DanBC

Be interesting to see if climbers like it - I'd love to see Wide Boys testing it out.

and the guys watching him were very lackadaisical about it.

Anyone who knows anything at all about suicide prevention is unsurprised by this. We know that observation does not work because staff cannot maintain it. This is true whether it's 15 minute obs, 5 minute obs, permanent line of sight obs, arms length obs, two to one arms length obs: they do not work.

There are countless examples of staff in hospital, on duty, doing obs, knowing their patient is at increased risk of suicide, falling asleep.

Your question was: "Does a balanced diet include fast food?"

The answer to that is simple: No

Registered healthcare professionals - dietitians - disagree with you, and do so pretty strongly.

I'm referencing Jonathan Haidt's work

Why not link to real numbers though? Haidt doesn't understand the numbers, misquotes them out of context, and mangles the data.

. The suicide rates of teen girls have tripled since the introduction of social media.

This is simply false.

It's what they claim to do. The science is bunk. It's genetic astrology.

Unfortunately, 1) these numbers come from Hamas

The official Israeli count is higher than the Hamas count.

Depression and sucidides in first world countries, the ones that tick all the intial boxes, are a highs not experienced since WWII. [1] is just from a quick googling and US-only. You won't have trouble finding much more evidence to support this though, for many other 1st world countries.

It's difficult to compare suicide statistics over time, especially over decades, because definitions change. (For one example, in England a coroner used to need to be able to prove beyond all reasonable doubt that a person had died by suicide, and that changed to balance of probabilities in 2018).

It's also important not to use sources like media outlets for suicide statistics, because they often don't understand what's being counted or how it's being counted. Statistics are tricky, and media often get them wrong.

You say that it's easy to show that suicides are at an all time high in many first world countries, but that's not correct. In many countries rates peaked in about 2008 - 2010 because of world wide financial crash, and have been declining since then. We might see another peak because of the financial (and other) distress caused by pandemic, but so far we're not seeing a big increase.

maybe it’s just me, but most of the new drugs seem to come from USA.

It's just you.

What we see from the US is re-patenting. Citalopram gets a minor change and becomes escitalopram, it gets a new patent and some bullshit sales pitch to make doctors switch from a cheap generic to a more expensive branded med. Or ketamine infusion becomes eskatamine nasal spray - moved from a generic and tricky to administer med to a branded and easy to administer med (and, it turns out, much less effective).

The other thing the US does is "Me too" drugs - someone develops an SSRI and the US is then able to spin up 8 different versions of SSRIs that are different enough to get their own names and patents.

Most of the funding in the US doesn't come from big pharmaceutical companies, but is government funding.

For the new meds that are developed in the US the funding normally comes from Government (NIHR) funding, and not direct from pharmaceutical companies.

It's also difficult to work out what to measure: do we look at GERD (gross expenditure on research and development) or do we look at GDP too? DO we look at the quantity of new meds, or the impact on quality of life or years of life lost to disability? Do we focus on meds aimed at diseases that affect wealthy countries (diabetes, breast cancer, etc) or on disease that mostly affects poorer countries? Because three meds that have moderate impact for a small population are "less" than one med that has a good strong impact on a large population.

I strongly agree with everything you say, but...

but I've always been slightly sceptical of claims about withdrawal effects of antidepressants.

Even the manufacturers warn against discontinuation effects. See the "If you stop taking venlafaxine" paragraph here: https://www.medicines.org.uk/emc/product/764/pil#gref

The UK NICE has advice about stopping antidepressant meds: https://www.nice.org.uk/guidance/ng215 and the UK BNF will mention withdrawal for some meds: https://bnf.nice.org.uk/drugs/venlafaxine/#treatment-cessati...

The Royal College of Psychiatrists has advice about stopping anti-depressants: https://www.rcpsych.ac.uk/mental-health/treatments-and-wellb...

Clearly, it's not a problem that affects everybody, and it's more common with some meds than others, but that doesn't mean these effects are not real.

