Might cricket ban close-in fielders some day?

Michael Jeh in Cricinfo


Following Matt Renshaw's concussion injury, a respected cricket writer posed the question: will we ever get to the point where short leg, bat pad and silly mid-off are banned in international cricket?

In junior cricket in Australia that is already the case. I'm not sure if it is the same in places like India, where the art of spin bowling (and batting against it) will be poorer for such rules. More realistically, given the litigious climate we inhabit, can a fielder refuse the captain's instructions to field in a position that compromises his or her safety? Especially in professional cricket, where livelihoods are at stake, what are the health and safety implications of deliberately putting an employee in a dangerous position, knowing full well that serious injury is a possible outcome?

Barely 40 years on from when Tony Greig wore a motorcycle helmet while batting, it is almost as rare to now see a first-class cricketer batting in a hat or cap.

I have seen the helmet policy change radically - from wearing one being optional, to having to sign an indemnity form if you didn't wear one, to it now being a case of "no helmet, no play" at my local cricket club. This transformation has taken place in the time it has taken my son to progress from Under-8s to U-13s, accelerated no doubt by the Phillip Hughes accident (even though Hughes was wearing a helmet at the time).

In first-class cricket, the rules are so ridiculous that you are allowed to bat in a cap, but if you wear a helmet, it has to meet certain design specs.


Can a fielder refuse the captain's instructions to field in a position that compromises his or her safety?

I remain convinced that this blind faith in helmets is breeding a generation of cricketers who are sometimes technically inept, attempting to pull off the front foot instead of getting inside the line of the ball, or trying to play shots when ducking may have been wiser. In the last two weeks, at least four international batsmen have been hit in the head in Australia and New Zealand. Musfiqur Rahim was the most serious of these cases.

Even bizarre accidents can sometimes be predictable. Umpiring in an U-9 game recently, I refused to allow a batsman to face up because he was not wearing gloves. The opposition coach (also a parent) took exception to my decision, arguing that his son was prepared to take the risk. My counter-argument was that I was not prepared to put my fielders at risk if the bat flew from his hand on a hot, sweaty Brisbane morning. The acid burn of the wrath I incurred hurts less today as I view the replay of Peter Nevill's injury in the Big Bash.

A few years ago Queensland Cricket, in a noble but futile attempt to improve the "spirit of cricket" on the grade-cricket scene, ran a workshop where every captain of every club in every grade was forced to attend an event that tried to encourage a less abrasive, more sportsmanlike atmosphere. If a captain did not attend this workshop, his team lost points if he subsequently captained that season.

On the night in question, when each group was given a different hypothetical situation to mull over (for example: what do you do if an overnight not-out batsman turned up ten minutes late the next day because he was tending to his sick child?) I raised the issue of bowlers and fielders making threats against the batsman along the lines of "I'm going to f***ing kill you." My point was that even if it was not meant literally but taken to signal they were going to bowl aggressively at the batsman's body, once those words were said, if the batsman was actually killed (or badly injured), would there be a case to answer for premeditated assault occasioning bodily harm or worse? Would witnesses (fielders, umpires, non-striker) be asked to testify, under oath, as to whether they actually heard that threat being made, regardless of whether they thought it was meant literally or not?



Gautam Gambhir leaps to avoid getting hit by a shot from Michael Clarke in Delhi, 2008 © AFP


On hearing my question, the first-grade captain of another club stood up in disgust and said that if the evening was going to descend into complete farce with questions of this nature, he was taking leave forthwith. And that was the general consensus in the room: ridiculous question, it will never happen, can we move on to more realistic scenarios please? The hypothetical question I posed was never addressed. Many in the room thought I had pushed credibility too far.

Sadly, vindication is often a dish served cold, but it has a sour aftertaste. It wasn't long before we had the coronial inquest into the death of Hughes, and many of those same questions were posed by the coroner, Michael Barnes. We never quite got to the bottom of the matter, but the coroner was sufficiently unconvinced to note: "The repeated denials of any sledging having occurred in the game in which Phillip Hughes was injured were difficult to accept. Hopefully the focus on this unsavoury aspect of the incident may cause those who claim to love the game to reflect upon whether the practice of sledging is worthy of its participants. An outsider is left to wonder why such a beautiful game would need such an ugly underside."

