It’s not just politics - families do need fathers

The role of the father is one that has been more stereotyped than any other. We have two main characters: the bumbling, useless, out-of-his-depth father and the househusband, the super-dad who does it all — and there's very little in between.
But set against these clichés, new research has identified two fresh trends in fatherhood today: men who spend more time with their children than ever before and fathers who are completely absent.
Two hundred years ago, the father was the focal point of the family — the paterfamilias — and acted as moral mentor and teacher. But the Industrial Revolution took many men away from home to work, leaving mothers to raise the children single-handedly.
Now, as more mothers return to the workforce, the set-up is similar to that of a couple of centuries ago, with the domestic workload, including the raising of the children, more evenly distributed between both parents. When surveyed, 75 per cent of fathers said they would trade career advancement for more time with their children, and the number of dads present at their children's births has risen from 27 per cent in 1974 to nearly 90 per cent today.
Inevitably, fatherhood has now become a political issue too. The Tories have called for fathers to be more involved with their children and have attacked “deadbeat dads” who abandon their responsibilities, while Labour wants to counter criticism that it has been too focused on mothers' rights by putting fatherhood at the centre of its social policy.
Health minister Andy Burnham will announce tomorrow that prospective fathers will receive lessons on breastfeeding and supporting their partner through childbirth. Meanwhile, a families green paper will propose measures to get fathers more involved in their child's upbringing from before birth and beyond, including forcing single mothers to name the biological father on the birth certificate and encouraging hospitals to allow fathers to stay overnight after the birth of a child.
But it's not all just a desperate vote-winning strategy. Research has, to an extent, confirmed the importance of dads: children benefit greatly from having increased interaction with their fathers and show better cognitive abilities when their fathers are highly involved during their development. Fathers offer greater tactile stimulation and are more likely to physically interact when they play, whereas mothers are more verbal and toy-mediated in their interaction.
Studies have shown that the young rely more on their fathers for factual information and look to their mothers for day-to-day care and emotional support: children are twice as likely to receive As in school when their fathers are involved in their education. And the benefits start early; babies are twice as likely to be breastfed if their fathers have received instruction about the benefits before birth, and further studies reveal that fathers who are around at the birth are far less likely to flee.
So while these initiatives certainly won't guarantee Labour safely through the next election, they may well help improve family life for future generations.

I am exploding the myths about health and winter

How is it that I can travel to a tiny Austrian village in the Alps to ski each year with minimal hassle yet can't go five stops on the Bakerloo line in winter to get to my Harley Street clinic?It seems we Londoners are out of touch with our seasons and how to cope with them. But in a way you can't blame us because so much nonsense is written about health and winter. The best-known myth is that going out in cold weather increases your chances of catching a cold. There is no evidence that you can get a cold from exposure to cold or wet weather: viruses cause colds. There are more colds at this time of year simply because people are cooped up indoors in sustained contact with others who might be contagious. However, cold weather may make the lining of your nose drier and more vulnerable to viral infection.
Another popular myth is that we lose most of our body heat through our heads: again, untrue. Head heat loss is usually less than 20-30 per cent of total heat loss. As one scientist who researched this put it: “If we lost 45 per cent of body heat through our heads, going out without a hat would feel like going out with no trousers.”
The complementary medicine brigade is responsible for more rubbish: echinacea, a herbal supplement which people use to treat colds, has been shown not to help prevent colds in adults and is useless in the treatment of children aged two to 11. In a similar vein, many swear that vitamin C wards off colds. But large-scale, controlled studies have produced no conclusive data as to its effectiveness. It's big money for manufacturers, however.
What is true is that a 5C drop in temperature has been associated with a 12 per cent increase in admissions for heart attacks and that 53 per cent more heart attacks take place in the winter than summer. The cold can cause arteries to constrict, reducing blood flow and therefore oxygen supply to the heart, leading to a heart attack. Research has also shown that very cold weather may increase the risk of blood clots via its effect on platelets in the blood. So we do need to be better prepared for our winters and if you're starting a new fitness regime, take the cold weather into account.
Always start gently — it won't then be such a shock to your system. Your cardiovascular system can adapt to slow, progressive changes but it has more difficulty adapting to sudden ones. You'll feel less sick and dizzy at the end of your workout and may actually keep it up beyond January.
Look on this month as a warm-up, a time for getting into the habit of exercise and healthy eating, rather than expecting unrealistic results. And whatever you do, try to do it indoors and avoid sudden exertion outside — it's this that can precipitate heart attacks and strokes.

