A ‘pragmatic, superiority, open-label, randomised controlled trial’ of sleep restriction therapy versus sleep hygiene has just been published in THE LANCET. Adults with insomnia disorder were recruited from 35 general practices across England and randomly assigned (1:1) using a web-based randomisation programme to either four sessions of nurse-delivered sleep restriction therapy plus a sleep hygiene booklet or a sleep hygiene booklet only. There was no restriction on usual care for either group. Outcomes were assessed at 3 months, 6 months, and 12 months. The primary endpoint was self-reported insomnia severity at 6 months measured with the insomnia severity index (ISI). The primary analysis included participants according to their allocated group and who contributed at least one outcome measurement. Cost-effectiveness was evaluated from the UK National Health Service and personal social services perspective and expressed in terms of incremental cost per quality-adjusted life year (QALY) gained. The trial was prospectively registered (ISRCTN42499563).
Between Aug 29, 2018, and March 23, 2020 the researchers randomly assigned 642 participants to sleep restriction therapy (n=321) or sleep hygiene (n=321). Mean age was 55·4 years (range 19–88), with 489 (76·2%) participants being female and 153 (23·8%) being male. 580 (90·3%) participants provided data for at least one outcome measurement. At 6 months, mean ISI score was 10·9 (SD 5·5) for sleep restriction therapy and 13·9 (5·2) for sleep hygiene (adjusted mean difference –3·05, 95% CI –3·83 to –2·28; p<0·0001; Cohen’s d –0·74), indicating that participants in the sleep restriction therapy group reported lower insomnia severity than the sleep hygiene group. The incremental cost per QALY gained was £2076, giving a 95·3% probability that treatment was cost-effective at a cost-effectiveness threshold of £20 000. Eight participants in each group had serious adverse events, none of which were judged to be related to intervention.
The authors concluded that brief nurse-delivered sleep restriction therapy in primary care reduces insomnia symptoms, is likely to be cost-effective, and has the potential to be widely implemented as a first-line treatment for insomnia disorder.
I am frankly amazed that this paper was published in a top journal, like THE LANCET. Let me explain why:
The verum treatment was delivered over four consecutive weeks, involving one brief session per week (two in-person sessions and two sessions over the phone). Session 1 introduced the rationale for sleep restriction therapy alongside a review of sleep diaries, helped participants to select bed and rise times, advised on management of daytime sleepiness (including implications for driving), and discussed barriers to and facilitators of implementation. Session 2, session 3, and session 4 involved reviewing progress, discussion of difficulties with implementation, and titration of the sleep schedule according to a sleep efficiency algorithm.
This means that the verum group received fairly extensive attention, while the control group did not. In other words, a host of non-specific effects are likely to have significantly influenced or even entirely determined the outcome. Despite this rather obvious limitation, the authors fail to discuss any of it. On the contrary, that claim that “we did a definitive test of whether brief sleep restriction therapy delivered in primary care is clinically effective and cost-effective.” This is, in my view, highly misleading and unworthy of THE LANCET. I suggest the conclusions of this trial should be re-formulated as follows:
The brief nurse-delivered sleep restriction, or the additional attention provided exclusively to the patients in the verum group, or a placebo-effect or some other non-specific effect reduced insomnia symptoms.
Alternatively, one could just conclude from this study that poor science can make it even into the best medical journals – a problem only too well known in the realm of so-called alternative medicine (SCAM).
“We are hugely concerned about the welfare of doctors and healthcare workers with long COVID”. These are the first words of a comprehensive survey of UK doctors with post-acute COVID health complications. It reveals that these doctors experience symptoms such as:
- muscular pain,
- nerve damage,
- joint pain,
- respiratory problems.
Around 60% of doctors said that post-acute COVID ill health has affected their ability to carry out day-to-day activities on a regular basis. 18% reported that they were now unable to work due to their post-acute COVID ill-health, and only 31% said they were working full-time, compared with more than half before the onset of their illness.
The report demands financial support for doctors and healthcare staff with post-acute COVID, post-acute COVID to be recognized as an occupational disease in healthcare workers, with a definition that covers all of the debilitating disease’s symptoms and for improved access to physical and mental health services to aid comprehensive assessment, appropriate investigations and treatment. The report also calls for greater workplace protection for healthcare staff risking their lives for others and better support for post-acute COVID sufferers to return to work safely if they can, including a flexible approach to the use of workplace adjustments.