So what's next? Players (employees) taking legal action against selectors for unfair recruitment policies? Suing your cricket board for making you play while injured? Been there, done that, thanks Nathan Bracken!

Can a batsman who has scored more runs in first-class cricket (Callum Ferguson, for example) make a case for unfair dismissal or discrimination if they jettison him after just one Test for an X-factor cricketer (Nic Maddinson) whose numbers don't quite match up and who is given three Tests? Ridiculous? Yes. Possible? Yes.

No bat pad? No leg slip? It might be a bridge too far. It will change the face of cricket forever, of course. But it won't be the first time that an outlandish suggestion morphs into an everyday reality.

Can we really justify spending £5.5m per Olympic medal at Rio 2016

Janet Street Porter in The Independent


Winning medals in Rio certainly makes us feel good, and the sight of dedicated, super-fit young people celebrating years of hard work is absolutely inspiring and moving. But the big question must be this: are the Rio Olympics anything more than high grade TV entertainment?

Our national success has been at a large financial and, possibly, social cost. UK Sport, which decides how to allocate tax and lottery money, has a ruthless policy. Put bluntly, its remit is to focus on backing winners, to hunt out the rare people who can achieve the remarkable. This highly controversial strategy means that sports which didn’t deliver predicted results at the London Olympics in 2012 – table tennis, swimming and volleyball, for example – had their funding cut.

Two thirds of UK Sport’s money goes to specially selected 14-25 year olds – the winners of the next decade and the 2024 Olympics – and they also fund an elite group of “podium level athletes” with extra cash for living expenses and training.

This policy has brought massive success in Rio, where the UK stands second above China in the medals table, when we were ranked 36th in Atlanta just two decades ago. But the picture on the other side of the television set is far from encouraging.

Slumped on sofas all over the country, we sit glued to the screen with spreading bums and tums and atrophied leg muscles. One in four of us now resemble Neil the Sloth from the Sofaworks advert.

In spite of the government spending millions on public health campaigns, Brits do less than 30 minutes of any exercise (including walking at a normal pace) in a week. Worse, new research reveals that years spent hunched over laptops, tapping on smart phones and playing video games has resulted in a generation of young men having weaker hand grips than 30 years ago. Their muscles are starting to atrophy and shrink.

How to address this lack of motivation in our national psyche, and make exercise part of everyday life? That’s the way it is here in Sweden, where I’m on holiday (I’ve seen very few fat children).

Sport England launched a four-year strategy last May to encourage more grassroots participation in sport, but the task is daunting. The truth is that Olympic success simply doesn’t galvanise ordinary people to take a walk, go for a swim, play a game of tennis or learn to box.

We look on our gold medal winners as gorgeous pinups, who we revere and cherish, but who perform in a way we cannot relate to. They have nutritionists, wear aerodynamic clothing, and are 100 per cent driven. They are not normal shapes, their bodies have adapted to achieve maximum potential through specialised training. Laura Trott, Jason Kenny and their teammates are modern gods, not role models.

The discrepancy between the impressive achievements by Team GB and a lack of motivation in the population at large is increasing. The number of adults playing any sport has dropped since 2012. In the poorest areas like Yorkshire and Humber, 67,000 fewer people are involved in sport. In Doncaster the decline is over 13 per cent, whereas in well-heeled Oxford, it’s up 14 per cent.

Overall, more than 350,000 people have taken to their sofas and given up exercise of any kind in the four years since London 2012.

David Cameron might have given an extra £150m to fund sports in primary schools until 2020, but that sum is pitiful given the way sport has been systematically downgraded by the Department of Education over the last 10 years. Now, the amount of time children spend each week playing sports and participating in PE has dropped to one hour and 42 minutes a week – that’s 25 minutes less than 2010.