Help for those who aren't waving but drowning

January is traditionally grim. The come-down after Christmas and New Year's celebrations hits us, we still haven't begun our tax returns, and the threat of an unbroken year of work stretches before us. So it's not surprising that January is when doctors are overrun with patients seeking advice for anxiety and depression.
Depression, stress and anxiety are certainly increasing: as life becomes more complex and demanding, we as a species have yet to evolve coping techniques and so are suffering as a result. The phrase “not waving but drowning” comes to mind.
Traditionally the medical profession has stuck those unable to cope on antidepressants. But the times they are a-changin'. It's now known that a combination of talk therapies and drugs works best. Research has shown that cognitive-based therapy, when conducted well, works as quickly and thoroughly as the drugs. When a person continues using the skills they learn with CBT, relapses are prevented — something the drugs don't do.
This is all great news but there is a problem: accessibility is limited.
As more people are diagnosed with depressive-type disorders, the national charity the Mental Health Foundation is quite rightly calling for more talk-based therapies to be made available, including meditation and yoga in the form of Mindfulness Based Cognitive Therapy. The National Institute for Clinical Excellence has approved MBCT, a treatment based on meditation techniques, as a suitable treatment which can cut relapse rates for depression by half.
The report claims that Mindfulness meditation can affect the workings of the brain and even its structure, and that people undertaking Mindfulness training showed increased activity in the pre-frontal cortex — the area of the brain which is less active in people who are depressed.
A large majority of GPs think this treatment would help their patients but only one in five has access to the therapy. What is most concerning is that three-quarters of GPs have prescribed medication to people with long-term depression, believing another form of treatment would actually have been better for them. That really goes against all the training and ethical guidelines that we medics should follow.
And here lies the problem. The best treatments may well be the talk therapies but they are simply not available to most.
I have another slight reservation: MBCT usually consists of an eight-week course in Mindfulness meditation, with elements of CBT and yoga, which sounds wonderfully holistic but I feel this is a wildly impractical aim in an already overburdened NHS. Also, every doctor knows that it's hard enough to get patients to finish a course of antibiotics, so I'm certainly not convinced a depressed, demotivated patient will bother attending meditation and yoga classes.
We clearly need to find a middle ground that provides good patient care with long-term lasting results which is accessible to all who need it. But then, isn't that the great challenge in all areas of the NHS, and one that may now be an impossible pipe dream without a radical overhaul of the way our health service is run and funded?

