear glitter eyeliner.

Christmas is, to me, an acknowledgement that times will be dark and hard ahead, but that I will get through those times, with the help of those around me. It reminds me of how far I've come, and how proud I am of myself. It reminds me of all the good I have found in the world, of all the little bits of help I have gotten from the most unexpected sources, of all the new people I have met and the pride I have in my oldest friendships. If humankind has the presence of mind to plonk a huge celebration in the middle of the darkest season (even if they have done so on the pretence of a god I don't believe in), then that's fine by me, and I shall do my damnedest to make sure I embrace it with gusto.

I love the standard Christmas songs. I'll dance about to a bit of Slade with the best of them. But the saccharine jingle bells of most of the tunes you'll find on Now Thats What I Call The Ultimate Best Ever Christmas Tunes In World... Vol 3 don't seem to quite catch the nuances of the festive season for me. I've only come across a few songs which do, and I have collected them here for your auditory pleasure. I'm keen to know of more, so if you have any you would like to recommend, please do let me know, either in the comments, by email, or by tweeting me (@SparkleWildfire). What I would like to do is create a playlist of genuinely good, beautiful songs that evoke both the joy and the darkness of Christmas.

Joy by Tracey Thorn.
Tracey Thorn's (of Everything But The Girl fame) Christmas album Tinsel and Lights, which she released last year, was a total revelation to me. Its a gorgeous, calming album which hits just the right pitch of melancholy and joy for this time of year. I think this song says it all really.

Snowglobe by Dean Owens.
I saw Dean play at the Tyneside Cinema just before that fateful christmas of 2010. This is a lovely, sad little song about having depression or mental health issues over Christmas time. It serves as a reminder that mental health issues don't instantaneously resolve over the festive period, and that this time of enforced happiness can be extremely hard for many.

December Will Be Magic Again by Kate Bush
You may already know by now that I absolutely adore Kate Bush. Even the title of this song is poignant. This song has the same theme to me as Joy: its about using tradition to cover the darkness of the winter.

Winter by John Smith
This is simply the best, most beautiful song about the baby Jesus that I have ever heard. I first saw John play as support for John Martyn, and I have since seen him live several times and been reduced to tears by him. I absolutely adore his voice. I don't mind that this is a song about the nativity: to me it is a song about a story, and I just love how plaintively he sings that "I was there" line.

A Christmas Fable by The Selecter
I love a bit of ska. I've spent a full day agonising over which song to go for from this single. Then it occurs to me: its a double A-side, so I can legitimately have both. The songs are supposed to symbolise the light and dark sides of christmas, so they're pretty perfect for my playlist. Skank 'Til Christmas is all about letting your hair down when everything else in life has gone to shit (I love the references to the current financial situation), whilst a Christmas Fable is about a rather distressing family breakdown on Christmas day.

River by Madeleine Peyroux & K.D. Lang
A cover of this track also appears on the aforementioned Tinsel and Lights album. Thanks to the ever marvellous Ian Robinson (@eyeswideshut75) for suggesting it.

White Wine in the Sun by Tim Minchin
Thanks to Steve Haigh for reminding me of this. There's so much truth and humour in this gorgeous little tune, and it really sums up a good old family Christmas.

The Atheist Christmas Carol by Vienna Teng
This is just gorgeous.Thanks to Jackie (@Jackpot73- one of those new people so I am so thankful for having met this year) for

Silent Night/ 7 O'clock News by Simon and Garfunkel
Pretty self explanatory.

Love is All We've Got by Paul Fisher
I have loved Paul's music since the first time I saw him at a folk night when I was still underage drinking. I can remember being completely astounded by the noises that were coming out of this guy on the tiny stage upstairs in the Egypt Cottage pub. Turns out he has made a beautiful, gorgeous, poignant Christmas song this year which I will be listening to over and over.

Candle Song 3 by Mojave 3.

Tar Barrel in Dale by Rachel Unthank and the Winterset
Another one suggested by the lovely Jackie. A New Year's song about a Northumberland tradition. This year has been so cruel to so many of my friends and people I know, so I listen to this hoping that the new one brings those who I love some luck.

Hxxx

P.S. Here's my Sparkle Wildfire Top Festive Tip for the year: mulled wine liquid soap might seem like a good idea in the shop, but its really not. You end up smelling like a wino.

The Tale Of The Pencil Woman..

She used to visit us in waves. We wouldnt see her for a few weeks, then it would be up to three times a day, every day, for a week. First, it was pencils, so she became known as The Pencil Woman.

She would ask us each time if we sold pencils. We would reply that we didn't. She would smile a lovely, lopsided grin, and say oh yes she remembered now, silly her.

One day a rep came round, and in his catalogue we noticed some pencils. We ordered them in.

She came in and asked for pencils. We told her that yes, we did have some in stock now. We sold her one, and off she went. 

She came back the next day, and asked if we sold pencils. We must have looked a bit confused, as we knew we had told her where they were yesterday.

"Oh yes, I remember now. I bought a pencil, but you see, its my son. He's an artist and he draws all the time, and he had ran out of pencils so I gave him mine. Now I need a pencil."

This started happening a lot. Always the same story. We laughed about it because we didn't know what else to do.

The next time we saw her was about three weeks later. She asked if we sold reading glasses. We showed her where they were, on the counter. She selected some, paid her 99p, and off she went. She came back the next day and asked if we sold glasses.

"Oh yes, I know I just bought some, but you see its my son. He needs glasses for when he is drawing, and he has taken my pair because he lost his. So now I need another pair. "    

She would sometimes return just an hour later, and say exactly the same. She would come in when we were really busy with prescriptions, and sometimes we would be impatient with her.

One morning, we sold her a pink, flowery pair of glasses, joking that her son wouldnt want to steal those ones. She was back in for more in the afternoon.     

There were various other sundries that she cycled through.

Then one day she asked for aspirin. I asked her all the questions, and she Said she wasn't taking any other medicines etc. She said she just like to keep them in the house in case she got a headache. So I sold her them.

The next day she came in and asked for aspirin.

"Well its my son you see. He had a headache too (probably because he does so much drawing) so he took the pack of aspirin to  work with him so now I need one for me."

The same thing happened over and over again. I tried to question her more and more, but without accusing her of lying I couldnt get anywhere. I tried to have long chats with her, to find out her name, and who her doctor was. She told me she wasn't registered with a doctor and she didn't like going to see them.

I was worried. She was obviously forgetting that she had bought aspirin, and buying more. The son was a clever cover story, for the times when she could see the pity in our faces. One day, she came in for aspirin again and I saw a large bruise on her hand. She said she didn't know where it had come from, it just appeared one day. I asked her to promise me that she would see a doctor. She held my hand and said she would and how sweet I was. 
                                                            
If she was forgetting that she had bought the aspirin, was she forgetting when she had taken  the aspirin. Was the bruising because she was bleeding because of taking too much aspirin?
                           
I asked our delivery driver to ask around when he was out and about, to see if anyone knew her. We asked in the local shop and pub if anyone knew her name or address so I could look her up on our records and see who her doctor was. No luck. Everyone knew her, but no one knew her name.

One day, a woman came in with some medi-boxes that had been dispensed from another pharmacy. She said she had found them in her mum's house, but her mum had plenty of boxes, so could we dispose of them. I did so, and just happened to glance at what was in there. It was some Alzheimer's drugs. I didn't think anything else of it.

The same woman rang the pharmacy a few days later, to ask something about her health. She said she was feeling really run down, as she was finding it hard to work full time and look after her mother who had dementia.

Something clicked, and I asked her to describe her mother to me. It might have sounded like an odd question to her, but she described the pencil woman.   

What happened next might have been a breach in confidentiality, but I told her about the aspirin, and the bruising, and how I had been worried about selling it. I figured yes, I had broken confidentiality, but the pencil woman was in danger if I didn't.

Her daughter told me the story. It started with tins of soup. She had cupboards and cupboards full. Then it was loaves of bread, which went mouldy, and the daughter had to clean out her whole kitchen. There were tears, and I had absolutely no idea what the right words to say were.

We still used to see her. When she came in to ask for aspirin, I told her that her daughter had been in to get her some and would see her later. I had agreed this line with her daughter. It was a little white lie that saved her from more embarrassment, and kept her a little safer.

I still think about her a lot, especially now my own Grandma is approaching the upper end of the  moderate stage of Alzheimers. I think of all the times we were impatient, or didn't have time to stop and chat. I wonder what her story was, and what she had done when she was younger. I wonder about all the tales she might have had to tell, and how many of them are lost.