To make regular activity part of a normal mindset, you have to start in primary schools. All over the country, ageing swimming pools are being closed by councils anxious to save money on repairs. Most will be in the poorest areas. Local authority cuts have seen playing fields sold off and opening hours of existing facilities curtailed.

It’s been estimated that each medal in Rio has cost £5.5m of public funding. There are some tough questions to be asked about whether financial priorities should be re-aligned to focus on the many, rather than the few.

Creative Visualisation - Your Mind Can Keep You Well

PSI TEK

Did you know that it is only recently that medical doctors have accepted how important the power of the mind is in influencing the immune system of the human body? Many decades passed before these men of science decided to test the proposition that the brain is involved in the optimum functioning of the different body systems. Recent research shows the undeniable connection --the link-- between mind and body, which challenged the long-held medical assumption. A new science called psychoneuroimmunology or PNI, the study of how the mind affects health and bodily functions, has come out of such research.

A psychologist at the University of Texas Health Science Center, Lean Achterberg, suggests that emotion may form the link between mind and immunity. “Many of the autonomic functions connected with health and disease,” she explains,” are emotionally triggered.”

Exercises which encourage relaxation and mental activities such as creative visualization, positive thinking, and guided imagery produce subtle changes in the emotions which can trigger either a positive or a negative effect on the immune system. This explains why positive imaging techniques have resulted in dramatic healings in people with very serious illnesses, including cancer.

OMNI magazine claims (February, 1989), in a cover article entitled “Mind Exercises That Boost Your Immune System”:

“As far back as the Thirties, Edmund Jacobson found that if you imagine or visualize yourself doing a particular action - say, lifting an object with your right arm - the muscles in that arm show increased electrical activity. Other scientists have found that imagining an object moving across the sky produces more eye movements than visualizing a stationary object.”

One of the most dramatic applications of imagery in coping with illness is the work of Dr. Carl Simonton, a radiation cancer specialist in Dallas, Texas. “By combining relaxation with personalized images,” reports OMNI magazine, “he has helped terminal cancer patients reduce the size of their tumors and sometimes experience complete remission of the disease.”

Many of his patients have benefited from this technique. It simply shows how positive visualization can help alleviate - if not totally cure - various diseases including systemic lupus erythomatosus, migraine, chronic back pain, hyperthyroidism, high blood pressure, hyper-acidity, etc.

However, individual differences have to be taken into consideration when discussing each patient’s progress. It’s understandable that individuals have varying abilities to visualize or create mental images clearly; some people will benefit more from positive-imagery techniques than others

Nevertheless, if visualization can help people overcome diseases, it could possibly help healthy individuals keep their immune system in top shape. Says OMNI magazine: “Practicing daily positive-imaging techniques may, like a balanced diet and physical exercise routine, tip the scales of health toward wellness.”

The Simonton process of visualization for cancer

Dr. Carl Simonton, a radiation cancer specialist, and his wife, Stephanie Matthews-Simonton, a psychotherapist and counselor specializing in cancer patients, have developed a special visualization or imaging technique for the treatment of cancer which is now popularly known as the Simonton process. Ridiculed at first by the medical profession, the Simonton process is now being used in at least five hospitals across the United States to fight cancer.

The technique itself is the height of simplicity and utilizes the tremendous powers of the mind, specifically its faculty for visualization and imagination, to control cancer. First, the patient is shown what a normal healthy cell looks like. Next, he is asked to imagine a battle going on between the cancer cell and the normal cell. He is asked to visualize a concrete image that will represent the cancer cell and another image of the normal cell. Then he is asked to see the normal cell winning the battle against the cancer cell.

One youngster represented the normal cell as the video game character Pacman and the cancer cell as the “ghosts” (enemies of Pacman), and then he saw Pacman eating up the ghosts until they were all gone.

A housewife saw her cancer cell as dirt and the normal cell as a vacuum cleaner. She visualized the vacuum cleaner swallowing up all the dirt until everything was smooth and clean.