Christmas means coping with the hangover from hell

Nagging about diet and exercise is all well and good but I do sometimes feel we doctors could give a little more useful advice from time to time. At this time of year an obvious theme jumps out at me: how to avoid hangovers.I hear so many myths circulating on this subject and most are complete nonsense. So whilst I cannot possibly condone heavy drinking, even to celebrate so auspicious an event as the arrival of the baby Jesus, I can at least advise you on how to get through your Christmas parties with the minimal of damage and pain afterwards.The first mistakes people make occur before they have even left the house. Number one error is not eating before a night on the booze. Drinking on an empty stomach can lead to a rate of absorption of alcohol that is similar to being given it via an IV drip. This leads to disaster very quickly, and while the liver is in overdrive dealing with the booze it is not able to metabolise glucose very well. This causes blood sugar levels to drop, causing shakes and sweats. The heart pumps harder as well, causing blood pressure to rise, thought to be the reason why some drinkers suffer heart attacks the next morning. Wolfing down a dodgy kebab on your way home is too little too late, and will probably only make your hangover nausea worse. The reason some people get completely sloshed very quickly and others take much longer is partly to do with food, but it’s also partly due to genetics. The quantity of stomach enzymes that break alcohol down differs: women get drunk more quickly than men because they have more fat, less muscle and fewer enzymes. The good news for women is that as they get older women almost catch up with men. Brains shrink a little with age too, making them less prone to headaches the morning after.Whilst out, be aware of the need to avoid dehydration. The kidneys will produce more urine than normal, in response to the diuretic properties of alcohol, and this will dehydrate and deplete the blood's levels of sodium, potassium, calcium and magnesium. Although your brain may seem to tell you otherwise the next morning, alcohol doesn’t actually dehydrate the brain; it causes it to swell, creating pressures on the surrounding membranes and causing the infamous headache. Avoid this by alternating one alcoholic drink with one soft drink, to keep up your hydration levels, and the advice of drinking a pint of water before you go to bed is sound, provided you are not so pissed that you pee yourself in the night.
Despite what you have heard, all alcohol is the same, whether you are drinking the finest champagne or the roughest of alcopops. All drinks contain ethanol which your liver and brain deal with it in exactly the same way whatever the source. It's a myth that mixing your drinks makes a hangover worse. Beer before wine, or wine before beer, both will make you feel rough if you drink enough of them. What does make a big difference is what is mixed with the alcohol. Different drinks will affect you in different ways, and at different times, so choosing what you drink will help you the next day. Generally speaking the browner the drink, the worse the hangover it causes. Rum, whiskey, brandy and port can all be cruel. Vodka is least likely to give you a hangover as it is repeatedly filtered to remove as many impurities as possible. Beer is probably the least dangerous to drink but it's the most calorie rich - one pint contains between 170 and 200 calories.Lastly, I should warn you that knocking back painkillers can be dangerous. Aspirin is popular but can irritate the stomach, and even causing bleeding with alcohol. Paracetamol, too, is not ideal as it can promote further liver damage when combined with alcohol –this makes it a popular although slow acting suicide choice. Taking some before you go to sleep will not help –their effects will have worn off in about 4 hours and probably long before you wake up.And for our herbal and ‘complementary’ friends researchers have reviewed all the available studies on hangover pills, such as yeast and artichoke extract and concluded that there is no compelling evidence of any effective treatment. The only proven cure is time, and getting it right the night before.

Warnings about iPods may fall on deaf ears

I come from a relatively small family but still find choosing Christmas presents one of the great headaches of the year.
Some small short-circuit occurs in my brain that prevents any form of sensible thought occurring any time I plan who should get what.
I thought I had it cracked this year, however. MP3 players are, according to consumer research, top of the list of most popular Christmas gifts. For Londoners, they provide some much-needed escape from the stress of Christmas shopping and the commute to work each day, so I thought I had my solution: iPods all round.
I'm sure even my mother would find some use for one, downloading Intermediate Spanish to practise on the bus, or listening to Eileen Atkins reading the latest Alan Bennett. But I've had to backtrack.
Increasingly shrill warnings are being issued by the various hearing protection organisations about how these gadgets, played at excessive volume, are setting us up for a future of hearing problems and deafness. Perhaps not the best present for a doctor to give after all —back to the drawing board.
Actually, come to think of it, I can't think of anything more irritating than sitting next to someone listening to their MP3 player too loudly. The tinny frenetic beat of their always utterly-unsuitable-for-the-time-of-day music is impossible to shut out.
It's the modern-day equivalent of the Chinese water torture. I have started asking people to turn theirs down.
But experts would say that I am doing these headbangers a favour. London commuters face the greatest risk of all as the noise on the Underground means that the devices have to be played at potentially damaging volume levels to be heard.
Hearing specialists are warning that for young people this is a huge problem and that prolonged listening could lead to permanent damage.
It's not an exaggeration. I have certainly seen an increase in young people coming to see me in clinic with ear problems, mainly tinnitus or dullness to their hearing, and on questioning they nearly all use MP3 players and go to concerts regularly.
Tinnitus can be an early sign of hearing damage due to noise, and occurs when the sensory hair cells in the cochlea are damaged by loud sounds. Some ear, nose and throat specialists explain the damaging effect of the noise exposure on the inner ear as being similar to the effect of a storm on a field of corn, flattening and damaging the stalks.
Proposals have been made to limit the maximum volume of a player to 100dB. As a rough guide to decibels, if you are listening to sound at 70dB it's possible to hold a conversation at normal volume; at 90dB one needs to talk loudly; at 100dB loud shouting is necessary, and from 105dB upwards it is no longer possible to hear speech at all.
Most MP3 players have a maximum volume of 125dB (equivalent to the sound of an aeroplane engine a few metres away, and more than 40dB more than generally permitted noise levels for a working environment), and according to a British study, 39 per cent of 18-24-year-olds listen to music for at least an hour a day at close to this upper volume limit.
This creates a serious danger of becoming deaf within about five years — and herein lies the problem. The damage can take a long time to show up and therefore is of no real concern to young people now.
One audiologist has even predicted that at current rates one third of young people using MP3 players today will need a hearing aid by the time they hit 50.

