Before I started a new job at a large, inner city maternity unit a few years ago, I’d imagined that the majority of my work would be dealing with post-natal depression.
To my surprise, most of the women referred to me didn’t actually have a mental illness but were dogged by feelings of anxiety and inadequacy because they felt failures as mothers before they’d even started.
Pregnant women and new mums are bombarded with contrary advice and recommendations from all manner of ‘professionals’, making early parenthood a stressful and anxiety-provoking time — and it was heartbreaking watching these women beating themselves up because they felt that in some way they’d failed.
Pregnant women and new mums are bombarded with contrary advice and recommendations from all manner of ‘professionals’, making early parenthood a stressful and anxiety-provoking time. File image
One common concern was that they’d inadvertently consumed alcohol before realising they were pregnant. They then blamed themselves for any subsequent complication in their pregnancy or birth.
I spent the lion’s share of my time at the maternity unit reassuring them — ‘don’t worry’ were my two most frequently used words — pointing out that there wasn’t good evidence that they would have caused their babies harm.
But it wasn’t easy when this is contrary to the prevailing message of doom and gloom coming from po-faced public health officials.
They seem to love telling pregnant women in particular what to do and what not to do. Yet the vast majority of this hectoring advice is just hearsay and anecdote.
But now, finally, someone has stood up and spoken sense.
The British Pregnancy Advisory Service said this week that women are being unnecessarily scared by guidelines telling them to avoid all alcohol during pregnancy when the guidelines aren’t based on reliable evidence. File image
The British Pregnancy Advisory Service said this week that women are being unnecessarily scared by guidelines telling them to avoid all alcohol during pregnancy — with some even having abortions — when the guidelines aren’t based on reliable evidence.
The really good public health campaigns don’t need to guilt-trip people or harangue them: they’re based on definitive evidence and are straightforward and clear.
And because they’re self-evidently beneficial, people do them of their own free will.
Take cot death, an awful occurrence which dominated the headlines for much of the Eighties and Nineties — not surprisingly, as it seemed to be the distillation of every parent’s worse nightmare.
The sudden drop in numbers was the result of a public health campaign called ‘back to sleep’ (now known as Safe To Sleep) which built on research linking cot death to babies sleeping on their front.
It therefore encouraged new parents to put their children to sleep on their back. A clear, simple, evidence-based campaign.
But, of course, it’s not just pregnant women: public health professionals don’t seem to have a clue when it comes to how to interact with the general public.
The Oxford medical student, Lavinia Woodward, who stabbed her boyfriend during a row, was told this week she may be spared jail when she’s sentenced in September — because a custodial sentence would damage her hopes of becoming a heart surgeon.
If she’d been a man, rather than a young, slim, attractive female, there’s no way this would have been suggested — or if it had, the liberal Left would have pounced on it as hateful and misogynistic.
While the judge didn’t want to damage Lavinia Woodward’s (above) career prospects, I would say it’s a public duty to do so
But the bigger issue here is whether Woodward should actually be a doctor. While the judge didn’t want to damage her career prospects, I would say it’s a public duty to do so.
Doctors hold a unique place in society, privy to the most intimate aspects of people’s lives. We transgress normal social boundaries in the questions we ask and how we touch and examine patients.
To do this, we must be able to command absolute, unconditional trust. And to maintain this, we must hold ourselves to the highest standards.
Of course, we’re still human and we make mistakes. But there’s a difference between getting a parking ticket, and stabbing someone. People who behave like Woodward have no place in our ranks.
I know quite a few public health doctors, and while they’re all very well-meaning — you’d happily buy a second-hand car off them — none of them comes across as though they let their hair down and have a good party every now and then.
And I think that’s part of the problem. Because they are so woefully out of touch with what normal, regular people enjoy and how they live their lives, the messages they come out with seem to consistently miss their mark.
If only public health officials realised that their puritanical, prescriptive and holier-than-thou attitude puts people off.
No one wants to be told how to behave by the dullard party-pooper sat in the corner with a scowl on their face. In fact, I’d argue that their approach often backfires and makes people behave in a contrary way.
In psychology, this is called ‘reactance’ and is based on the observation that people don’t like being told what to do, feel or think — and the more they’re pressured into this, the more they resist.
I experienced this myself when I smoked. The more campaigns I saw trying to scare me into quitting, the more I resisted. That’s how the mind works.
You’d think that people working in public health would know this.
Reactance is made all the worse when it becomes apparent that there’s no clear evidence for modifying your behaviour.
The classic example of this is with alcohol guidelines.
The way that public health officials have flip-flopped about the amounts people should, and shouldn’t, be drinking is, to my mind, a textbook case in how not to do it.
The messages are contradictory, keep changing and lack any credible evidence base. I’m a doctor, yet I’m now confused about the ‘safe’ limit for drinking.
Then, to cap it off, we had the Chief Medical Officer, Dame Sally Davies, saying there’s no safe limit and every glass carries a risk.
She said we should do as she does and think of cancer when considering whether to have a glass of wine.
Is she serious? What a party-pooper. Too often, those in public health come across as bossy and self-righteous. It means people switch off. Who can blame them?
Doctors tend to roll their eyes if patients say they’ve consulted ‘Dr Google’. Yet new research suggests that it can actually improve the relationship by making patients feel less sure about what’s wrong — and so value their GP’s contribution.
And sometimes, rather than turning people into hypochondriacs, it does the opposite.
One patient I treated in A&E said that based on what she’d read, she ‘just’ had glandular fever: in fact, she had TB. A salutary lesson in the risks of self-diagnosis.
Over the years that I have been a doctor, I have seen dozens of people who’ve become psychotic using cannabis. File image
I’ve seen cannabis ruin lives – DON’T legalise it
What on earth are the Liberal Democrats thinking? Reading their manifesto this week, I was horrified to see they were proposing to legalise cannabis. They need their heads examined.
It’s utterly absurd that a political party that has made so much in recent years of championing mental health would actively pledge to legalise something we know is linked to severe, crippling mental health problems.
It’s like someone championing running but promising to stamp on your foot.
Cannabis wrecks lives. Over the years that I have been a doctor, I have seen dozens of people who’ve become psychotic using it, and the number has increased recently as stronger forms such as skunk have become more widely available. The libertarian in me thinks that people should be free to make choices about what they do to themselves — then I remember my patients.
People aren’t making informed decisions about the risks because few ever witness the true horrors. Those that cannabis ruins are locked away in mental hospitals, or shut away in their rooms while their parents can only watch as their child slips away from them.
Proponents of legalisation erroneously claim there are few health problems associated with its use, but they cherry-pick individual studies to support their stance.
The prevailing evidence shows clear links between cannabis use and mental health problems. The Royal College of Psychiatrists is unequivocal: regular use of the drug has been found to double the risk of a psychotic episode or developing schizophrenia.
A seven-year study in Australia found that teenagers who used cannabis were five times more likely to develop depression or anxiety in later life. As the parent of any teenager who uses it will tell you, cannabis is also associated with personality and behavioural changes.
It enrages me that I have spent years trying to pick up the pieces of lives ruined by cannabis, yet here is a political party proposing reckless legislation that would see even more people destroyed.