Friday, September 26, 2008

British Doctors told to curb use of Ritalin in hyperactive children

Children with attention deficit hyperactivity disorder (ADHD) should be treated with drugs such as Ritalin only in severe cases and never when they are younger than 5, under official health guidelines issued today. Widespread concerns that medication is used too freely to calm hyperactive children have been recognised by two clinical practice watchdogs, which are now advising doctors not to prescribe drugs whenever possible.

Most children with ADHD should instead be offered psychological therapy to improve their behaviour, backed up by training to support their parents and teachers, the National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Mental Health (NCCMH) recommend. Drugs such as Ritalin and Concerta (brand names for methylphenidate) and Strattera (atomoxetine) should be used as frontline treatments only when severe ADHD is diagnosed, or when other options have failed.

While up to 3 per cent of school-age children in Britain are affected by ADHD, only about a third to a quarter of these would qualify as severe cases. In a typical school of 1,400 children, between 30 and 40 would have a diagnosis of ADHD, and about 10 would be classed as severely affected.

The symptoms of ADHD include an inability to concentrate for long periods, hyperactive and restless behaviour, and impulsive actions, such as speaking without thinking of the consequences or failing to wait and take turns. It also affects about 2 per cent of adults.

ADHD support groups welcomed the guidelines, but said that they would have to be backed by increased resources for behavioural therapy if they are to have the desired effect. Andrea Benbow, chief executive of the Attention Deficit Disorder Information and Support Service, said that many parents had to wait months or even years to be given psychological therapy and training, and that many programmes were not designed for ADHD or effective for it. "There are huge waiting lists, and many training programmes are not ADHD-specific and they're useless," she said. "We need these interventions - drugs are not the be all and end all - and parents would welcome them if they were there. "This needs to be backed by better resources. Lots of the good programmes are delivered by the voluntary sector, but the problem is, who funds them?"

The new guidance follows growing disquiet among some parents, teachers and doctors about the number of children taking medication for ADHD, who often remain on drugs for years. More than 600,000 prescriptions for the three drugs were filled in 2007 in England, though the number of children who received them is estimated at between 50,000 and 100,000 because only a month's supply is generally prescribed at once.

Ritalin is the most common ADHD drug, with 461,000 prescriptions filled in England in 2007. This compares with 199,000 in 2003, 26,500 in 1998 and 3,500 in 1993. The growth has alarmed some observers, concerned that some doctors are turning to medication too quickly to control a disorder that often responds well to other treatment strategies. Ritalin and Concerta can have side-effects that include nervousness, insomnia, appetite loss and weight loss. Strattera can cause nausea, dizziness, fatigue and mood swings. There has also been little research into the implications of taking them as long-term treatments.

Prescription rates vary widely. In July a study by the Health Service Journal found that some primary care trusts offer Ritalin up to 23 times more than others: in Wirral, pharmacists dispensed one prescription for every seven children under 16, compared with one for every 159 children in Stoke-on-Trent.

Other treatment options include sending children on courses of cognitive behavioural therapy or social skills training, and training parents in how to cope with the condition and improve their children's behaviour. Teachers can also be trained to manage children with ADHD. These can be highly effective, but drugs are often used instead because they offer a quicker solution and are not subject to long waiting lists.

The guidelines recommend a sparing approach to drug use when possible. Tim Kendall, a consultant psychiatrist in Sheffield and joint director of the NCCMH, who sat on the expert panel, said: "Quite commonly, people tend to revert to offering methylphenidate or atomoxetine. "When they do that, it's not always because there's a good balance of risk and benefits. It's because the child has got what appears to be ADHD and that's what's available. It's easier to prescribe a drug when other options like parent-training programmes are not available."

Gillian Leng, deputy chief executive of NICE, said: "Today's guideline, which is published during ADHD Awareness Week, is the first guideline to address the diagnosis and management of ADHD within both clinical and education settings. At its heart is the recognition of the importance of establishing a multidisciplinary team, including the person with ADHD, their family and their teachers in order to help support the person with ADHD achieve their full potential."

Professor Eric Taylor, of the Institute of Psychiatry in London and chairman of the guideline development group, said: "I believe these guidelines will make people with ADHD, and their families, more confident that their problems will be recognised and can often be helped, and that they will provide professionals with a framework for good practice nationally."