I wonder where she is now, if she is still alive. I wonder how her son and daughter are coping. 

I think of the embarrassment and terror in her eyes when she was telling us about how its her son, you see.

Today is Dementia Awareness Day. I think of The Pencil Woman.

Pharmacies, pharmacies, everywhere

"Phew, I tell you what, I can't move for pharmacies these days. They're everywhere I turn, and I can't walk down a street these days without tripping over multiple green crosses. Everywhere you go its pharmacy here, pharmacy there, pharmacies everywhere"- No-one, ever.

And yet, apparently there are too many of the blighters, according to some pharmacy leaders. About 3,000 too many, give or take. Funnily enough, I beg to differ. And here's why.

I have worked in two newly-opened pharmacies in my career. In each, I was inundated with customers wandering in and telling me how lucky they were to have a pharmacy in their area. In one, the residents of the local area had campaigned for years to get their own pharmacy. Within months, the pharmacy was busy and the delivery service was thriving- and this was in a very small pit village.

We weren't, however, busy enough to justify a second pharmacist. This meant that I-despite good, efficient staff- would have to work many a late night-for no extra pay or lieu time- just to keep my head above water. The pharmacy closed at 5.30pm. I was regularly there until 10.30pm on a Thursday night, dispensing and checking prescriptions to make sure we were clear for Friday morning so that we could get all the prescriptions done and delivered in time for the weekend. This was just to keep on top of the day to day dispensing and didn't take into account any of the routine business things I had to do, like writing SOPs, Business continuity plans, finances, etc etc etc as a pharmacy manager. The pharmacy opened at 9am. I would turn up at 7:30am (again, unpaid) to get the till float done, prescriptions counted etc before we opened.

Its not that my time management or organisation was bad. It was just the sheer volume of work that needed to be done. I got away lightly- one of my fellow pharmacists in a different branch was known to be still at work at 2am at least once a week, just to keep afloat.

This was a few years ago now, but I locum fairly regularly and I still see busy pharmacies, with staff working flat out to get their work done as efficiently as possible. Not that much seems to have changed. What I don't see is empty, quiet overstaffed pharmacies filled with bored staff who have nothing  to do.

One day, the managing director for the company came round, and had a go at me because I hadn't been doing enough Medicines Use Reviews (MURs). Now, I was initially enthusiastic and excited about MURs. I couldn't wait to sit down with patients and get my teeth into providing a good quality service.

But I just couldn't do it. I didn't have time to do as much training, preparation, and CPD as I wanted to, and as a result I was nervous of doing MURs. What didn't help was the fact that, throughout each one, a large part of my brain was taken up with worries about how many prescriptions were piling up in the dispensary, when I wanted to give the patient my full attention. Each 15-20 min slot I spent in the consultation room with a patient meant I was behind with prescriptions- and because most of mine were deliveries, this had a huge knock on effect on the delivery drivers, and ultimately, the patients, who would then ring up in a panic wondering why their medicines hadn't been delivered by the usual time, putting us even further behind schedule. Thus began a vicious circle, worsened by my own constant feeling that I was so thinly stretched I just wasn't able to do enough justice to every aspect of my work. I'm by no means a perfectionist, but I like to do things well, and the fact that I just didn't have the resources to do so constantly played on my mind.

I ended up frustrated at my own inadequacies and inability to get on top of the situation, stressed to breaking point, and incredibly disheartened. I'd even go so far as to admit that resentment started creeping in too. I know I'm not alone here, and suspect that the majority of community pharmacists have felt this way.

MURs are just one example of a service of course. In the year and a bit I worked at that pharmacy, we started doing MURs, morning after pill, over 50 men's health checks, diabetes screening, a minor ailments scheme, smoking cessation schemes, and a weight management scheme, amongst others. I was desperately swimming against a tidal wave of more and more jobs to do in the same amount of time.

Each time I read a pharmacy magazine like Chemist + Druggist, there seems to be yet another call from yet another pharmacy body or the other for pharmacists to be involved in delivery of yet another service. And my heart sinks, because I wonder just how on earth this is supposed to fit in with all of the other jobs that need doing.

Now, I'll admit that I haven't read the Now or Never report from the Royal Pharmaceutical Society commission (on account of being a cash-strapped non-member pleb). Nor have I kept up to date with the response to it on social media, blogs etc (on account of a fairly severe bout of anxiety-induced apathy over the last few days). With that in mind, though it still seems to me that the following metaphorical conversation is going on:

Pharmacy leaders: "And, and, and, you would be really good at delivering all these new services, so you should start doing that."

Pharmacist (from underneath a large pile of prescriptions that need checking, in between phone calls, and being called to the counter to speak to patients): "Yeah, I probably would be good at that. And I would love to do it, if only I had time."

Pharmacy leaders: "Good, well that's settled then. We'll pay you less for dispensing, but because you'll be doing all these services that will definitely be okay because you'll make up the money elsewhere."

Pharmacist (desperately attempting to gulp from a cold cup of tea to avoid dehydration): "Erm, right. Sorry, I need to go and talk to a patient now hold on... right, sorry, I'm back, what were you saying again? oh hang on, that's the phone ringing, I'll just have to get that..."

Pharmacy leaders: "We're so pleased you're co-operating. Oh, and by the way, we've decided there's too many pharmacies, so we're going to close all the ones near you, so you'll be getting more prescriptions to do, and more customers."

Pharmacist: "hang on, whaa- yes Mrs Brown, your prescription will only be a couple more minutes"

Pharmacy leaders: "Great! so to summarise, that's more prescriptions, more customers, more services, less pay. See you later!" (flounces off)

Pharmacist: "What in the hell just happened?... No no, Mr Smith, its okay, I don't need to see your haemorrhoids again, thank you"

Strategic decisions and the bigger picture are all very well, but at the end of the day they are just words if the people at the front line aren't able to deliver the vision because they are already overloaded. To me, it feels like new ideas, new visions and new services are bandied about by the top level folk, but what they neglect to do is look at the minutiae and check how the "little people", the folk on the ground are doing and what they think about any changes.

The realities of life on the shop floor are, in my mind, not conducive to delivering the sorts of services that the profession is calling for, unless there is a huge overhaul in how pharmacies are staffed, funded, and managed. And given that, in these austere and pressured times, everything possible is being done to reduce costs, pare down staffing, and maximise profits, I just cannot see the sort of situation in which we can do all of these things to the best of our abilities well panning out in real life. Yes, great changes in the direction of the profession need to come from the top, but they also need to come from the pharmacists behind the counter in the little pharmacy in the tiny pit village too.

The only way that I would have been able to deliver MURs in my pharmacy to the standard and quality that I so desperately wanted to acheive would have been to have had a second pharmacist present. And the only way a second pharmacist would have been present was if they had been paid. And the only way the company would have paid for a second pharmacist would have been if they were absolutely, just short of gunpoint, forced to.

I'd like to suggest that before the profession starts excitedly waving its hands and shouting "ME ME ME!!" to every available service going, we take a step back and decide whether or not we can actually deliver it, given everything else we also have to do. That enthusiasm is great, but if we can't follow it up with actions, we will end up an all-talk and no substance sort of profession.

So, in summary: are there too many pharmacies? No, although there might be the odd street or village which has more than its fair share. To be honest its a moot point. What's a more important question is: "what can we do to support pharmacists and improve the quality of services in the pharmacies we've got?"

Hxx

Stick a label on this...

Since before I began my career in pharmacy, there has been a drive to get pharmacists "out of the dispensary", in a bid to better utilise their medicines expertise with patients. This sounds great- we have unique clinical knowledge and skills that we have always wanted to use more to make sure medicines are used effectively, safely and efficiently.

For a patient to use a medicine effectively, they need to actually have it in their possession. There is no getting away from the fact that dispensing prescriptions remains a large part of the community pharmacy business model (leaving aside concerns about the contract and reimbursement etc for now). However, dispensing remains the frumpy friend of the drop dead gorgeous, charismatic clinical side of pharmacy. It seems that these days it is seen as repetitive drudgery: the smartie counting and label sticking that we hear so much about. It is, in short, a waste of pharmacists' time, and is something the profession as a whole seems to unquestioningly want to leave behind.

I believe, however, that it is pharmacy's unique selling point. Its only through dispensing that a prescriber's directions are translated into reality. We can prescribe and advise on the most efficient use of medicines imaginable, but if the patient doesn't physically have the right medicines and know how to use them, all of that is pointless.