Sex and booze and the festive"spirit"

An advantage of the Virgin Birth was that it neatly bypassed the risk of catching STIs. Before you accuse me of blasphemy there were significant numbers of STIs around, even in Jesus’ day. Indeed his persecutor Herod was thought to have died of syphilis, a common disease of the time, his death following internal pains and burning sensations, swelling of the feet, convulsions, an ulcerated colon, putrefied and worm-eaten genitals, and very, very bad breath. Many biblical stories and particularly the list of rules offered in parts of the Old Testament merely give practical medical advice on how to stay fit and healthy during those times. Most is utterly outdated today of course but it’s interesting to read how circumcision, mandatory in biblical times, has now been shown to reduce infection rates of herpes, HPV and to a lesser extent HIV. As the world turns full circle and another Christmas approaches the threat of syphilis and other STIs remains ever present, but unfortunately for our STI and teen pregnancy stats virgin births seem few and far between. The NHS is launching a campaign warning Londoners about ‘Christmas Chlamydia’ as the party season approaches. This is inspired by research showing that a quarter of under 25 year olds admitted having unprotected sex during last year’s festive season, of which 60% were left unsure whether they had caught the sexually transmitted infection or not. The main culprit, of course, is alcohol. Sex and alcohol is a powerful combination that frequently leaves you with more than you bargained for. Alcohol based stats show that more than one in ten 18 – 34 year olds in London have had sex with someone they just met due to the influence of alcohol at a party over the festive season, more than one third admitted to having sex under the influence of alcohol that they wouldn’t have had if sober, nearly two in five have had sex that they regretted the morning after it happened and the majority have drunk to the point where they would describe themselves as ‘out of it’. Women are also more at risk of an unplanned pregnancy during Christmas and New Year than at any other time. Marie Stopes International is so aware of the problem that they have advised women to stock up on emergency contraception to cover this season. They have also put together festive family planning pack (containing two condoms, two luminous spikeys [to stop people spiking your drink], the Emergency Contraception pill Levonelle 1500, a pocket sized Christmas sexual health guide and even a festive chocolate) priced at £15 in an effort to reduce the incidence of unwanted pregnancies and infections. The excess of alcohol and the general over-excited atmosphere of the dreaded office party lead to fewer inhibitions and more casual hook ups, again upheld by the stats which reveal that almost one third of those surveyed claimed to have had sex with a colleague either during or after an office party. This then makes less surprising the news that in January and February of 2007, more women than ever before in MSI’s thirty year history, attended its nine UK centers for abortion services and official statistics show that the first quarter of every year always produces the highest numbers of women having abortions.But there is a darker side. Along with the increased alcohol and reduced inhibitions comes increased vulnerability. Sexual consent can be a confusing subject at the best of times. Add in buckets of alcohol and the pent up frustration of the past year spent flirting at the photocopier and things can get badly out of hand. But to the police there are no grey areas with regards to sex without consent: if there is doubt, it’s treated as rape.
If you have had unprotected sex over the festive period, a test for sexually transmitted infections is advisable, even if you don’t have symptoms, and if you are a woman and don’t want to be pregnant, visit your local pharmacy, doctor’s surgery or sexual health clinic for emergency contraception as soon after the unprotected sex as possible. All this can be avoided, however, by making sure you carry condoms with you; in AD2009 this is no longer seen as meretricious.