Compare the mainstream American Academy of Pediatrics to the fringe American College of Pediatricians.

One pushes mainstream evidence based treatment, the other pushes socially conservative, Christian values, based "treatment".

https://en.wikipedia.org/wiki/American_Academy_of_Pediatrics

https://en.wikipedia.org/wiki/American_College_of_Pediatrici...

The Cass Review has also said that children should have easier access to cross sex hormones - they're considering removing the requirement for children to have spent time on puberty blockers before moving onto CSH.

The Cass review supports transition.

The alternative explanation is that it was almost impossible for trans children to access healthcare in the UK and the only people making their way through the pipeline of GP to GIC to hormone centre were those who were undeniably trans.

Double check those bone density results, because new research shows they're present before treatment with puberty blockers starts. Some theories are that some children have reduced access to sporting activity.

Puberty blockers have a long use in children. Unlike a lot of paediatric medications puberty blockers are licensed for use in children, and are used for their licensed use (blocking puberty), albeit for a different population (gender incongruent children with strong trans indicators, instead of children with precocious puberty).

This - being licensed in children, and being used mostly in line with the license - is better than many paediatric meds.

We have a lot of research about use in precocious puberty - they meds are mostly harmless. We don't have a huge amount of research in trans children, but that's for exactly the same reason we don't have research in a bunch of different meds for children.

they wheel you into the procedure room, and then you pass out.

This is the bit that a lot of people have a problem with, and there's usually some choices in the amount and type of sedation you get.

In the US they use much heavier sedation than other countries - use of propofol is not uncommon in the US - and it's one of the things that makes colonoscopy more risky than it needs to be.

One thing is clear: Screening works. If you’re of the appropriate age, please get screened. If your tubes are acting funny, please get screened without delay.

Screening is for people without symptoms.

If you have symptoms it's not screening, it's diagnostic testing. Diagnosis is important - if you bleed from anywhere you need it to be explained - but there are big differences in how you look at a test that's done for screening vs diagnosis.

Let's discuss what "invasive" means.

Putting something in the body and getting it back out without tearing, is not invasive.

Just for clarity colonoscopy is an invasive procedure.

Shaun Lintern is an experienced health system journalist. This piece, written by him and Danny Fortson, is a comprehensive take down of Babylon.

Lots of people had serious concerns about Babylon Health - mostly around obviously false claims of accuracy - for years, and it was baffling to see them keep getting money.

And the real story is pretty grim - copious amounts of corruption and deception, and a system not holding them to account.

It's notable that a key feature of their model - quick access GP appointments to push patients to private secondary care (where the people providing the GP appointments and the people providing the hospital care are in the same company) did not work, and could not work because the finances didn't make any sense even with the corruption and deception.

There are often discussions around NHS models of care, and people will suggest moving to a mix of public and private, or private but non profit insurance models. The simple fact is the model doesn't matter: healthcare doesn't work unless you fund it.

where they don't have money to fund NHS

We do have the money to fund the NHS. Successive Conservative governments have made the choice to defund the NHS, along with public health, and social care. And they did all of this on top of Brexit.

But the average for people in the US with insurance is better than it is in many systems with universal coverage,

No, this is actually untrue. People who pay for insurance want to see a return on investment, so they want to see lots of testing. This is why over-testing, over-diagnosis, and over-treatment are so common in the US, and why the rates of harm from these things is so prevalent in the US.

This thought - that insured Americans do better - often comes from a misunderstanding of things like 5 year survival rates for cancer. Imagine someone who will die, no matter what you do, from a slow growing cancer at the age of 75. In many countries that cancer is detected when the person is 73 or so, and they move onto a palliative pathway. In the US that cancer may be detected when the person is 67, and their insurance is drained and then their life savings are drained and then they're eventually moved onto a palliative pathway.

Do people really think that if they restrict access to methods of suicide people will magically get better?