Yes, there are ways to reduce the pharmacist's input in the dispensing process. There are robots, accredited checking technicians etc. But a prescription still needs to be clinically checked- and that requires the unique skills, knowledge, and abilities that only pharmacists have.

But lets say we step away from dispensing and move in a purely clinical direction. We sit in a room and do reviews of patient's medicines, answer queries, prescribe medicines, monitor and screen patients. Does this sound familiar to you? It sounds to me like the sort of thing a GP does. So, why do pharmacists exist? What do they add to the healthcare picture? Doubtless such pharmacists would be useful, but the profession would become more nebulous, the edges of our role more diluted and less defined.

In my eyes it is our practicality, our ability to supply essential medicines in a safe and effective way to patients that defines us as a separate profession. That, to me, doesn't have to just mean sticking labels on boxes, and doesn't mean that the profession has to be at a standstill. I just think that we need to stop putting ourselves down and accept and be proud of our role in supply. For years we have been declaring ourselves as able to provide new and more clinical services- and we can. But we need to make sure that we define and build on our niche to give us the solid foundations we need to start branching out.

We pharmacists are an interface. Our role is as go-between, and a bloody important role it is. We are go-between a patient and their GP or their consultant, or whoever. Or, we are a go-between the patient and complex medicines information- we can, crucially, convert difficult to understand evidence into patient friendly terms. We can explain what they read in the paper or on the internet, what the directions of a reducing dose are, help them to navigate through the overwhelming choice of medicines over the counter. We are a go-between the drug manufacturing plants and the patient's bathroom cabinet. And the thing that underpins this role is our accessibility. And the reason we are so accessible is because- wait for it- we dispense prescriptions.

If you ask me (not that anyone will), we need to stop thinking of dispensing as the poor relation and see it for just how useful it is.

Hxxx

What Zombies Don't Tell You

Today it is Hallowe'en. And in honour of one of the scariest, most horrific things to have happened today (the release of What The Doctors Don't Tell You's clearly illegal and highly dangerous Cancer Special), here is the fruits of my lunch hour's labour:

You're welcome, world.

Enjoy Hallowe'en.

Hxxx

Disclaimer: The advice given in this publication  is not intended to replace that of Randy. Before following any of the advice given, please check with him first.

PS: Randy is an obscure reference to the We're Alive podcast. If you're a Behemoth zombie, you're probably already riddled with tumours anyway.

PPS: Brains probably don't cure cancer. But then neither will any of the other nonsense that What The Doctors Don't Tell You are peddling. 

Is XLS-Medical Fat Binder worth its weight?

Oh Omega Pharma. Once again you provide me with some juicy blog fodder.

XLS-Medical Fat Binder has been on my radar for some time, but I haven't really gotten round to writing a blog post on it or taking a proper look at the evidence. However, prompted by a bit of real-life work I've just been doing, I've been doing some digging.

So what is it? Well, it contains something called litramine, which appears to be a cactus extract. It supposedly binds onto dietary fat and stops it being absorbed. Sounds suspiciously similar in action to orlistat, a licensed medicine. However, XLS- Medical Fat Binder is instead marketed as a medical device.

Here's what the company have to say on the matter:
  
"What is a medical device and how does it differ from traditional medicine? 

• A medical device is designed to work on or inside the body - either temporarily or permanently. Its main aim is to prevent, diagnose, monitor or treat diseases. 

• The key difference compared to traditional medicines is that medical devices work mechanically as opposed to pharmacologically. So it works alongside or with your body rather than affecting the chemistry of the human cells."

I think what they've missed out here is this: "If we sell this product as a medical device we just need to fill in a form and send it to the MHRA rather than actually having to bother proving that it works so YAY LETS JUST DO THAT!!." It would seem pretty bizarre that orlistat, which is also not absorbed from the GI tract and which also prevents absorption of fat from the diet is regulated as a medicine whereas this product isn't.

What of the evidence? Well, Omega Pharma once again provide us with a list of the most vague references ever seen, making it virtually impossible to find anything to back up the results they are shouting about. As references go, just writing: "In vivo, 2-armed, randomised, placebo-controlled, double-blind study, conducted in Germany, 2009" is, as someone so succinctly put it on Twitter, the equivalent of saying "This one time, at Band Camp...". These studies don't appear to be published in any peer-reviewed medical journals, so there is no way to verify the results from them. Oh dear.

Well, two can play that game.

Of course, not one to rely on the manufacturers alone, I performed a literature review to see if there was anything else out there. And there is: all of one study. And to be honest, the results are promising. Whilst there is a link to this bit of evidence on the XLS Medical website, its hidden away in the tiniest of tiny footnotes, which seems a bit odd really, given it seems to show that Litramine actually works. The trial appears well desgined (double-blind, randomized, placebo-controlled), and whilst not massive (n=123), it isn't as tiny as the usual sort of guff that can be purported as evidence. Patients who used Litramine lost an average of 3.8kg (+/- 1.8) compared to 1.4kg (+/- 2.6) in the placebo group (p<0.001), which actually seems rather encouraging.

Hang on though, let's not all jump for joy and throw away the salad leaves just yet. Patients in the trial had a hypocaloric diet plan and exercise regimes. The trial only lasted for 12 weeks, so is pretty short- term. and of course its still quite small, and the results would need to be replicated in further, larger, well-designed trials before we could know for sure.

And here's the big problem with it. the study medication is described as:

"Litramine IQP G-002AS is a natural fiber complex derived from Opuntia ficus-indica, enriched with additional soluble fiber from Acacia spp.IQPG-002AS is standardized for its lipophilic activity and has been shown to reduce the dietary fat absorption through GI fat binding." 

- Grube B, Chong P, Lau K, and Orzechoski H. A Natural fiber complex reduces body weight in the overwieght and obese: A double blind, randomised placebo controlled study. Obesity 2013. 21: 58-64

 

The study participants were given 500mg tablets three times a day. However I can't see anywhere on the XLS-Medical website that actually tells me how much litramine is in the tablets- it could be 5mg or 500mg. . So whether or not we can apply these promising results to XLS-Medical, we simply can't say.  

 

And wahoosa are these things are expensive. £39.99 for a months supply? That's six and a half hour's work at minimum wage.

Hxxx

Facebook, breasts, and why the combination of both annoys me.

"I like it on the living room floor!"

"I like it on the kitchen counter!"


Blah blah blah. These are the sorts of bawdy Facebook statuses that surface every year. They're then followed up with a message along the lines of "hey, let's not tell the MEN what we're doing, but according to this arbitrary nonsense below, put something attention seeking as your status update to help raise awareness of breast cancer".

There's always the inevitable guilt trip of "most of you wont bother with this, and you're all terrible, terrible, evil people who don't care about people with cancer and you will all go to hell"

These sorts of statuses/ messages have always bothererd me. The whole Carry On Breast Cancer vibe is just uncomfortable, for starters. They are infused with the same sort of superstitious, guilt-ridden nonsense as the old chain letters you used to get back in the late 80s. And people seem to go to great lengths to defend them, and any even remotely negative comments about them are batted straight back with an unthinking "why wouldn't you want to raise awareness of breast cancer? are you some sort of EVIL PERSON?!"  I have raised the point on my own Facebook and have also seen some friends take flack for daring to question these games.

There is a great piece of writing about exactly this subject that you can find about this subject here. You'll also find a piece from Skepchick here. However, there are a couple of other points that I want to raise in addition and to compliment the points raised in that piece, and some of the arguments used to defend the game that I have seen used on Facebook. These points are in no particular

How much awareness are these "games" raising? 
Given that the messages contain no information on the symptoms or how to check for breast cancer, or any links to good quality information sources, I'm not convinced that it is raising awareness. There have already been huge campaigns to raise awareness of breast cancer- people in the main already know that the disease exists. Therefore this campaign needs to add something specific to that: how best to check for signs of breast cancer, practical tips, or signposting to other good quality sources of information. Furthermore, actively excluding an entire gender or other large group of people from your awareness campaign seems like a very odd tactic indeed. The messages include how the "bra game" made it to the press- this appears to be the case, although not in the way the message would like to imply. But have any of the other campaigns that surface regularly made it to the press? I certainly haven't seen so.

Who has started these campaigns, and what charity etc are they raising money for? its not clear, and it would seem that no one knows who or why they originated. So what sort of awareness are they really raising?