Patients are asked to do this type of visualization three times a day for 15 minutes each time. And the results of the initial experiments in visualization to cure cancer were nothing short of miraculous. Of course, being medical practitioners, Dr. Simonton and his psychologist wife were aware of the placebo effect and spontaneous remission of illness. As long as they were getting good results with the technique, it didn’t seem to matter whether it was placebo or spontaneous remission.

The Simontons also noticed that those who got cured had a distinct personality. They all had a strong will to live and did everything to get well. Those who didn’t succeed had resigned themselves to their fate.

While the Simontons were exploring the motivation of cancer patients, they were also looking into two interesting areas of research at that time: biofeedback and the surveillance theory. Both areas had something to do with the influence of the mind over body processes. Stephanie Simonton explains in her book The Healing Family:

In biofeedback training, an individual is hooked up to a device that feeds back information on his physiological processes. A patient with tachycardia, an irregular heartbeat, might be hooked up to an oscilloscope, which will give a constant visual readout of the heartbeat. The patient watches the monitor while attempting to relax…when he succeeds in slowing his heartbeat through his thinking, he is rewarded immediately by seeing that fact on visual display.

The surveillance theory holds that the immune system does in fact produce ‘killer cells’ which seek out and destroy stray cancer cells many times in our lives, and it is when this system breaks down, that the disease can take hold. When most patients are diagnosed with cancer, surgery, radiation and/or chemotherapy are used to destroy as much of the tumor as possible. But once the cancer is reduced, we wondered if the immune system could be reactivated to seek out and destroy the remaining cancer cells.

The Simontons reasoned that since people can learn how to influence their blood flow and heart rate by using their minds, they could also learn to influence their immune system. Later research proved their approach to be valid.

For instance, according to the Time-Life Book The Power of Healing, “chronic stress causes the brain to release into the body a host of hormones that are potent inhibitors of the immune system”. “This may explain why people experience increased rates of infection, cancer, arthritis, and many other ailments after losing a spouse.” Dr. R.W. Berthop and his associates in Australia found that blood samples of bereaved individuals showed a much lower level of lymphocyte activity than was present in the control group’s samples. Lymphocytes are a variety of white blood cells consisting of T cells and B cells, both critical to the action of the immune system. T cells directly attack disease-causing bacteria, viruses, and toxins, and regulate the other parts of the immune system. B cells produce antibodies, which neutralize invaders or mark them for destruction by other agents of the immune system.

The Power of Healing concludes: “The idea that there is a mental element to healing has gained acceptance within the medical establishment in recent years. Many physicians who once discounted the mind’s ability to influence healing are now reconsidering, in the light of new scientific evidence. All these have led some physicians and medical institutions toward a more holistic approach, to treating the body and mind as a unit rather than as two distinct entities. Inherent in this philosophy is the belief that patients must be active participants in the treatment of their illnesses.




Using visualization for minor ailments

Today, many scientific breakthroughs have proven that minor infections and viruses may be healed, or at least lessened in severity by employing mental techniques similar to those used by cancer patients who have successfully shrunk tumors through positive imaging or visualization.

The theory is that creative visualization can create the same physiological changes in the body that a real experience can. For example, if you imagine squeezing a lemon into you mouth, you will most likely salivate, the same way as when a real lemon is actually being squeezed into your mouth. Einstein once declared that, “Imagination is more important than knowledge.”

In the 1985 World Conference on Imaging, reports OMNI magazine (February 1989), registered nurse Carol Fajoni observed that “people who used imagery techniques to heal wounds recovered more quickly than those who did not. In workshops, the same technique has been used by individuals suffering from colds with similar results.” The process has been hailed as a positive breakthrough and is currently being used by more enlightened doctors, according to OMNI magazine.

Visualize that part of your body which is causing the problem. Then erase the negative image and instead picture that organ or part to be healthy. Let's say you have a sinus infection. Just picture your sinus passageways and cavities as beginning to unclog. Or if you have a kidney disorder, imagine a sick-looking kidney metamorphose into a healthier one.