British city objects to paying for land it stole

It wants to pay only the vastly reduced value that it created by denying permission for housing to be built on the land -- even though the land had been used for housing for many years. Below is their tale of woe. They think that THEY have been hard done-by because the land owners have the law on their side. There is nothing like a British bureaucracy. They think that people have rights only if they graciously allow it. The claim that it will cost the taxpayer a heap is rubbish. They just have to stop their obstruction of rebuilding on the site and it will cost them nothing.

Taxpayers will have to foot a $3.2 million bill to buy the 0.22 acre plot from a firm of property speculators, even though its true value is just $30,000. A judge who reluctantly ordered the council to pay the extortionate fee described the law as "utterly deplorable" and there are now fears of a rash of similar cases in London and other cities which were bombed by the Luftwaffe.

The wrangle centres on a scrap of land measuring roughly 20 yards by 50 which makes up part of a public park called Fred Wells Gardens in Battersea, south west London. A row of Victorian terraced houses, making up numbers 9 to 15 Orville Road once stood on the site, but they were destroyed by what is thought to have been a V1 flying bomb.

After the war the council cleared the site and added it to the neighbouring park, but it was privately owned, and was bought for $60,000 in 2001 by an investment firm called Greenweb Ltd, which wanted to build houses there. When the London Borough of Wandsworth refused planning permission to build on the site, Greenweb served a purchase notice compelling the council to buy the land because it would not allow it to be used for any commercial purpose. The current market value of the land, as a public open space, was independently set at $30,000, but Greenweb's legal team invoked an obscure clause in the Land Compensation Act 1961 which gives automatic planning permission for the rebuilding of houses destroyed by German bombs. That meant the value of the land suddenly shot up to $3.2m, even though the council would never allow it to be developed.

Councillor Maurice Heaster, Wandsworth's cabinet member for corporate resources, said: "This case really does prove the old saying that sometimes the law is an ass. "This could all have been avoided. Civil servants and ministers have been warned on numerous occasions that this piece of legislation was a ticking time bomb that should be ditched, but they have done nothing and local residents will now have to pay the price for their inaction."

The council, whose lawyers argued that the law was "absurd", appealed against the valuation by the Lands Tribunal, but three Appeal Court judges have upheld the decision, whilst making clear their disgust that the law still existed. Lord Justice Buxton said there was "no escape" from the law, but described the situation as "utterly deplorable" and called on councils to lobby the government for a repeal of the law to avoid "the unmeritorious deprivation of very scarce funds that occurred in this case". Lord Justice Thomas said it was "highly regrettable" that taxpayers in Wandsworth had to fund the purchase of the land for more than 100 times its true value, while Lord Justice Stanley Burnton said he upheld the law "most reluctantly".

The council is now considering a fresh appeal to the House of Lords, arguing that the law was only ever intended to ensure fair compensation for people whose properties were destroyed in the war. The London Development Agency, which is responsible for buying the land for London 2012 Olympics venues in the east end of London, said the ruling did not affect any of the sites being purchased.


Children in risk-averse Britain 'trust no-one'

Britain's suspicious and risk-averse culture is leading to children growing up trusting no one, according to an adviser to Gordon Brown. Baroness Neuberger, the Liberal Democrat peer and one of Britain's foremost female rabbis, believes that many people are put off working with the young because of the fear of being branded paedophiles. Others are so petrified of being sued that they avoid helping people in their communities. As a result, once commonplace and small acts of kindness, such as embracing a hospital patient, are being shunned and the population is becoming increasingly selfish.

In an address due to be given to the Royal Society of Arts today, the peer, a champion of volunteering, says: "It is hard for ordinary people to give a leg up to someone less fortunate, to help the kid in care or the granny whose life is getting tough. We have become seriously risk-averse - fearful as a nation, scared of terrorists, child molesters and violence on the street. As a result, we make it harder and harder to help those who need our aid."


Setback in battle against Britain's compulsory retirement age

How Brits love compulsion!

Hundreds of workers who want to work beyond the age of 65 were dealt a blow yesterday after campaigners lost an important round in their legal battle to banish Britain's compulsory retirement age. A preliminary legal opinion at the European Court of Justice in Luxembourg rejected a claim by Age Concern that to compel people to stop work at or after 65 without compensation breaches EU equality requirements.

Although the opinion could yet be overturned by the full European Court, it will dismay hundreds of people who have been forced to retire and who are claiming compensation through employment tribunals. If the opinion is upheld by the European Court, employees who want to work beyond 65 will continue to need the agreement of their bosses. About 260 tribunal claims are on hold, awaiting the outcome of the test case, and thousands more claims could follow if pensioners are forced to retire.