Cold, hard cash
These games aren't asking for money to be donated to any particular charity. Yet, when it comes to cancer research, it is cold hard cash that makes the difference. There is a risk that people may feel that by taking part in the game, they have done their bit already in helping to raise awareness, which might discourage any further action. In actual fact, if you want to help, donate some money to a cancer research charity.Is there any evidence that this sort of bid to raise awareness translate into money being donated? No, of course there isn't, so we should all be focusing our efforts elsewhere.

Dignity
Really people, are we that unimaginative that we require this arbitrary nonsense to put something titilling as a status? Do we so desperately want to feel a part of something that we will lower ourselves to this sort of bawdy crap? Can we really not think up any better innuendos to grab male attention as we appear to be so desperately doing here? These sorts of statuses sit on the same level of annoyance as the ones that are simply an unhappy face so that many people will reply with "what's up hun?" and the original poster will get lots of attention. If you want to be tacky and attention seeking, go right ahead, but do so with a bit of imagination and personality, not according to some formulaic crap involving handbags.

Exclusion

In 2010, breast cancer rates in men were approximately 1 per 100,000. Just imagine how emasculating, shocking, and devastating this diagnosis may be. The fact that bright pink is constantly associated with this disease can't help matters. That awareness campaigns like this one actively exclude men is frankly unforgivable. Campaigns that raise awareness of testicular or prostate cancer are often very inclusive of women (I'm thinking of the Movember campaign in particular, problematic as it may be for other reasons), despite the fact that for obvious reasons the likelihood of women getting these types of cancers is zero.

In addition, as a good friend of mine pointed out, it may be men who notice or feel changes in their partner's breasts before they do. Why would they therefore be excluded from any awareness campaign? It just doesnt make sense.

Humour
"Oh but its just a bit of a laugh isn't it?". I've seen this used as a defence for these games. No actually, no its not a bit of a laugh- its breast cancer, for crying out loud. Humour is undoubtedly a powerful tool in coping with such a diagnosis, but this is going to be different for everyone and needs to be treated as such. some people might find this funny whilst others might find it plain offensive. No Facebook chain message is going to be able to deal with the complexities of when and how to use humour in the face of a potentially devastating diagnosis.

So there is some thoughts to be going on with. I may or may not add to them as time goes on. In the meantime, if you'd like to do your bit, you could always donate a few pennies here. Meanwhile, for information on how to check your breasts, try this Breakthrough Breast Cancer page.

Hxxx

So this one's for the friends

"So this one's for the friends

If not so for themselves

And this new life's directing us

Remind us in a town

You made us feel at home

We broke our backs on floors of stone

But I'd rather wake there any day

Than wake up here alone"

-The Chronicles of a Bohemian Teenager, Get Cape. Wear Cape. Fly

Today is World Mental Health Day. although this year the focus is on older people, I am in a nazel-gazing, emotional kind of a mood, and have found myself thinking a lot about my friends.

There are two aspects to this. Firstly, I know a lot of people with varying degrees of mental health problems. In fact, I would say that I probably know more people with some sort of mental health problem than those who don't. I find myself thinking of how much I wish I could change how they feel, draw out some of their pain or anxiety or depression for them and lighten their lives a little bit. I think of how wonderful and individual they are, and how amazingly brave and strong they are. The reasons for their problems are as diverse as they are- if there are reasons. I think of how badly they are treated by others, of the stereotypes that are applied to them, and want to shout from the rooftops about how wonderful all of these people are.

The other aspect is how my friends treat me. Its not big, sentimental gestures, nor is it anything to do with the length of time I have known someone. Its the bunch of flowers and bottle of wine that arrived in the post a few days after my marriage broke down. Its lending me an oil-filled radiator when the heating in my flat has broken and fixing my DVD player. Its letting me sit on the sofa in their house in silence because I don't feel like speaking but I don't want to be on my own. Its the rushing round to my flat to remove a spider because I'm too scared to do it myself. Its the constant sarcasm and good-natured banter at work. Its the tweeps who always cheer me up and check how I am when I am in a self-pitying mood, and the patient soothing of my drunken self via WhatsApp at 3am. Its the afternoons of laughter and the knowledge that, if I need to cry hysterically I could, and no one would think any worse of me. Its the quiet, unthinking hug when I am struggling to smile during someone's wedding, or the amazing poem written for my birthday.

These are the sort of things that I have built into my little emotional fortress. There are people out there who can't understand where I derive meaning from in life- I have no god, no children and no husband after all. But all of these little gestures, and all of these wonderful people form the basis of my meaning. Without them, I really don't know where I would be, but I'm pretty sure it would be an awfully dark place. This, for me, is the foundation of my humanism.

I don't tell my friends this kind of thing enough, but I'm so thankful and lucky to have them.

Hxxx

CBT session one

So last Friday I began a course of Cognitive Behavioural Therapy sessions, to help me deal with the social anxiety that I talked about in a previous blog post.

I don't really expect to learn anything new from the course, to be honest. I'm pretty good at accepting, rationalising and challenging myself to face my fears, but what I'm finding more and more lately is that I reach breaking point more easily. I've always been able to keep the anxiety in check and have always just thought that I am shy, but various things- the bout of psoriasis I had, being single again, stuff happening with my friends etc has meant that I've been much less able to control it of late. So much of my brain is taken up by being anxious that there is little left over for anything else. My organization skills, which were poor at best anyway, are completely shot, and even the most basic problems at work leave me feeling totally overwhelmed.

My friends are my world, and its hard for me to describe how much I love them and how much I love spending time with them. Since my divorce, when they rallied round and were totally amazing, I have made sure that they are the centre of everything I do. But this thing is getting in the way of that, and its making me miserable as a consequence.

The best way I can think to describe it is like an energy bar in a computer game, but instead of life force, mine is a social bar. It gradually decreases, then eventually I run out and require recharging. In more stressful situations (like going to parties or meetings where I know no-one, or-horror of all horrors- dating, for example) it runs out a lot quicker than if I am spending time with by best friends. The recharging usually involves lying on my sofa watching old episodes of Dexter and not talking to anyone, although lately I've noticed a much more scary emptiness creeping in, and I can find myself lying on my bed staring at the ceiling with no thoughts or feelings or emotions at all. These hours are terrifying and are something that has never really happened to me before. 

So, having seen my GP, I got referred onto this group CBT course. The irony of being on a group course for social anxiety has not escaped me, and of course I found myself worrying about all aspects of the course. How will I get the time off work? Will I find the place? (this sort of anxiety stems from a fear of looking stupid if I don't know where I'm going) Will I have to make awkward small talk with the other people on the course? Will they think that my reasons for going are stupid? What if I have to speak about my emotions to them? etc etc etc. One of my biggest worries is whether I was bad enough to justify being on the course. The fact that I have spent several days if not weeks worrying about whether I am anxious enough to justify it has also tickled my sense of irony.

Anyway, I managed to find the place, and staggered in red-faced, dry mouthed, sweaty and with my heart beating (irregularly) out of my chest. The other folk in the waiting room looked serene and at home. The course started late due to technical problems, which rather than giving me time to calm down made me even worse.

Once I was in there, I felt somewhat better. The initial session is all about the causes and symptoms of anxiety and how it can manifest in different people, so we didn't really cover any CBT techniques. I was very pleased to hear the trainers talking about the evidence base for CBT, and they explained the pros and cons and process of what we would be doing over the next few weeks. I was starting to feel quite settled. It was nothing I didn't know already, of course, but its always good to know that there are other people suffering from the same thing as you.

Then came the two slides on medication. The slides just covered some really general points which I agreed with, but one of the women there talked about how she didn't want to try any medication as she was so worried about side effects. The trainers said they knew very little about specific medicines, and she should speak to her GP or pharmacist. Well, I tried to keep my mouth shut, I really did, but I couldn't help myself. I thought about just trying to make out like I was someone who knew a bit about medicines, but I could tell that this woman was really worried. She was wanting to try an antidepressant, and thought it could benefit her in the short term, but she was really concerned that they could amplify her anxiety permanently. I wanted to help and reassure her, and before I knew it, I could hear myself saying "I'm a pharmacist..." I explained a bit about how the drugs work, what sort of side effects could happen, and what the sort of terms used to describe how common a side effect is actually mean. She, the other attendees, and the trainers all listened attentively and said how great it was to have it all explained in context rather than to just look at a really long list of scary words on a patient information leaflet.