In November 2021, an online survey investigating the emotional states of depression, anxiety, stress, compassion satisfaction, and compassion fatigue was administered to 78 Italian healthcare workers (HCWs). Between 5 and 20% of the cohort showed the effects of the adverse psychological impact of the pandemic and more than half of them experienced medium levels of compassion fatigue as well as a medium level of compassion satisfaction. The results also show that those with fewer years of clinical practice might be at greater risk of burnout, anxiety, and stress symptoms and might develop a lower level of compassion satisfaction. Moreover, the factors that potentially contribute to poor mental health, compassion fatigue, and compassion satisfaction seem to differ between residents and specialist physicians.
A cross-sectional study was conducted from September 2021 to April 2022 and targeted all physicians working at King Fahd Hospital of the University, Al Khobar, Saudi Arabia. Patient Health Questionnaire-9 and General Anxiety Disorder-7 were used to elicit self-reported data regarding depression and anxiety, respectively. In addition, sociodemographic and job-related data were collected. A total of 438 physicians responded, of which 200 (45.7%) reported symptoms of depression and 190 (43.4%) of anxiety. Being aged 25-30 years, female, resident, and reporting a reduction in work quality were factors significantly associated with both anxiety and depression. Female gender (AOR = 3.570; 95% CI = 2.283-5.582; P < 0.001), working an average 9-11 hours/day (AOR = 2.130; 95% CI = 1.009-4.495; P < 0.047), and self-perceived reduction in work quality (AOR = 3.139; 95% CI = 2.047-4.813; P < 0.001) were significant independent predictors of anxiety. Female gender (AOR = 2.929; 95% CI = 1.845-4.649; P < 0.001) and self-perceived reduction in work quality (AOR = 3.141; 95% CI = 2.053-4.804; P < 0.001) were significant independent predictors of depression.
An observational, multicenter cross-sectional study was conducted at eight tertiary care centers in India. The consenting participants were HCWs between 12 and 52 weeks post-discharge after COVID-19 infection. The mean age of the 679 eligible participants was 31.49 ± 9.54 years. The overall prevalence of COVID sequelae was 30.34%, with fatigue (11.5%) being the most common followed by insomnia (8.5%), difficulty in breathing during activity (6%), and pain in joints (5%). The odds of having any sequelae were significantly higher among participants who had moderate to severe COVID-19 (OR 6.51; 95% CI 3.46-12.23) and lower among males (OR 0.55; 95% CI 0.39-0.76). Besides these, other predictors for having sequelae were age (≥45 years), presence of any comorbidity (especially hypertension and asthma), category of HCW (non-doctors vs doctors), and hospitalization due to COVID-19.
Such data are scary. Not only will we have a tsunami of long-Covid patients from the general public, and not only do we currently lack effective causal treatments for the condition, but also is the number of HCWs who are supposed to deal with all this drastically reduced.
Most if not all countries are going to be affected by these issues. But the UK public might suffer the most, I fear. The reasons are obvious if you read a previous post of mine: in the UK, we have significantly fewer doctors, nurses, hospital beds, and funding (as well as politicians who care and would be able to do something about the problem) than in other comparable countries. To me, this looks like the emergence of a perfect storm.
Yesterday, the NHS turned 75, and virtually all the newspapers have joined in the chorus singing its praise.
The idea of nationalized healthcare free for all at the point of delivery is undoubtedly a good one. I’d even say that, for a civilized country, it is an essential concept. The notion that an individual who had the misfortune to fall ill might have to ruin his/her livelihood to get treated is absurd and obscene to me.
The NHS was created the same year that I was born. Even though I did not grow up in the UK, I cannot imagine a healthcare system where people have to pay to get or stay healthy. To me, ‘free’ – it is, of course not free at all but merely free at the point of delivery – is a human right just as freedom of speech or the right to a good education.