Jan Marzak, the Advocate-General of the court, most of whose opinions are followed by the court, argued yesterday that a fixed retirement age was not necessarily contrary to EU rules. He agreed with Age Concern that British rules on mandatory retirement were covered by the EU directive. But he said that discrimination on the ground of age could be justified in certain circumstances in the context of a country's labour market and employment policy. He said that to allow employers to force workers to retire at 65 or over "can in principle be justified if that rule is objectively and reasonably justified in the context of national law by a legitimate aim relating to employment policy and the labour market, and it is not apparent that the means put in place to achieve that aim of public interest are inappropriate and unnecessary for the purpose".

Employers welcomed the opinion, saying that it would enable them to plan their workforce and ensure a "dignified exit" for employees whose performance was starting to decline.

Help the Aged said that the opinion was very disappointing and condemned it as flying in the face of fairness and common sense, as well as the trend towards greater life expectancy. Kate Jopling, the charity's head of public affairs, said: "Allowing companies to show loyal workers the door just because they are 65 or over makes a mockery of age discrimination laws which are there to make clear that age is just a number, not an indicator of your competency. "There is simply no justification for allowing a 65th birthday card to come hand in hand with a P45, regardless of competency or previous track record." Lawyers for Age Concern told a hearing this year that the Employment Equality (Age) Regulations breach the EU's Equal Treatment Directive, which bans employment discrimination on various grounds, including age.

The regulations, introduced in 2006, ban discrimination on the ground of age but exclude pensioners, who can be dismissed at 65 without redundancy payments, or at the employer's mandatory retirement age if it is above 65. Government lawyers insisted that the exception was a national matter and that rules on retirement-age workers should not be governed by the EU directive.

One of Age Concern's member organisations, Heyday, took the case to the High Court, which sent it to the EU court for a ruling. The "opinion" is not legally binding, but is followed by the EU judges in about 80 per cent of cases. The final verdict is due in about six months.

The Advocate-General also rejected Age Concern's claim that national governments should have to provide a specific list of which differences of treatment in retirement age are justified. A victory for Age Concern - not ruled out but now unlikely - could lead to a far-reaching change in domestic employment law, and a flood of compensation actions in addition to the 260 now pending. About 25,000 workers are estimated to face "default retirement" at 65 in Britain every year, when they would be happy and able to carry on.


Amazing! Brutal Muslim child abuse penalized in Britain

But no jail time. Just a slap on the wrist. And apologies for bringing the prosecution

A man who encouraged two teenage boys to flog themselves until their backs were covered in bloody cuts was given a suspended jail sentence yesterday. Syed Mustafa Zaidi, 44, a Shia Muslim, was taking part at a mosque in Levenshulme, Manchester, in the traditional Ashura festival, a ritual of lamentation commemorating the slaughter of the Prophet Muhammad's grandson, Hussein, and his followers in the 7th century AD. Participants encourage each other to flail themselves with a whip with a wooden handle and five chains that end in sharp blades, to recreate the suffering of the martyrs.

Zaidi, a warehouse supervisor from Eccles, Greater Manchester, was found guilty last month of child cruelty for his role in encouraging the two boys, aged 13 and 15, to use the adult bladed whip rather than one specifically designed for youngsters. Both boys required hospital treatment.

He was given a 26-week prison sentence at Manchester Crown Court, suspended by Judge Robert Atherton for 12 months. Zaidi was ordered not to allow or encourage anyone under 16 to beat themselves during the next year. The prosecution had emphasised that bringing the legal action was not an attack on the practices of Shia Muslims. However, protesters declaring that the courts should not have become involved in what is a religious ceremony paraded placards outside the court building.

Judge Atherton said: "It should be clearly understood by everyone that the jury's verdict was not a comment upon that ceremony and no one should misinterpret it as being such. "The law recognises that children and young persons may wish to take part in some activities which it considers they should not. It is sometimes expressed as protecting themselves from themselves."

Zaidi had denied two counts of child cruelty amounting to "wilful ill-treatment".The boys, who cannot be named for legal reasons, said that they had wanted to beat themselves, but not under duress and not using blades.

Carol Jackson, for the Crown Prosecution Service, said: "Given the age of the children concerned, the refusal of Mr Zaidi to admit any wrongdoing and the likelihood of such an incident occurring again, we are satisfied that it was in the public interest to bring this case."