I left feeling happy that I had shared some of my expertise, but sort of worried about the rest of the course. I fully expect next week to walk in and be asked various different questions about the medicines people are taking. You get used to this happening when you tell people that you're a pharmacist. The problem comes from the fact that now I feel like I need to be "on", and in professional mode, when what I actually sort of want is a place that I can switch off my forcefield and fall apart, so I can put myself back together in a more rational, calmer way.

Hxxx

Common Community Pharmacy Annoyances

It's funny how variable working in a community pharmacy can be. Nowadays, I locum here and there, and I tend to really enjoy it. I usually do evening shifts, so you have an hour or two of bedlam, followed by several hours of blissful calm and quiet, where you get to sort out all the outstanding things, do lots of other bits and pieces like checking owings, controlled drug stock levels, and cleaning. I usually also end up having bizarrely deep and meaningful conversations about life, love and philosophy with whoever I am working with. Usually when I leave a pharmacy it is as clean and tidy as possible, I've sorted out what I can, and have left notes for anything that I haven't been able to deal with fully.

I say all this because I lately did one of *those* locum shifts. The ones where it is constantly busy, no prescription is straightforward, the fax machine isn't working, and you seem to have to deal with every problem under the sun. On this particular locum shift, I think my colleagues and I encountered every single type of category of impolite customer possible in a 4 hour shift.

So, because the only way that we can cope with such things is to laugh about them, and because I fancy a self-indulgent rant, here is my compilation of the things in pharmacy that annoy me and that happened in that locum shift.

The Mythical Taxi
Some people do get a taxi to their local supermarket. I have done it myself. But it would appear that taxi companies must have an amazingly lucrative trade in ferrying people to and from pharmacies if the frequency of use of the phrase "Can you do it quickly please, I've got a taxi waiting" is anything to go by. These are not, as far as I am aware, magic words that will somehow warp the time-space continuum so that I am able to dispense and check a twenty item prescription in a mere matter of seconds. Whether or not you actually have a taxi waiting will simply mean that your prescription gets put in the queue in the same place it would have done anyway, and you will wait the same amount of time as you would have done anyway. Needless to say, I suspect that many of these taxis don't actually exist, but merely a tactic used by some people to attempt to "hurry their prescriptions along".

The Dry Chesty Cough
"What sort of a cough is it?" "Well, its a dry, chesty cough."
No, no it isn't. It's either dry or its chesty, its not both. And either way, there is little point buying anything for it given that there is no evidence that any cough medicines work.

The Evil Eyes
Glaring at me continuously for the entire time that I am dispensing your prescription will not in any way speed up my work, and in fact may have the opposite effect as I am more likely to lumber around in a sloth-like manner just to annoy.

"I Need To Be Somewhere"
At 6:05pm, a woman handed in her prescription of 4 items. At 6:07pm, having spent all of two minutes repeatedly sighing and tapping her feet, she asked to speak to the pharmacist. Off I went, leaving a prescription half-dispensed. She demanded to know how long her prescription was going to be (the one I left to go and speak to her), because she needed to be somewhere. I gave her an estimation, told her I was doing it now, then went off to complete it. She then asked to speak to me a further three times to find out how long it was going to be, each time meaning it would take a little longer. "But I need to be somewhere at 6:15!!" she told me each time. I handed her the prescription at 6:12pm, thanking her for her patience. She then proceeded to rant for several minutes about how long the prescription had taken and how it meant she was going to be late and she had to be somewhere at 6:15. She eventually stopped complaining at exactly 6.15, and I returned to the dispensary, whereupon I noticed out of the corner of my eye that she had taken the time to hang around to complain about how long it had taken her to get her prescription to some of her friends who she just happened to bump into in the shop. Goodness only knows what time she actually left.

Invading Privacy
If you have ever picked up a prescription from a pharmacy, you will have probably been asked to confirm your address. This is so that we can make sure that you actually get the correct prescription. This is not because we are evil assassins or because we want to sit in a bush outside your house and spy on you- we really don't- and you're address is written on the prescription so if we wanted to we could anyway. On this locum shift, however, we were accused of invading someone's privacy for asking for this information. "I don't need to give you that information!" he declared. The counter assistant advised him that this is a routine question to ensure that we give out the correct prescription. But this wasn't good enough, and he wanted to speak to someone in charge. Off I went into the breach. I told him that he could come into the consultation room to give us his address so no one could overhear, but this was "an inconvenience", apparently.

By this time, he was shouting and other people in the queue were staring at him.

Again, I advised that we routinely confirm the address to ensure that the correct prescription is given out.

He decided to prove that the prescription was his instead by giving out his name, date of birth, and by telling me every item that was on the script. Loudly. One of which was sildenafil (Viagra).

Magicking Up Medicine
Me: "I'm sorry, we don't have that item in stock. There is a manufacturing problem on it, so we can't get it from our suppliers"
Patient: "But I need it"
Me (in head): "Oh I see. Well if you can hold on a few minutes, I'll just nip round the back into our large pharmaceutical manufacturing factory, dig out the raw materials, and whip you up a batch right now then"
Me (in real-life): "I understand, but I'm really sorry, we can't get any in at the moment."
Patient: "But I need it."
Me: "Where is the nearest wall please, so that I can bash my head against it repeatedly?"

The Expert Customer
I'm advising a patient about how to manage their child's teething problems. Another customer waiting in the queue decides to chip in with "Those Nelsons Teetha sachets are really good." (Nelsons Teetha sachets are homeopathic, therefore contain nothing of use and have no pharmacological effect). From then on, I (and my many years of training and experience) might as well not exist, as nothing I say can steer the patient away from believing that Nelsons Teetha are simply THE best thing since sliced bread, and in her eyes I'm obviously a terrible pharmacist for not recommending them immediately.

Impatient Patient Questioning
You ask the patient all the usual questions. They're all answered with a loud sigh, vacant eyes, and a disinterested "yes" or "no" at all the bits that they think are right. I could be asking anything, and I'd get the same response. So sometimes, I like to mix it up a bit and throw in a question they're not expecting. If its something like Nytol or a codeine containing medicine, I'll ask "Do you take it regularly?" to which the response is usually a bored yes. In which case, I advise them that I can't sell them any, then swiftly duck for cover when they inevitably throw things at me.

A variant You ask the patient if they are taking any other medications, to which they sigh and say "no". It's only when they're about to hand over their money that they a) ask what would happen if they were taking medicines, then confess, or b) whip out an inhaler and proceed to take a couple of puffs right in front of you after they have just told you that they don't have asthma or COPD.

Specifics
The patient can inexplicably only take one or two brands of generics for a product. You are, of course, expected to telepathically know this and dispense the right one, and woe betide anyone who doesn't. Now, I am entirely understanding of cases where a patient has specific requirements for one type of product- maybe an allergy to an excipient, say. But when there is not reason for it, and the patient is shouting at you for not giving them "the right medicine" despite them at no point telling you what "the right" one is, then I tend to feel a bit put out.

Mobile Misery
Now I am known for being attached to my mobile phone. However, one of the most annoying things when working in retail is having to deal with customers who refuse to hang up theirs whilst you are trying to have a conversation with them. Over a pharmacy counter, we often need to give detailed counselling, and of course we need to ask a lot of questions. I can't really do that if you are also listening to so-and-so discussing who was drunkest down the pub the other night. At this particular locum shift, I had to attempt to explain that there was an item owing on a prescription to a chap who was having just such a conversation. The icing on the cake was when he said to his phone-based friend "Hang on, I can't hear you, this stupid woman keeps talking about something and wont give me my prescription". Needless to say, despite me explaining the owing and handing him an owing slip, he returned a few minutes later demanding to know where the missing item was. This "stupid woman" then had to patiently and politely re-explain everything I had already told him.

How do I deal with situations like this? Politely, professionally, and with a smile on my face. I might have a bit of a rant and a laugh about it later in the back of the pharmacy, but outwardly in these situations I remain as calm as possible and attempt to be as helpful as I can. I've had many years of practice. The worst thing about this shift was that I was working with a new counter assistant and a newly qualified pharmacist, and I could see their morale slipping minute by minute. Their shoulders slumped, their smiles became more forced, and I found myself desperately trying to reassure them that this is just how some days go. Of course, we pharmacy types do make mistakes on occasion, and inconveniences do happen. I can understand that, when it comes to health, people can be scared and anxious, and that can come across as aggression. It is my firm belief, however, that a little bit of kindness and manners get you everywhere, and I am always much more likely to respond positively to calm and polite customers than those who default to outright rudeness, although I will do what I can to ensure that I help them all.