Doctors must stop refusing to confront Aids

Yesterday was World Aids Day. It's a hugely important event given that there are more than 33 million people living with HIV worldwide and it is the number one killer of women aged 15-44. It matters.
New research offers some hope that the number of new Aids cases is decreasing but fear and misunderstanding of HIV are still, even in 2009, hindering the introduction and implementation of more improvements.
HIV prevention programmes are having an impact but as in so many areas of sexual medicine shame, embarrassment and ignorance are our greatest opponents. And then comes stigma and taboo, which are still rampant.
As long as discrimination exists, people will be much less willing to get tested. My faith in human nature is sorely tested when I hear, even today, people stating that HIV and Aids is revenge from God for promiscuity.
Continental Europe is streets ahead of us, promoting greater openness and understanding in dealing with sexuality, including teen sexuality.
This has created wider and easier access to sexual health information and services for people of all ages.
Most important for me is that in Europe political and religious interest groups have little influence on public health policy.
This means that the stigma of sexually transmitted infections (STIs) is just not there - going for a check-up is seen as being cool and responsible.
How have they achieved all this? For a start, doctors make STI screening and HIV testing part of normal GP practice.
Ours, in many cases, do not. Ignorance and stigma apply not just to the public's attitude but also, I'm ashamed to say, to my colleagues too.
Many UK doctors still view HIV/Aids as a specialist subject and one that they do not feel confident or willing to get involved with.
HIV is now so prevalent, especially in a large city such as London, that it must now been seen as part of normal, everyday general medicine.
While I agree that the management of HIV-positive patients does indeed require expert care, basic advice and, in particular testing, does not. Any doctor should be able to do it.
There are still far too many GPs who refuse to do HIV tests and send their patients to GUM (genito-urinary medicine) clinics instead.
This sort of insensitive handling only adds to the stigma, and decreases the public's willingness to be tested.
It can take a lot of courage for some people to seek help and one callous comment - even if unintentional - from a stressed doctor can do untold damage.
GPs do an incredible job (for little thanks and many complaints) and are probably in the best possible position to make a difference.
All too often many of us allow personal prejudice, religious beliefs or even academic ambitions to affect the way we practice.
This must stop if doctors are ever going to improve medicine and come crawling from the 20th century into the 21st.
We alienate ourselves at the expense of our patient's health and I am sorry to say that I suspect we may compound the problem of worsening STI and HIV figures in many cases, instead of helping to lower them.

A green planet is a healthier world

We doctors were always taught about the various diseases as if they were separate, individual afflictions, with little interaction.
The fact that a multitude of other factors, including environmental ones, also strongly influence disease was rarely discussed.
If we have been a bit slow on the uptake, those heading the campaign on climate change certainly haven't.
Frustrated by the slow response from many of us to their pleas to make "green" changes to our lifestyles, they have sought new ways to bribe us into submission - and come up with the impact that climate change could have on our health as a topic that hopefully will get us listening.
Health Secretary Andy Burnham has declared that health should now be at the centre of our fight against climate change and has called upon ministers and professionals across the world to recognise the danger that climate change poses to public health.
Wherever we live in the world the climate has powerful impacts on human life. We are brilliantly designed to live in many environments but there are limits.
Extremes of heat and cold can cause potentially fatal illnesses and research has shown that they can increase death rates from heart and respiratory diseases.
It's already happening. Heatwaves across Europe cause thousands of deaths and the recent flooding in Cumbria disrupted many lives, significantly increasing the risk of disease.
The majority of people rely on safe drinking water, sufficient food, secure shelter and good social conditions to ensure their health.
A changing climate is likely to adversely affect all of these conditions.
It's clear to see how changing ecological systems may affect the prevalence and range of infectious diseases.
Vector-borne diseases such as malaria, dengue fever, yellow fever and encephalitis are currently among the largest global killers.
It has been predicted that the global population at risk from malaria will increase by between 220 million and 400 million in the next century.
While it is unlikely that climate change would cause malaria to become re-established in somewhere like London, the overall effects of a rapidly changing climate on health are likely to be overwhelmingly negative, particularly in the poorest communities - which ironically have contributed least to greenhouse gas emissions.
One reason we in the West have done so little about it is that most of these climate-related disasters occur in developing countries.
Perhaps if we started to suffer from them saving the environment would become more of a priority.
There are added benefits to getting greener. Cutting down on red meat consumption means livestock numbers can be reduced, lowering methane emissions but also improving our diets, particularly our saturated fat intake.
As is so often the case it's the elderly, the very young, the homeless and the poor who are especially vulnerable to increase risk of disease.
Darwin would certainly have something to say on this but only the fittest being able to survive is no longer acceptable.