Green idealists fail to make grade, says study

People who believe they have the greenest lifestyles can be seen as some of the main culprits behind global warming, says a team of researchers, who claim that many ideas about sustainable living are a myth. According to the researchers, people who regularly recycle rubbish and save energy at home are also the most likely to take frequent long-haul flights abroad. The carbon emissions from such flights can swamp the green savings made at home, the researchers claim.

Stewart Barr, of Exeter University, who led the research, said: "Green living is largely something of a myth. There is this middle class environmentalism where being green is part of the desired image. But another part of the desired image is to fly off skiing twice a year. And the carbon savings they make by not driving their kids to school will be obliterated by the pollution from their flights." Some people even said they deserved such flights as a reward for their green efforts, he added.

Only a very small number of citizens matched their eco-friendly behaviour at home by refusing to fly abroad, Barr told a climate change conference at Exeter University yesterday. The research team questioned 200 people on their environmental attitudes and split them into three groups, based on a commitment to green living. They found the longest and the most frequent flights were taken by those who were most aware of environmental issues, including the threat posed by climate change.

Questioned on their heavy use of flying, one respondent said: "I recycle 100% of what I can, there's not one piece of paper goes in my bin, so that makes me feel less guilty about flying as much as I do."

Barr said "green" lifestyles at home and frequent flying were linked to income, with wealthier people more likely to be engaged in both activities. He said: "The findings indicate that even those people who appear to be very committed to environmental action find it difficult to transfer these behaviours into more problematic contexts."

The team says the research is one of the first attempts to analyse how green intentions alter depending on context. It says the results reveal the scale of the challenge faced by policymakers who are trying to alter public behaviour to help tackle global warming.

The study concludes: "The notion that we can treat what we do in the home differently from what we do on holiday denies the existence of clearly related and complex lifestyle choices and practices. Yet even a focus on lifestyle groups who may be most likely to change their views will require both time and political will. The addiction to cheap flights and holidays will be very difficult to break."

The frequent flyers said they expected new technology to make aviation greener, echoing comments made by Tony Blair last year, who said it was "impractical" to expect people to take holidays closer to home. He said the solution was "to look at how you make air travel more energy-efficient, how you develop the new fuels that will allow us to burn less energy and emit less."


Charming NHS worker abuses woman for needing a Caesarian

Go NHS and get treated like cattle

A pregnant woman about to have a Caesarean after a difficult three-day labour was sworn at by a hospital worker who demanded to know why she couldn’t give birth naturally, a hearing was told today. Samantha Shepherd was told that her baby’s life would be in danger if she didn’t have a Caesarean. But the conversation with her doctor was interrupted when Nigel Baglin, a surgery assistant, stormed into the room and shouted “F****** hell, why can’t women in this hospital give birth naturally?”

Mr Baglin, an anaesthetic support agency worker at Newham University Hospital, East London, crashed his trolley into the door of the room during the outburst, the competence committee hearing heard. The worker said he made the comments because he was “aghast” at the number of Caesarian sections being carried out at the hospital. “It was like every patient on the ward wanted one and had consented to them. “As a personal opinion, I did not think this was natural. It was a sarcastic comment aimed at the doctor and it was a mistake on my part,” Mr Baglin, who now works in Derby, said.

Mrs Shepherd, a mother of three, said she already had reservations about the Caesarean and was left devastated by the confrontation. “I felt I was a complete failure,” she said. “I was really nervous about having the baby. I had two previous births naturally. Every woman has a plan and this labour was not going along as hoped,” she said. “The doctor was explaining that I needed to have a second epidural when he (Mr Baglin) entered the room and banged the door with his trolley.” She said everyone in the room heard his outburst. “He stormed out and everyone was in shock. I felt worthless and told my husband I was a complete failure.” She said she would not use the hospital if she fell pregnant again.

Mr Baglin said the outburst was not intended personally. He said: “It was an off-the-cuff comment. I admit it was inappropriate but I was being rushed around.” But a witness said Baglin’s comments were directed straight at Mrs Shepherd. The woman said: “He was so angry you could see the veins in his neck. He wanted to be an exhibitionist and he wanted it to be heard.”

After the incident in February last year, the hospital reported Mr Baglin’s outburst to his agency, and said it would not employ him in future. Mr Baglin told the inquiry at Park House, Kennington Park Road, south east London, he resigned from his work at the hospital the day after the incident when a formal complaint had been made against him. A panel on the committee will rule whether Mr Baglin’s fitness to practise is impaired. The hearing continues.


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