Hxxx

Is Gareth Bale worth more than eradicating malaria?

Many moons ago, in what now feels like a different life, I went on a trip to London. The date was October 12th, 2009, and I was armed with a long pole, a dispensing basket I had nicked from work, and a mosquito net.

I had an hour. An hour, to do whatever I wanted, in Central London. Its not particularly unusual to have an hour to kill in the capital, but it just so happened that I would be spending this hour atop the Fourth Plinth in a moonlit Trafalgar Square. I had been lucky enough to have been selected to take part in Anthony Gormley's One & Other artwork. I decided, after much deliberation, to represent the Malaria No More charity. I gave out packs of sweets and leaflets about the cause, wore a dress made of a mosquito net, and even did a little bit of crafting, sewing the words Malaria No More onto a large blue mosquito net. Mostly, I felt utterly terrified, and had horrendous stage fright, more so than I had ever imagined I would have.

Malaria No More, amongst other things, aim to distribute insecticide-treated bed nets (ITNs), eventually with a view to eradicate malaria entirely. According to them:

"£10 can transport 150 life-saving nets to a community in rural Ghana; enough to protect 300 people."

 Blimey, that sounds far too good to be true, doesn't it? But luckily, there is good, robust, independent evidence that impregnated mosquito nets really do prevent deaths from malaria:

"About 5.5 lives (95% CI 3.39 to 7.67) can be saved each year for every 1000 children protected with ITNs...ITNs are highly effective in reducing childhood mortality and morbidity from malaria. Widespread access to ITNs is currently being advocated by Roll Back Malaria, but universal deployment will require major financial, technical, and operational inputs.." -Cochrane Database Syst Rev. 2000;(2):CD000363.

So the idea is that two people can sleep under one net, but because of the insecticide, there is an area outside the nets which is also protected. If there are enough nets in a household, or even a village, then the whole area could be protected, even when people are out and about and not just when they are sleeping under the net. The available evidence seems to back this up-the little extract I have copied above only refers to deaths, but the results are even better when it comes to reducing the incidence of malaria illness- a reduction of 62% in areas of unstable malaria, for example.

This got me thinking a bit. With the news today that Gareth Bale, a man that I have never heard of, who runs about on a bit of grass after an inflatable round thing is apparently worth a record £85.3 million, I can't help but do some little calculations. Obviously these are all estimates, but it makes for an interesting thought experiment.

• £10= 150 mosquito nets

• £85,300,000/10=8,530,000 mosquito nets

• As each of those 8,530,000 nets can protect two people= 17,060,000 people could be protected.

• 5.5 lives can be saved for every 1000 children protected with ITNs. If we assume all the people protected are children:
• 17,060,000/1000= 17,060
• 17.060*5.5=93,830 children could be saved.

The WHO estimates that there were 660 000 malaria deaths in 2010. So that amount of mosquito nets, could, in actual fact, prevent a large chunk of those deaths (we dont know how many adult deaths it could prevent, either) meaning that over a few years, malaria could potentially be eradicated.

Now, I'm sure this Bale chap is very good and all, but I do wonder whether, in the context of all the World's problems, this sort of amount is appropriate. Personally, I would rather opt for reducing the massive morbidity and mortality caused by a disease that is potentially eradicable given the right resources, but then what do I know?

Before anyone complains, yes I know this is terribly simplistic, and its not as easy as that, and all of that sort of hoohah. I just want to make a bit of a point about how vast sums of money need a context, and in my humble opinion, I don't think it is particularly appropriate or such sums to exchange hands when there are still people dying of hunger or preventable diseases.  I'm sure some men doing footballing makes some people happy and all, but come on. I'm not even convinced that Christian Bale is worth that much, despite that scene of him running around naked, bloodstained, and with chainsaw in hand in American Pyscho.

Hxxx

The difference of a diagnosis.

I have Social Anxiety Disorder. Its all official and everything, having just come back from the doctors' surgery, where all of my rehearsed, clear and concise explanations of how I have been feeling lately descended into some soggy, disordered sentences and lots of apologies. 

What, precisely does this mean? It means I feel weird, and I don't quite know what to do with myself. It's interesting, the effect of having a label. I imagine this particular effect is broadly similar for many diagnoses, to lesser and greater degrees. It's a waveform: you just start relaxing into it, and feeling relived by it, then you think 'oh shit, there's something wrong with me!', then it all starts again.

There is a satisfying feeling of loose ends being tied up. It's the explanatory scene at the end of every episode of Poirot, the metaphorical jigsaw pieces being placed. You think of all the things that you've been feeling over the years and you squidge all of your individual experiences into the shape of the words on the leaflet you've been given.

But its weirdly hard to relinquish the long-held belief that actually you're just quite shit at life, that its your own fault and you're just not trying hard enough, to something external like an Actual Real Life Diagnosis. Bits of what I thought were my personality are instantly explained and I can't quite accept that its not just me being defective.

There is also a fear that now I have an excuse, a reason to stop berating myself, I will luxuriate in it. Will I kick back and stop pushing myself as much as I have been, and retreat? Will it take even more effort now to venture out and smile, with a diagnosis weighing me down?

People who know me may be inclined to think that this is bollocks, that I'm just going through a rough patch and will be fine in a bit. I keep telling myself that too, to be honest. I'll shake it off and it'll be fine. but this is an underlying thing that has always been there. Most of the time it lurks, but sometimes it pushes itself into the front row, knocks out the bouncers, and jumps on the stage and dances naked. In other words, its pretty damn distracting, and it takes up a fair amount of my working brain. 

There are a few cruel dichotomies that I am the victim of in life. I love nothing more than lying for hours in the sunshine, yet I have the palest, most prone to burning skin, for example. And this is one too. I love being around people. I love my friends more than anything, and I rely on them for my very existence. But this thing, this bloody diagnosis, means I can end up spending the precious time I have with them fighting with my instincts to run away from them, even though I desperately want to be with them.

You could be the one person who I want to spend the most amount of time with in the world. You could be the person that I am most interested in getting to know, or the person who I most want to impress. I might be really interested in your opinions, and desperately want to know about your life. But what will most likely happen is that I will sit in awkward silence and you will think "she hates me", or "she's not remotely sociable" or "bloody hell, she's really boring". If only you could hear the things running through my head at these times though. In my brain, I am running through all of my most sparkling, wittiest, intelligent observations and quietly discarding every one of them as being too unworthy of your consideration. Yeah, I know I should let you judge that, and I think about it constantly afterwards and how stupid I have been for not saying anything, but in the moment, none of those rational thoughts help. Conversely, you could be someone who I know I will never meet again. You could be a random person on the street who asks me directions, or a train conductor, or a waitress in a restaurant I will never visit again, and I will still have the same reactions.

I can often mask it, but my body lets me down. I can be sat having a nice chat with someone I have been friends with for years, and I am internally in full on fight-or-flight mode. My heart is pounding irregularly, my brain is rushing and I blush extravagantly. If this is how I am with people who I know love me, and who I have known for years, imagine how I am when I meet new people.

Some of you might be thinking 'why in the hell is she writing about this in public?' Some would say that this is the kind of thing that should be kept under wraps, behind closed doors, under the carpet and all that kind of thing. Well, I say bollocks to that. I have written before about how stubborn the stigma of mental health is, and I just don't subscribe to the idea that we still, in this day and age, need to be embarrassed about it. It's actually really hard and scary to write about it all in public, but it makes me feel better and I don't want to hide it away. I have enough faith in you, Dear Reader, that you wont think any less of me for it or judge me too much. 

Hxxx

Postscript: Homeopathic Harms 3.1: C's Story

Imagine you're twelve years old.

You're on the cusp of adolescence, a time where you start to move away from the comfort and protection of your family and begin to forge your own way in life. Friendships become increasingly important, and you're in a constant process of trying to make new ones, maintaining old ones, and falling out with others. The world seems confusing, terrifying, and wonderful in varying measures, and you spend a lot of your time watching those around you and drinking in how they act, what works and what doesn't, deciding how to act yourself to fit in and be accepted. This is the time when, though the ground is constantly shifting beneath your feet. you start to put down little social foundations and try to make sense of the world.


There is a wealth of evidence that suggests many benefits of connecting with people of your own age during adolescence. At such a crucial, tumultuous time of life, being socially isolated from your peers can have long lasting and harmful effects.