“In trying to envision yourself healthy, you need not view realistic representations of the ailing body part. Instead, imagine a virus as tiny spots on a blackboard that need erasing. Imagine yourself building new, healthy cells or sending cleaning blood to an unhealthy organ or area.”

“If you have a headache, picture your brain as a rough, bumpy road that needs smoothing and proceed to smooth it out. The point is to focus on the area you believe is causing you to feel sick, and to concentrate on visualizing or imaging it to be well. The more clearly and vividly you can do this, the more effective the technique becomes.”

Another method for banishing pain was developed by Russian memory expert, Solomon V. Sherehevskii, as reported by Russian psychologist Professor Luria. To banish pain, such as a headache, Sherehevskii would visualize the pain as having an actual shape, mass and color. Then, when he had a “tangible” image of the pain in his mind, he would visualize or imagine this concrete picture slowly becoming smaller and smaller until it disappeared from his mental vision. The real pain disappears with it. Others have modified this same technique and suggest that you imagine a big bird or eagle taking the concrete image of the pain away. As it flies over the horizon, see it becoming smaller until it disappears from your view. The actual pain will disappear with it.


Of course, the effectiveness of this imaging technique depends on the strength of your desire to improve your health and your ability to visualize well. But there is no harm in trying it, because unlike drugs, creative visualization has no side effects.

Practice any of these visualization techniques three times a day for one week and observe your health improve.

If "Protest never changes anything"? Look at how TTIP has been derailed

Owen Jones in The Guardian

People power has taken on big business over this transatlantic stitch-up and looks like winning. We should all be inspired.

 

Illustration by Ben Jennings


For those of us who want societies run in the interests of the majority rather than unaccountable corporate interests, this era can be best defined as an uphill struggle. So when victories occur, they should be loudly trumpeted to encourage us in a wider fight against a powerful elite of big businesses, media organisations, politicians, bureaucrats and corporate-funded thinktanks.

Today is one such moment. The Transatlantic Trade Investment Partnership (TTIP) – that notorious proposed trade agreement that hands even more sweeping powers to corporate titans – lies wounded, perhaps fatally. It isn’t dead yet, but TTIP is a tangled wreckage that will be difficult to reassemble.

Doubts rise over TTIP as France threatens to block EU-US deal



Those of us who campaigned against TTIP – not least fellow Guardian columnist George Monbiot – were dismissed as scaremongering. We said that TTIP would lead to a race to the bottom on everything from environmental to consumer protections, forcing us down to the lower level that exists in the United States. We warned that it would undermine our democracy and sovereignty, enabling corporate interests to use secret courts to block policies that they did not like.

Scaremongering, we were told. But hundreds of leaked documents from the negotiations reveal, in some ways, that the reality is worse – and now the French government has been forced to suggest it may block the agreement.

The documents imply that even craven European leaders believe the US demands go too far. As War on Want puts it, they show that TTIP would “open the door” to products currently banned in the EU “for public health and environmental reasons”.

As the documents reveal, there are now “irreconcilable” differences between the European Union’s and America’s positions. According to Greenpeace, “the EU position is very bad, and the US position is terrible”.

The documents show that the US is actively trying to dilute EU regulations on consumer and environmental protections. In future, for the EU to be even able to pass a regulation, it could be forced to involve both US authorities and US corporations, giving big businesses across the Atlantic the same input as those based in Europe.

With these damning revelations, the embattled French authorities have been forced to say they reject TTIP “at this stage”. President Hollande says France would refuse “the undermining of the essential principles of our agriculture, our culture, of mutual access to public markets”. And with the country’s trade representative saying that “there cannot be an agreement without France and much less against France”, TTIP currently has a bleak future indeed.

There are a number of things we learn from this, all of which should lift hopes. First, people power pays off. European politicians and bureaucrats, quite rightly, would never have imagined that a trade agreement would inspire any interest, let alone mass protests. Symptomatic of their contempt for the people they supposedly exist to serve, the negotiations over the most important aspects of the treaty were conducted in secret. Easy, then, to accuse anti-TTIP activists of “scaremongering” while revealing little of the reality publicly.