While reading some of what has been written about the NHS’s 75th birthday, I came across more platitudes than I care to remember. Yes, we are all ever so proud of the NHS but we would be even more proud if our NHS did work adequately. I find it somewhat hypocritical to sing the praise of a system that is clearly not functioning nearly as well as that of comparable European countries (where patients also don’t have to pay out of their own pocket for healthcare). I also find it sickening to listen to politicians paying lip service, while doing little to fundamentally change things. And I find it enraging to see how the conservatives have systematically under-funded the NHS, while pretending to support it adequately.
How can we be truly proud of the NHS when it seems to be dying a slow and agonizing death due to political neglect? In the UK, politicians like to be ‘world beating’ with everything, and I am sure some Tories want you to believe that, under their leadership, a world-beating healthcare system has been established in the UK.
Let me tell you: it’s not true. I have personal experience with the healthcare systems of 5 different nations and worked as a doctor in 3 of them. In Austria, France, and Germany for instance, the system is significantly better and no patient’s finances are ruined through illness.
Now there is talk about reform – yet again! Let us please not look towards the US when thinking of reforming the NHS. I have lived for a while in America and can tell you one thing: when it comes to healthcare, the US is not a civilized country. If reform of the NHS is again on the cards, let us please look towards the more civilized parts of the world!
It has been reported that the PLASTIC SURGERY INSTITUTE OF ·UTAH, INC.; MICHAEL KIRK MOORE JR.; KARI DEE BURGOYNE; KRISTIN JACKSON ANDERSEN; AND SANDRA FLORES, stand accused of running a scheme out of the Plastic Surgery Institute of Utah, Inc. to defraud the United States and the Centers for Disease Control and Prevention.
Dr. Michael Kirk Moore, Jr. and his co-defendants at the Plastic Surgery Institute of Utah have allegedly given falsified vaccine cards to people in exchange for their donating $50 to an unnamed organization, one which exists to “liberate the medical profession from government and industry conflicts of interest.” As part of the scheme, Moore and his co-defendants are accused of giving children saline injections so that they would believe they were really being vaccinated.
The co-defendants are Kari Dee Burgoyne, an office manager at the Plastic Surgery Institute of Utah; Sandra Flores, the office’s receptionist; and, strangest of all, a woman named Kristin Jackson Andersen, who according to the indictment is Moore’s neighbor. Andersen has posted copious and increasingly conspiratorial anti-vaccine content on Facebook and Instagram; Dr. Moore himself was a signatory on a letter expressing support for a group of COVID-skeptical doctors whose certification was under review by their respective medical boards. The letter expresses support for ivermectin, a bogus treatment for COVID.
According to the indictment, the Plastic Surgery Center of Utah was certified as a real vaccine provider and signed a standard agreement with the CDC, which among other things requires doctor’s offices not to “sell or seek reimbursement” for vaccines.
Prosecutors allege that, when people seeking falsified vaccine cards contacted the office, Burgoyne, the office manager, referred them to Andersen, Dr. Moore’s neighbor. Andersen, according to the indictment, would ask for the name of someone who’d referred them—it had to be someone who’d previously received a fraudulent vaccine card, per the indictment—then direct people to make a $50 donation to a charitable organization, referred to in the indictment only as “Organization 1.” Each vaccine card seeker was required to put an orange emoji in the memo line of their donation.
After making a donation to the unnamed charitable organization, prosecutors allege, Andersen would send a link to vaccine card seekers to enable them to make an appointment at the Plastic Surgery Institute. With adult patients, Moore would allegedly use a real COVID vaccine dose in a syringe, but squirt it down the drain. Flores, the office’s receptionist, gave an undercover agent a note, reading “with 18 & younger, we do a saline shot,” meaning that kids were injected with saline instead of a vaccine. Prosecutors allege the team thus disposed of at least 1,937 doses of COVID vaccines.
All four people are charged with conspiracy to defraud the United States; conspiracy to convert, sell, convey, and dispose of government property; and conversion, sale, conveyance, and disposal of government property and aiding and abetting.
Throughout the scheme, the group reported the names of all the vaccine seekers to the Utah Statewide Immunization Information System, indicating that the practice had administered 1,937 doses of COVID-19 vaccines, which included 391 pediatric doses. The value of all the doses totaled roughly $28,000. With the money from the $50 vaccination cards totaling nearly $97,000, the scheme was valued at nearly $125,000, federal prosecutors calculated.