What's this got to do with homeopathy?

I've written before about how poor advice from homeopaths can potentially cause a lot of damage, and through our Homeopathic Harms series of blog posts, Nancy (of the Evidence Based Skepticism blog) and I have hopefully managed to convey to you an idea of how it can sometimes be the seemingly innocuous and difficult to quantify harms that can be most worrying.

I received an e-mail the other day that I have since been thinking a lot about and which I wanted to share with you. Its a real-life example of just how much harm poor advice from a homeopath can cause. The chap who sent me the email has very kindly allowed me to share his story with you, but of course I am going to respect his anonymity and refer to him as C.

C's story

C. had delayed puberty. Now this is something that is fairly common, happening in about 3% of cases, and which can be caused by a number of factors, but the most common type is Constitutional delay in growth and puberty (CDGP). This is basically a technical way of saying 'Just one of those things, which might be caused a whole load of stuff or possibly just chance.'

Conventional medicine would manage CDGP by... well, usually just by waiting, really. Monitoring, and reassurance are often all that is required. Otherwise, short courses of sex hormones should be enough to do the trick. If the delay in puberty is caused by something, then ideally the underlying cause would be appropriately treated. You can see some good, reliable guidance on management here.

Note, by the way, that the definition of delayed puberty according to patient.co.uk specifies '...in boys beyond 14 years old'.  Now, I have no way of saying what the definition of delayed puberty was at the time that we join C's story, but his experiences began when he was 12- well below the point where we would diagnose delayed puberty nowadays.

C's mother consulted a homeopath. He was given some homeopathic pills, which on account of just being made out of sugar, had no beneficial effects, but also no harmful effects. However, the homeopath also appears to have given C's mum some advice, the goal of which seems to have been isolating him from his peers between the ages

C was:

• not allowed to stay at school for lunchtime, but instead had to go home.
• not allowed to stay at school after the school day had finished.
• not allowed to cross the local footbridge over the motorway, which cut him off from the majority of his peers.
• not allowed to go down the street of the one classmate who lived on his side of the motorway.
• allowed and encouraged to socialise with one boy who was two years his junior.

The first question is why. Why on earth would a homeopath give such advice? We can only speculate that the homeopath in question thought- apropos of nothing- that since C was a late developer he should be kept away from people his own age and instead only socialise with younger children. I've had a look around some homeopathic websites on the internet, and found nothing that looks similar to this sort of advice. [I did, however, find this website, which amused me no end due to its impressive reference list. No, really, go and look at the link and scroll to the bottom, if you want a good laugh]. In fact, I couldn't find anything at all suggesting that enforced social isolation is good for anyone or for treating anything, really.

C's case would appear to be one of a homeopath acting outside of their competence and providing bizarre and very harmful advice. In C's case, homeopathic treatment was certainly not safe, although this had nothing to do with the sugar pills themselves.

The result of this set of rules on C were, in his own words:

"a boy who was immature, shy and lacking in self-confidence. When it came to puberty I had significant mental health problems (starting with OCD due to high levels of anxiety) which have had an impact throughout my life....I didn't regain a sense of normality (in terms of socialising properly) until the age of 25-26."

Limitations

C's story is, of course, merely one anecdote, and as good skeptics we of course have to realise the limitations of it. There's nothing to say that, if C hadn't have followed these rules, he wouldn't have gone on to develop any mental health problems, and indeed delayed puberty itself is not without an increased risk of psychological problems.

Given our very human need to fit in, it may be the case that children with delayed puberty have a preference for younger friends, as they stand out less. This is entirely understandable, but in C's case it is clear that his situation was enforced upon him.

 But given the established link between social isolation in adolescence with mental health issues, I think we can pretty safely say that this is a case where at the very least homeopathy worsened his situation. His quality of life was undoubtedly affected when he had to obey the rules.

Thankyou to C

Many, many thanks to C for sharing his story with me. I think its so important to hear these stories, as they might help to raise awareness of the less obvious, nebulous harms that can arise from treatment by unregulated, alternative practitioners. Unfortunately, its really difficult to quantify these sorts of harms into cold hard evidence, and that's why I, and many others like me, keep banging on as loudly as we can about them. If you have any examples of potential harm caused by homeopathy, it goes without saying that I would love to hear from you.


H xxx

I ain't afraid of no ghosts... oh hang on...

"Girls, come over here. You'll be safe from the evil spirit on this side of the vault. A lady came in today and blessed it- you can see how she left healing flowers as part of the ritual."

This sentence would appear at first glance to be the sort of thing that would send me into an apoplectic rage. There is so much woo encapsulated in that one little sentence: ghosts (which don't exist), sexism (the men were left on the un-blessed side), god (who doesn't exist) healing flowers (medicinal woo) and rituals (spiritual nonsense which makes no difference).

However, standing in the pitch black, musty cold of one of Edinburgh's vaults, clinging onto my friend Hesther and a complete stranger for dear life, I found myself repeating in my head 'its alright, I'm safe. A lady has been in and blessed it. Nothing bad is going to happen' over and over again in a desperate and unsuccessful bid to stave off hysteria.

This was just over a year ago. Every year, my friends and I take a trip over the border to take in the Edinburgh Fringe Festival. In amongst the sight-seeing, drinking, burning of the candle at both ends, and stand-up comedy binging, we always tend to do something ghostie-related. Edinburgh is a very charismatically historical and spooky city. The first year, we went to Mary King's Close, then last year was a vaults tour. Each time, I have shown myself up as a pathetic, borderline hysterical scaredy-cat.

In another vault during last year's tour, we were told how a coven of Wiccan witches had tried to use a particular vault as a meeting room (I suspect meeting room isn't the correct terminology, to be honest, but never mind.). They had moved some stones to form a protective circle in the middle of the vault, but found that terrible things happened when they were inside the circle, including the appearance of a terrifying, animalistic evil demon which trapped them in the vault, stalking the corridor murderously so they couldn't get out. The tour guide very dramatically informed us of how no one had set foot inside the circle in her presence, but how she would leave us alone for a while and we could do so if we wished, before swooping out theatrically. Now, you and I know that this was just a room, and a tourist putting a toe into a circle of inert stones is not going to make a non-existent demon turn up.

However, as one chap went to put his foot within the circle, an inhuman sound emanated from the corner of the vault. It could only be described as a guttural shriek, and went something like:

"DONTEVENFUCKINGDAREORIWILLKILLYOUWITHMYBAREHANDS"

Something like that, anyway. I can't quire remember the exact words I used. Here I was, an atheist who believes firmly in science, screeching violent threats at a complete stranger all because he had moved his foot vaguely in the direction of the stone circle. I was, to say the least, utterly terrified, and it was only after a good few vodkas in the bar afterwards that I started to calm down.

But this was before I started to get really interested and involved in skepticism. I've since found myself being a whole lot more rational about many aspects of my life, and applying skeptical principles, critical thinking, and rationality has become a lot more second nature to me. This year's tour, which took in some supposedly more active vaults, as well as a graveyard and mausoleum, home of Edinburgh's most active and evil poltergeist, would be a breeze. After all, I would be able to calmly rationalise all aspects of it and see it for what it really is: pure entertainment. Skeptical pharmacist extraordinaire that I am, I would be serenely smirking at all of my friends and the rest of the tour group as they clung onto one another and shrieked.

Umm, well...

As it happened, I was marginally less hysterical than last time. I would love to say that this was due to my skepticism, but in actual fact is due to the fact that there was a bigger group of people, the tour guide was more comedic than dramatic, and that I had imbibed some gin beforehand.  But I do mean marginally. I was still clinging onto whoever was near me for comfort, (whimpering "don't leave me, please don't leave me"). I used up the last vestiges of my phone's battery for light because I was so terrified of the darkness. In the graveyard, I was telling myself that ghosts were less powerful in the open air, rather than that ghosts do not exist. In the mausoleum, I consoled myself with the fact that the Mackenzie poltergeist would probably like me because I'm an atheist and not a catholic, rather than that it is merely a tall tale made up to appease tourists and that there was a perfectly rational explanation for everything. Barely a rational thought crossed my mind for the whole sodding one and a half hours of the tour. 

It would seem then, based on this n=1 social experiment, that one is perfectly able to be paralyzingly frightened of something that you don't believe in, given the right circumstances. In the dark, having to listen to stories of ghostly hands grabbing at ankles, i can confirm that there is a minority part of my brain that not only takes over the rational, skeptical majority, but beats it into a pulpy submission then stamps on it repeatedly.