But rather than give up, activists across the continent organised. They toxified TTIP, forcing its designers on the defensive. Germany – the very heart of the European project – witnessed mass demonstrations with up to 250,000 people participating.

From London to Warsaw, from Prague to Madrid, the anti-TTIP cause has marched. Members of the European parliament have been subjected to passionate lobbying by angry citizens. Without this popular pressure, TTIP would have received little scrutiny and would surely have passed – with disastrous consequences.

Second, this is a real embarrassment to the British government. Back in 2011, David Cameron vetoed an EU treaty to supposedly defend the national interest: in fact, he was worried that it threatened Britain’s financial sector. The City of London and Britain are clearly not the same thing. But Cameron has been among the staunchest champions of TTIP. He is more than happy to undermine British sovereignty and democracy, as long as it is corporate interests who are the beneficiaries.

And so we end in the perverse situation where it is the French government, rather than our own administration, protecting our sovereignty.

And third, this has real consequences for the EU referendum debate. Rather cynically, Ukip have co-opted the TTIP argument. They have rightly argued that TTIP threatens our National Health Service – but given that their leader, Nigel Farage, has suggested abolishing the NHS in favour of private health insurance, this is the height of chutzpah.

Ukip have mocked those on the left, such as me, who back a critical remain position in the Brexit referendum over this issue. But if we were to leave the EU, not only would the social chapter and various workers’ rights be abandoned – and not replaced by our rightwing government – but Britain would end up negotiating a series of TTIP agreements. We would end up living with the consequences of TTIP, but without the remaining progressive elements of the EU.
Instead, we have seen what happens when ordinary Europeans put aside cultural and language barriers and unite. Their collective strength can achieve results. This should surely be a launchpad for a movement to build a democratic, accountable, transparent Europe governed in the interests of its citizens, not corporations. It will mean reaching across the Atlantic too.

For all President Obama’s hope-change rhetoric, his administration – which zealously promoted TTIP – has all too often championed corporate interests. However, though Bernie Sanders is unlikely to become the Democratic nominee, the incredible movement behind him shows – particularly among younger Americans – a growing desire for a different sort of US.

In the coming months, those Europeans who have campaigned against TTIP should surely reach out to their American counterparts. Even if TTIP is defeated, we still live in a world in which major corporations often have greater power than nation states: only organised movements that cross borders can have any hope of challenging this unaccountable dominance.

From tax justice to climate change, the “protest never achieves anything” brigade have been proved wrong. Here’s a potential victory to relish, and build on.

I’m starting to hate the EU. But I will vote to stay in

George Monbiot in The Guardian

On jobs, health and wildlife, the European Union is often all that stands between us and unfettered corporate power

 

Slurry runoff polluting a river: ‘What Cameron described in parliament as “pettifogging bureaucracy” are the rules that prevent children from being poisoned by exhaust fumes, rivers from being turned into farm sewers.’ Photograph: Alamy



By instinct, like many on the left, I am a European. I recognise that many issues – perhaps most – can no longer be resolved only within our borders. Among them are grave threats to our welfare and our lives: climate change and the collapse of the living world; the spread of epidemics whose vectors are corporations (obesity, diabetes and diseases associated with smoking, alcohol and air pollution); the global wealth-grab by the very rich; antibiotic resistance; terrorism and conflict.

I recognise that the only legitimate corrective to transnational power is transnational democracy. So I want to believe; I want to belong. But it seems to me that all that is good about the European Union is being torn down, and all that is bad enhanced and amplified.

Nowhere is this clearer than in the draft agreement secured by David Cameron. For me, the most disturbing elements are those that have been widely described in the media as “uncontroversial”: the declarations on regulations andcompetitiveness. The draft decisions on these topics are a long series of euphemisms, but they amount to a further dismantling of the safeguards defending people, places and the living world.