“By allegedly falsifying vaccine cards and administering saline shots to children instead of COVID-19 vaccines, not only did this provider endanger the health and well-being of a vulnerable population, but also undermined public trust and the integrity of federal health care programs,” Curt Muller, special agent in charge with the Department of Health and Human Services for the Office of the Inspector General, said in a statement.
I am already baffled by anti-vax attitudes when they originate from practitioners of so-called alternative medicine (SCAM). When they come from real physicians and are followed by real actions, I am just speechless. As I stated many times before: studying medicine does unfortunately not protect you from recklessness, greed, or stupidity.
Drip IV is “Australia’s first and leading mobile healthcare company specialising in assisting with nutritional deficiencies”. They claim to provide a mobile IV service that is prescribed and tailored individually to your nutritional needs. Treatment plans and customised infusions are determined by a medical team to suit individual requirements. They deliver vitamins, minerals and amino acids directly to the body via the bloodstream, a method they state allows for optimal bioavailability.
These claims are a little puzzling to me, not least because vitamins, minerals and amino acids tailored individually to the nutritional needs of the vast majority of people would mean administering nothing at all. But I guess that virtually every person who consults the service will get an infusion [and pay dearly for it].
The Australian Therapeutic Goods Administration (TGA) seems to have a similarly dim view on Drip IV. The TGA has just issued 20 infringement notices totalling $159,840 to the company and to one of its executive officers. The reason: unlawful advertising of intravenous infusion products to Australian consumers on a company website and social media. Ten notices totalling $133,200 were issued to the company and ten notices totalling $26,640 were issued to an executive officer. The TGA considers the intravenous infusion products to be therapeutic goods because of the claims made about them, and the advertising to be unlawful because the advertisements allegedly:
- contained prohibited representations, such as claims regarding cancer.
- contained restricted representations such as that the products would alleviate fatigue caused by COVID-19, assist in the treatment of Graves’ Disease and Alzheimer’s Disease, and support the treatment of autoimmune diseases such as Multiple Sclerosis. No TGA approval had been given to make such claims.
- referred to ingredients that are prescription only, such as glutathione. Prescription medicines cannot be advertised directly to the public in Australia.
- contained a statement or picture suggesting or implying the products were ‘TGA Approved’. Advertising of therapeutic goods cannot include a government endorsement.
- contained a statement or picture expressing that the goods were ‘miraculous’.
Vitamin infusions have become very popular around the globe. There are now thousands of clinics offering this service, and many of them advertise aggressively with claims that are questionable. Here is just one example from the UK:
Modern life is hectic. If you are looking to boost your wellbeing, increase your energy levels, lift your mood and hydrate your body, Vitamin IV Infusions are ideal. Favoured by celebrities such as Madonna, Simon Cowell and Rihanna, Vitamin IV Infusions are an easy, effective way of delivering vitamins, minerals and amino acids directly into your bloodstream via an IV (intravenous) drip. Vitamins are essential for normal growth and staying healthy – but our bodies can’t produce all of the nutrients we need to function and thrive. That’s why more than one in three people take daily vitamin supplements – often without realising that only 15% of the active nutrients consumed orally actually find their way into their bloodstream. With Vitamin IV Infusions, the nutrients enter your bloodstream directly and immediately, and are delivered straight to your cells. We offer four different Vitamin IV Infusions, so you can choose the best combination for your personal needs, while boosting your general health, energy and wellbeing.
My advice to consumers is a little different and considerably less costly:
- to ensure you get enough vitamins, minerals, and amino acids, eat a balanced diet;
- to boost your well-being, sit down and calculate the savings you made by NOT using such a service;
- to increase your energy levels, take a nap;
- to lift your mood, recount the money you saved and think of what nice things you might buy with it;
- to hydrate your body drink a glass of water.
Perhaps it is time the authorities in all countries had a look at what these clinics are offering and what health claims they are making. Perhaps it is time they act as the TGA just did.
All healthcare professionals have an ethical obligation to be truthful and act in the best interest of the patient by adhering to the best available evidence. Providing false or misleading information to patients or consumers is thus a breach of medical ethics. In Canada, the authorities have started taking action against nurses that violate these ethical principles.
- A nurse has been suspended for asking a co-worker to create fake vaccine records.