Hxxx

P.S. Spirits almost definitely did have something to do with the fact that I randomly fell over just before the tour even started.

Pills, Thrills and Methadone Spills 2: A Book Review

Community pharmacy can be a pretty lonely career at times. It can be a horrendously stressful and pressured environment to work in. It can also be hysterically funny, and those times often make the rest of it worthwhile. In a workplace that is ultimately centred around illness, the pinpricks of hilarity become all the more important.

Its good, then, that someone decided to make a book of all those funny moments that happen in the average pharmacy day. Its even better when they decide to do so twice. Enter the second instalment of Pills, Thrills and Methadone Spills by fellow anonymous pharmacist Mr Dispenser.

Those of us pharmacy types who use (for which read obsessively depend on) Twitter or who read any pharmacy magazines will no doubt be aware of Mr Dispenser, who is a regular day-brightener with his wit and humour. 

Partly constructed of tweets, part blog-anthology, this is a warm and good natured collection of anecdotes. All but the most curmudgeonly of pharmacists will find themselves laughing out loud, and there will certainly be many moments of recognition in there too. You find yourself thinking 'oh I've got one of those stories too'.

Its a nicely inclusive format, which I think in its own little way helps to address the isolation of the job.  If you look closely enough, you'll even find a couple of pearls of wisdom from yours truly, which is nice. Its like sitting in a pub with a big group of other pharmacists and having a good old chortle about the daft things you encounter everyday. You're left feeling much cheerier about your lot, and with a nice sociable glow. to a non-pharmacy eye, some parts may be slightly close to the bone, but I think that from within the profession its clear that it is meant affectionately.

There is, however, a bit of a disappointing #everydaysexism moment later on in the book in 'Gender Bender'. Given that I write this whilst an unfinished blog post about how harmful portrayals of women can be sits in my blogger account, this is me courteously reminding Mr Dispenser that all women do not merely discuss hair and nails and read Hello magazine, nor do they all coo over babies whilst men leer at sports cars and read Top Gear magazine (Which, by the way, I used to have a wardrobe full of. despite having no driving license). So less of the stereotyping, please, and we will all get along fine at this year's Pharmacy Show

Now lets address the font. Very attentive readers of this blog will know that there is one font that I consider to be an abomination against mankind. Comic sans  is not big, its not clever, and its certainly not jaunty. It doesn't make me think "ooh, a light-hearted and humourous piece of writing!", but rather makes me stabby. There's is nothing wrong with good old arial, and the writing in this book is funny and clever enough on its own without having to resort to comic bloody sans.

Hxxx

DISCLAIMER: This book isn't actually due out yet for 8 weeks or so and may be subject to font changes and editing. If this occurs, I'm going to leave this post as it is, as a testament and reminder of how I can occasionally have some influence. Also possibly because I will be too lazy to amend it.   

You can also find this post- and a whole variety of mine and many other lovely people's book reviews over at Backlight, my collaborative book review blog for busy people. 

The Home Office can go back to where it came from, if you ask me.

Immigration is all over the news today. The last few days have seen a very, very uncomfortable atmosphere developing, which has been widely likened to that seen in Nazi Germany. In a bid to curry favour with UKIP voters (for which read either bigots, or just sadly ill-informed people), the Home Office have begun gleefully posting pictures of people of colour being shoved into the back of vans, along with bragging about how many illegal immigrants they have rounded up in that particular day. And then there is that bloody van driving around too.

Now, dear readers, I am going to sort of write something vaguely political. I'm going to do so in my own, incompetent, ranty way, so do forgive me if it ends up having very little to do with anything except for my thought. I've had very little sleep last night, and am grumpy as anything already. There might even be some mild swearing. There will almost definitely be terrible typos. Just stick with me, though, eh?

Can a white, British girl like me get angry about such things? well, in short yes, and there are many, many similar angry people out there. All it really takes is to have a heart, and some empathy for other humans, to realise that what is going on out there is very, very wrong. Okay, so people might be in the country illegally, and they should have done it by the books ideally. But its easy to see that these people are hardly lying on a bed of solid gold rose petals, being fanned by the poor, downtrodden white folk who have lost their proper job because an unspecified European could do it cheaper. They're probably working crappy jobs for little pay and long hours, and probably living in shitty places. They're dealing with constant shit from ignorant white people.  And they're here because its a better life than what they left behind.

If you were to switch the TV on at about 4 o'clock in the afternoon, you will probably find a programme on called A Place In The Sun, or similar. In such programmes, white, middle class, British couples tramp around a foreign country looking for a quaint little 6 bedroomed villa with an olympic sized swimming pool and a simply darling, quaint, local little village just down the road where there are all the amenities *they* need to suit *their* needs, and all for a charming price of £5000. "oh, well its a different way of life", they say. "The pace is so relaxed over here. We don't even mind if it takes 20 mins for Betty down at the Dog and Duck to bring us our steak and kidney puddings- there are plenty of other ex-pats for us to talk to in the meantime"

Why is this sort of immigration not such a problem? Why do we as a country not think that actually we are in no place to criticise, when we merrily trample the globe and plonk ourselves down wherever we like, safe in the knowledge that we can merely speak up to overcome the language gap?

Immigrants to the UK might use our free healthcare system. They probably use it because they're sick, and given that they are humans, and  I don't like to see anyone feeling under the weather, I'm pretty cool with that. What of our English acquaintances over in Spain? They'll be paying their way, right? They won't be discussing ways to get round recent changes to the country's healthcare systems on Expat forums, oh no of course they wont. You might also be interested in this article in today's The Lancet, which looks at just how much UK Health Tourism there actually is compared to what the papers say. The implications of UK citizens buggering off to Mexico for cheaper plastic surgery, then returning with a nasty infection that needs to be treated by the NHS don't seem to be shouted about in the Daily Mail quite as much as they probably should be. 

Well, but they are at least there legally. It's not like British people would be in a country illegally now, would they? And its not like there would be a massive outcry if the Australian government decided to start doing random checks on anyone wearing a bowler hat just in case they happen to be evil British illegals.

I was nearly an immigrant once. I was going to move to Canada. I studied for nearly two years and passed the PEBC Evaluating Exam (7 hours and a 72 page syllabus, including questions on High Performance Liquid Chromatography, if you please). I kept going back there for holidays and interviews and the like. I was welcomed warmly wherever I went, and was able to freely explore the cities without fear. I knew that, had I moved over there, I wouldn't have had to spend my life having to justify my place there, or defend the fact that I had a job which could have gone to a Canadian citizen. We British folk have that privilege and it is the very scraping-of-the-barrel-least that we can do to at least acknowledge it.

As for stopping people of colour on the street to see if they are an illegal immigrant... Its somewhat of a revelation to me that in this day and age anyone can look "a bit foreign". Believe it or not, Home Office, but there have been black people in this country for many, many years. Some of them were even born here. And then some of those have gone on to have children too. I know, right? What a revelation that British people aren't all pale. Some of us don't even wear socks and sandals with our cricket whites. People just look like people, and unless they happen to be walking around with their noses stuck into a copy of The Illegal Immigrant's Guide To Avoiding Detection By The UK Home Office, there's really no way to judge.

Are we really that insular an (Anglo-Saxon) nation that we can't see our own double standards? Are we really that unable to see people as people, and look past their colour, nationality, and creed? Yes, we are wired to want to stick with people who are similar to ourselves. But it really doesn't take that much effort to overcome that and look through minor differences and just take each person on an individual basis. I know I have generalised horribly in the words above, but I am doing so to demonstrate a point- that the double standards in this country are really quite horrific. And yes, there are many facets to the whole thing that I haven't considered here, blah blah blah. In the end, all I am trying to say is that I'm very saddened, ashamed and disheartened by this whole nonsense, and that I'm a firm believer that immigration is a beautiful, enriching thing that should benefit everyone. Its not scary, its not negative, and it means that we are a better, more versatile and robust country because of it.

If you're reading this and thinking 'hmm, well maybe, but there needs to be limits, and UKIP's immigration policies seem to make sense', then this is a plea for you to dig a little deeper into what those policies are, the evidence that they are based on, and who they benefit.

If you're reading this and thinking 'naive lefty silly girl', then get lost. If, however, you're reading it and thinking 'naive lefty silly YOUNG girl' then by all means go right ahead.

Hxxx