No, but we have good evidence that as part of a package of measures it's an effective way to reduce the numbers of people dying by suicide.

Your post contains a number of flags that show you're not familiar at all with this topic. (eg, use of the phrase "commit suicide"). If you want more evidence based information you could look at the UK's NCISH. https://sites.manchester.ac.uk/ncish/

The difference is that statistics were used in de Berk's prosecution, but were not used in Letby's prosecution.

or should we read this article to imply Lucy herself might be innocent?

No, the point being made is that a murderer was able to evade detection because her employing organisation did not understand the data they had, because they did not understand statistics.

Just for clarity: statistics were not used in the Letby prosecution.

The problem with Letby is that a serial killer was able to hide because finding a rare event (a member of staff murdering multiple babies) is hard to do in the noise (the mish mash of data available).

Currently the English NHS is moving away from SIRI (Serious Incident Requiring Investigation) to PSIRF (Patient Safety Incident Response Framework) which focuses a lot more on "no blame" and "open culture", so it's important that NHS Trusts get the stats right to be able to detect and understand these very rare events.

Day One of her cool new job in the UK NHS she was handed a stack of paperwork that she had to fill in. Needless to say she did badly; it took her forever and everything was misspelled. She lasted a month before they let her go, and she was glad to go. Her degree was very vocational - there aren't many opportunities for qualified OTs outside the health industry - and every single OT needs to deal with stacks of paperwork every day. [0]

I'm sorry to hear your ex-girlfriend's employer failed in their legal duty to provide reasonable adjustments under the Equality Act.

If it was a trust in England I'd be happy to push through complaints for her.

Often early detection does very little to change when people die. It will mean that 5 year survival rates get better, because you have earlier detection which means more people know they have cancer for five years before they die, rather than finding out they have cancer 3 years before they die.

For lots of people this means they'll get lots of testing, lots of treatment, lots of harm caused by testing and treatment, and some of them will die early, and some of them will die at the same time, and some of them will have their life extended by all this testing and treatment.

It's really complex for the general public to understand this because it involves probability and statistics and these are both things that are very tricky for people to understand. (See eg Monty Hall or regression to the mean or anything involving percentages).

Without knowing the sensitivity or specificity there's no way of knowing if it's telling you that you definitely do have cancer or just may have cancer.

Any death by suicide is a tragedy, and whatever the rate is for surgeons it's too high. This is especially true because there are some protective factors for surgeons - high pay, stable employment, and close connections to health care.

But it's simply incorrect to say that surgeons, or doctors in general, have high rates of death by suicide.

Whenever anyone presents information about suicide it's important to ask what's being counted, how is it being counted, and who is doing the analysis.

Here's CDC suicide rates by industry: https://www.cdc.gov/mmwr/volumes/69/wr/mm6903a1.htm

And Male and female suicide rates per 100,000 civilian, noninstitutionalized working persons aged 16-64 years for major industry groups meeting reporting criteria: https://stacks.cdc.gov/view/cdc/84274

The rate for healthcare is 7.5 per 100,000 population, but that's driven by female nurses (who have a higher rate of death by suicide than doctors).

Compared with rates in the total study population, suicide rates were significantly higher in five major industry groups: 1) Mining, Quarrying, and Oil and Gas Extraction (males); 2) Construction (males); 3) Other Services (e.g., automotive repair) (males); 4) Agriculture, Forestry, Fishing, and Hunting (males); and 5) Transportation and Warehousing (males and females). Rates were also significantly higher in six major occupational groups: 1) Construction and Extraction (males and females); 2) Installation, Maintenance, and Repair (males); 3) Arts, Design, Entertainment, Sports, and Media (males); 4) Transportation and Material Moving (males and females); 5) Protective Service (females); and 6) Healthcare Support (females).

US's lifespan is not caused by lack of access to healthcare though, that is fentanyl.

How do people with substance use disorders stop using substances? They use healthcare, unless they're in the US where they'll using some quasi-religious abstinence-only residential programme.