Stress has many causes and symptoms

We all need a certain amount of pressure in our lives to make our work satisfying and help us meet our deadlines.
But too much pressure without having the chance to let off steam causes stress. Of course, what is stressful for one person may not be stressful for another. Some thrive on it while others crumble.
If you feel that you are always rushing about, trying to be in too many places at once, missing meal breaks, for ever taking work home with you, and never seem to have enough time for exercise, relaxation or spending time with your family, then you may well be at risk of developing stress-related problems.
Stress is caused by a wide variety of different situations, and so can also have a wide range of symptoms. I tend to divide these into physiological, psychological and behavioural symptoms.
Physiological symptoms caused by stress include headaches, migraines, stomach disorders, raised blood pressure, changing sleep patterns, muscle spasms, back/shoulder/neck pain, general malaise and an unwillingness to work.
Psychological symptoms can cause you to grow resentful towards your work, making it a place of anxiety, tension and the cause of irritability, low self-esteem and forgetfulness. It can even lower your sex drive.
Finally, behavioural symptoms can cause sufferers to becoming irritable, aggressive and withdrawn, and to stop communicating.
An affected person may show signs of changes in eating and sleeping patterns; they may drink and smoke more, and even start excessively self-medicating.
Of course, these will also affect home life, making them more “difficult” outside work, less able to cope with their family and maybe even neglecting their hygiene and personal appearance.
There is rarely any one single cause of work-related stress.
While sudden, unexpected pressures can trigger it, it is often the result of a range of stressful factors that build up over time. If they are left undetected and untreated, they can reach boiling point and cause a full mental breakdown.

Why sport is a vital goal for women

A local school in Lambeth, near to where I walk my dog, is the venue Sport England has chosen to announce the launch today of its new £10 million campaign targeted at getting women from disadvantaged communities to play more sport.
Even Gordon Brown is urging a cultural change that allows girls to see sport and physical activity as aspirational - something that is most definitely not the case now.
Many girls enjoy games such as netball and hockey at school but as soon as they leave often all sporting activities stop. This is a shame.
The statistics show that campaigns of this sort really are needed.
There has been almost no change in the level of women's physical activity in the UK for the past 20 years, with 80 per cent of women doing too little exercise to benefit their health.
Twice as many men play competitive sports as women and six out of 10 women prefer exercising alone to team sports. Is this because sporty athletic girls are seen as unfeminine and female team sports a little too sweaty and "butch"?
I suspect that early experiences at school (don't we all have memories of terrifyingly masculine PE teachers hurling medicine balls at us?) have a greater impact on how girls perceive sport, and this is backed up by some evidence.
Research has shown that nearly a quarter of women say that PE at school put them off sport, two in five girls felt selfconscious about their bodies in PE lessons and a quarter of women hate the way they look when exercising or playing sport.
I remember having to play in "skins" (meaning top off) as one team colour as opposed to "shirts" (top on) and absolutely hating it, feeling terribly self-conscious, but I suspect getting small boys to run around with their tops off is forbidden now. I did go to a public school, after all.
This has got me thinking about the way we doctors sell the idea of exercise to our patients. I tend to say "join a gym" as an automatic response when discussing weight loss, as this is the London thing to do.
Talking to my colleagues has confirmed that this seems to be the standard advice that most of them give. But is the gym quite the same, and does it have the same benefits as a team sport? I favour the mindless gym as my own choice of training.
I work out admittedly a little excessively and go about five times a week, which means I like to think I am pretty fit. But I suspect my speed, agility, balance and endurance are actually very poor.
I lift weights in the main which will make me strong but that's about it.
Playing sport would certainly redress this imbalance. So this idea has struck me as rather a good one, and perhaps something we should be suggesting more - and gym membership a little less.
The benefits of sport go far beyond simple weight loss.
We know that women who play sports do better academically; they have improved learning, memory, and concentration, giving active women an advantage.
Sport teaches teamwork and goal-setting skills; important in business where teaming up with others to meet goals can be the key to success.
Some benefits of sports are immediately obvious - such as improving fitness and maintaining a healthy weight, but women who play sports are less likely to smoke and have reduced chances of getting breast cancer and osteoporosis later in life.
We also know that women involved in athletics feel better about themselves, both physically and socially, and playing sports can help deal with stress and fight depression. I don't know why I didn't think of it before.