Now it has been reported that a former registered nurse in West Kelowna has been suspended for four weeks after giving a vulnerable client anti-vaccine information and recommending “alternative pseudoscience” treatments.
According to the terms of a consent agreement posted on the B.C. College of Nurses and Midwives site, Carole Garfield was under investigation for actions that happened in September 2021. The college claims that Garfield contacted the client when she was off duty, using her personal mobile phone and email to give information against the COVID-19 vaccine and recommending so-called alternative medicine (SCAM). The exact nature of the “pseudoscience modalities” Garfield recommended to the client was not listed in the college’s notice.
Garfield’s nursing licence was cancelled back in April, according to the college’s registry. It’s unclear how exactly the four-week suspension will be applied. In addition to her month-long suspension and a public reprimand, Garfield is not allowed to be the sole nurse on duty for six months. She will also be given education about ethics, boundaries, and client confidentiality, as well as the province’s professional nursing standards. “The inquiry committee is satisfied that the terms will protect the public,” read a statement from the college.
In my view, it is high time for professional bodies to act against healthcare professionals who issue misleading information to their patients. In the realm of so-called alternative medicine (SCAM), issuing false or misleading information is extremely common and causes untold harm. Such harm would be largely preventable if the professional bodies in charge would start acting responsibly in the best interest of patients. It is high time that they follow the Canadian example!
Learn how to offer the healing energy of Reiki to yourself, people, and animals while enhancing your animal connection skills!
From daily support for health or challenges during times of crisis, Reiki helps restore balance on physical, emotional, spiritual, and mental levels for all living beings, enabling the body to do what it does best—heal itself. These benefits extend to other people, animals, trees/plants, and self-healing.
Reiki offers so many benefits for animals and for their human caregivers that I call it the gift that keeps on giving!
Reiki also enables students to connect and communicate more deeply with animals. If you think animals like you now, wait until they discover you’ve got Reiki—you’ll become an animal magnet!
For 25+ years Reiki has blessed me, my animal companions, students, and as a teacher I love sharing those benefits with as many people and animals as possible.
For many years I’ve taught a LIVE personally-mentored 6-week audio class where students learn all the basic skills needed by a beginning Reiki practitioner in addition to foundational principles of energy healing. And you don’t even need to leave the comfort of your home!
TAKEN REIKI BEFORE but don’t feel confident? Students who have retaken Reiki with me share that the weekly calls, opportunities to practice, online community, and opportunity to ask questions and receive guidance have helped them make Reiki a part of their daily lives and feel confident in offering it to loved ones.
REIKI LEVEL 1 CLASS SERIES
August 3 – September 7, 2022
LIVE WEEKLY CALLS and PERSONAL MENTORING
Every Wednesday at 6:00 p.m. Pacific for six weeks. Each call will be recorded and available for replay for students, including those in other time zones/countries. You do not have to attend live to take this class.
In addition to the 60-90 minute weekly calls, each student receives handouts and personal guidance for practice sessions.
When the class concludes, and all requirements have been fulfilled, each student receives a Reiki Level 1 certificate.
To learn more or register:
AND NOW FOR THE IMPORTANT BIT:
Choose one payment for all six classes. Payment is available with Visa, MC, or PayPal (choose PayPal credit card option for payment with Amex or Discover). PayPal also offers a payment plan option. Confirmation will be sent after registration along with instructions on how to join the first call. If you were unable to register in time to attend the first class live you can very easily catch up with the replay. Final deadline for registration is the day of the second class.
Single Pay Plan: $249.00
This seems like a good little earner to me!
Congratulations to whoever invented it.
Yet I do feel that something has been forgotten:
If you search for Reiki on Pubmed, you find a baffling array of papers many of which arrive at positive conclusions. If you then check out the primary studies, you realize that most of them are of extremely poor quality, published by members of the Reiki cult (often in 3rd class journals for the nursing professions). If you search for independent systematic reviews that adequately account for the quality of the primary studies, you discover that, in fact, the evidence does not support the notion that Reiki is effective for anything. Here are a few examples:
- There is insufficient evidence to say whether or not Reiki is useful for people over 16 years of age with anxiety or depression or both.
- The serious methodological and reporting limitations of limited existing Reiki studies preclude a definitive conclusion on its effectiveness.
- In total, the trial data for any one condition are scarce and independent replications are not available for each condition. Most trials suffered from methodological flaws such as small sample size, inadequate study design and poor reporting.
And what about Reiki for animals?
As far as I can see, there is no good evidence at all.
So, does this render the above and similar courses fraudulent?
I let you answer this question for yourselves.
Given the high prevalence of burdensome symptoms in palliative care (PC) and the increasing use of so-called alternative medicine (SCAM) therapies, research is needed to determine how often and what types of SCAM therapies providers recommend to manage symptoms in PC.
This survey documented recommendation rates of SCAM for target symptoms and assessed if, SCAM use varies by provider characteristics. The investigators conducted US nationwide surveys of MDs, DOs, physician assistants, and nurse practitioners working in PC.
Participants (N = 404) were mostly female (71.3%), MDs/DOs (74.9%), and cared for adults (90.4%). Providers recommended SCAM an average of 6.8 times per month (95% CI: 6.0-7.6) and used an average of 5.1 (95% CI: 4.9-5.3) out of 10 listed SCAM modalities. Respondents recommended mostly:
- mind-body medicines (e.g., meditation, biofeedback),
The most targeted symptoms included:
- mood disturbances,
Recommendation frequencies for specific modality-for-symptom combinations ranged from little use (e.g. aromatherapy for constipation) to occasional use (e.g. mind-body interventions for psychiatric symptoms). Finally, recommendation rates increased as a function of pediatric practice, noninpatient practice setting, provider age, and proportion of effort spent delivering palliative care.
The authors concluded that to the best of our knowledge, this is the first national survey to characterize PC providers’ SCAM recommendation behaviors and assess specific therapies and common target symptoms. Providers recommended a broad range of SCAM but do so less frequently than patients report using SCAM. These findings should be of interest to any provider caring for patients with serious illness.
Initially, one might feel encouraged by these data. Mind-body therapies are indeed supported by reasonably sound evidence for the symptoms listed. The evidence is, however, not convincing for many other forms of SCAM, in particular massage or acupuncture/acupressure. So encouragement is quickly followed by disappointment.
Some people might say that in PC one must not insist on good evidence: if the patient wants it, why not? But the point is that there are several forms of SCAMs that are backed by good evidence for use in PC. So, why not follow the evidence and use those? It seems to me that it is not in the patients’ best interest to disregard the evidence in medicine – and this, of course, includes PC.
Bach Flower Remedies are often mistaken for homeopathy. Yet they are quite different. They were invented about 100 years ago by Dr. Edward Bach (1886–1936), a doctor homeopath who had previously worked in the London Homeopathic Hospital. His remedies are clearly inspired by homeopathy; however, they are by no means the same because they do not follow the ‘like cures like’ principle and neither are they potentised. They are manufactured by placing freshly picked specific flowers or parts of plants in water which is subsequently mixed with alcohol, bottled, and sold. Like most homeopathic remedies, they are highly dilute and thus do not contain therapeutic concentrations of the plant printed on the bottle. In other words, flower remedies (or essences) are placebos. This does not stop enthusiasts to continue submitting them to clinical trials.
This study tested the effects of flower essence bouquets on the signs and symptoms of stress in nursing students. The study was designed as a randomized clinical trial, triple blind, with two groups (flower essence group and placebo group), carried out with 101 nursing students. Bach’s flower essences Cerato (Ceratostigma wilimottianum), Cherry Plum (Prunus cerasifera), Elm (Ulmus procera), Impatients (Impatiens glandulifera), Larch (Larix decidua), Olive (Olea europaea) and White Chestnut (Aesculus hippocastanum) were selected by the researcher based on the experience of attending nursing students on flower essence therapy. The formulas were prepared in a 30 ml amber glass bottle with a perforated cap with a white seal and bulbs, and labeled according to randomization (Group 1 or Group 2). The groups applied the treatments for 60 days at a dosage of 4 drops 4 times a day. The outcome was evaluated using the Baccaro Test and the Perceived Stress Scale applied at the beginning and at the end of the intervention.
The results demonstrated no significant difference between the groups in stress reduction (p > 0.05). Both groups showed a reduction in scale scores (p < 0.001) with a large effect size. There was an influence of the COVID-19 pandemic in the reduction of Baccaro Test scores.
The authors (who seem to have been advocates of Bach Flower Remedies) concluded that the intervention with flower essence therapy was not more effective than placebo in reducing stress signs and symptoms.
Is anyone surprised?
I am not!
For my last post of the year 2021, I take the liberty to borrow parts of a BMJ editorial entitled A NEW YEAR’S RESOLUTION OF HEALTH WORKERS:
The prospect of a return to normality seems within reach. But what will that normality look like? We believe that health workers, who have been at the frontline of the pandemic, must offer a vision of a healthier future. We must not let the terrible events of this year recast the pre-pandemic world in a glowing light. The normality we departed from at the onset of the pandemic was unjust, unsustainable, and shaped the evolution of, and responses to, the pandemic with devastating consequences, particularly for the most deprived and vulnerable.
The start of a new year offers an opportunity to question old ways of working and to ask how we can create a better future for everyone. It is a cliché to say that you should never waste a crisis. Just as in wartime and in the global financial crisis, many have profited greatly from the pandemic, whether as providers of online services or by taking advantage of the rush to procure essential goods such as personal protective equipment.
But many were far less fortunate, living in circumstances that rendered them vulnerable to an infection that spread especially rapidly through communities where successive generations had been living ever more precarious lives. As the recovery begins, the powerful groups who benefited from the social and economic systems that created those conditions will, once again, seek to shape the world to their advantage. Health workers cannot remain silent. They must offer a compelling vision of how we should reconfigure the world so that it produces and sustains health for all, resilient in the face of future threats…
A country navigating the pandemic is like a ship navigating treacherous and unpredictable waters in a storm. If the ship, its crew, and its passengers are to come through the experience unscathed it needs three things. First, it needs an experienced captain who understands the ship and commands the trust of the crew. Unfortunately, in some of the countries worst affected, captains were either away from the bridge, denied there was a storm, or had lost the trust of those on whom they depended.
Second, it needs a crew that is adequate for the size of the ship, that is well trained, and that is working as a team to achieve the same goal. Yet in too many countries, skeleton crews were working in health systems that were highly fragmented. Dissenting voices who raise the alarm about the integrity of the ship, the working of the team, or its leadership must not be silenced or lives can be lost. It also needs passengers who are as seaworthy as possible so that they can withstand the storm. One of the sentinel challenges of covid-19 was finding large segments of the population weighted by a disproportionate burden of preventable disease that predisposed them to severe covid-19 once infected.
Third, we need a ship that is securely constructed. Yet in many of the countries that have fared worst, we have been working in vessels that are full of holes. Social safety nets have been ripped asunder, allowing too many people to fall through the holes. We have made many demands on our people—to stay at home, to face loss of income—and we have added greater uncertainty to what were already difficult situations, particularly for certain racially and economically marginalised groups. The disproportionate exposure to covid-19 of many in these groups—a consequence of precarious jobs and social circumstances that denied them the luxury of social distancing—drove, in large part, the high burden of covid-19 among minority and marginalised groups worldwide.
As we look to the prospect of a covid-19 secure future, with effective vaccines, new treatments, and continued countermeasures as necessary, we must ask how we can strengthen the foundations of our societies, coming together to repair the torn safety nets. We must never be afraid to challenge our political leaders when they are going in the wrong direction, and we must insist that they really are guided by the science, and not just those bits that support their beliefs. And we must ensure that our fellow citizens are as healthy as possible so they can withstand the inevitable storms that lie ahead. We must insist that our health systems and other public systems are adequately staffed, with the tools needed to do the job, with teams that are working together, pulling in the same direction. If we do all this, then we, and the populations we serve, can be confident that we can weather any future storms.
The editorial was written by 4 authors:
- Martin McKee, professor of European public health
- May C I van Schalkwyk, NIHR doctoral research fellow
- Nason Maani, assistant professor in public health evaluation
- Sandro Galea, dean
I think it is most sensible and thought-provoking and I suspect many of us agree with its sentiments. If it did not make you think, perhaps this information will do so:
Yes, 2021 has disappointed many of our hopes and turned out to be a difficult year.
I wish us all that 2022 will be better, much better.