What Cameron described in parliament as “pettifogging bureaucracy” is the rules that prevent children from being poisoned by exhaust fumes, rivers from being turned into farm sewers and workers from being exploited by their bosses. What the European commission calls reducing the “regulatory burden for EU business operators” often means increasing the costs the rest of us must carry: costs imposed on our pockets, our health and our quality of life. “Cutting red tape” is everywhere portrayed as a good thing. In reality, it often means releasing business from democracy.

There is nothing rational or proportionate about the deregulation the commission contemplates. When Edmund Stoiber, the conservative former president of Bavaria, reviewed European legislation, he discovered that the combined impact of all seven environmental directives incurred less than 1% of the cost to business caused by European law. But, prodded by governments including ours, the commission threatens them anyway. It is still considering a merger and downgrading of the habitats and birds directives, which are all that impede the destruction of many of our precious places and rare species.

Alongside such specific threats, the EU is engineering treaties that challenge the very principle of parliamentary control of corporations. As well as theTransatlantic Trade and Investment Partnership (TTIP), it has been quietly negotiating something even worse: a Trade in Services Agreement (Tisa). These claim to be trade treaties, but they are nothing of the kind. Their purpose is to place issues in which we have a valid and urgent interest beyond the reach of democratic politics. And the commission defends them against all comers.

Are such tendencies accidental, emergent properties of a highly complex system, or are they hardwired into the structure of the EU? The more I see, the more it seems to me that the EU’s problems are intrinsic and systemic. The organisation that began as an industrial cartel still works at the behest of the forces best equipped to operate across borders: transnational corporations. The commission remains a lobbyists’ paradise: opaque, sometimes corruptible, almost unnavigable by those without vast resources.

People such as the former Labour home secretary Alan Johnson, who claim the EU is a neutral political forum – “simply a place we have built where we can manage our interdependence” – are myth-makers. They are the equivalent of the tabloid fabulists who maintain that European rules will reclassify Kent as part of France, force people to trade in old battery-operated sex toys for new ones, and ensure that dead pets are boiled for half an hour in a pressure cooker before they are buried.

So should those who seek a decent, protective politics vote to stay or vote to leave? If you wish to remain within the EU because you imagine it is a progressive force, I believe you are mistaken. That time, if it ever existed, has passed. The EU is like democracy, diplomacy and old age: there is only one thing to be said for it – it is not as bad as the alternative.

If you are concerned about arbitrary power, and the ability of special interests to capture and co-opt the apparatus of the state, the UK is in an even worse position outside the EU than it is within. Though the EU’s directives are compromised and under threat, they are a lot better than nothing. Without them we can kiss goodbye to the protection of our wildlife, our health, our conditions of employment and, one day perhaps, our fundamental rights. Without a formal constitution, with our antiquated voting arrangements and a corrupt and corrupting party funding system, nothing here is safe.


Though the EU’s directives are compromised and under threat, they are a lot better than nothing

The UK government champs and rears against the European rules that constrain it. It was supposed to have ensured that all our rivers were in good ecological condition by the end of last year: instead, lobbied by Big Farmer and other polluting businesses, it has achieved a grand total of 17%. On behalf of the motor industry, it has sought to undermine new European limits on air pollution, after losing a case in the supreme court over its failure to implement existing laws. Ours is the least regulated labour market in Europe, and workers here would be in an even worse fix without the EU.

On behalf of party donors, old school chums, media proprietors and financial lobbyists, the government is stripping away any protections that European law has not nailed down. The EU’s enthusiasm for treaties such as TTIP is exceeded only by Cameron’s. His defence of national sovereignty, subsidiarity and democracy mysteriously evaporates as soon as they impinge upon corporate power.

I believe that we should remain within the union. But we should do so in the spirit of true scepticism: a refusal to believe anything until we have read the small print; a refusal to suspend our disbelief. Is it possible to be a pro-European Eurosceptic? I hope so, because that is what I am.

This NHS crisis is not economic. It's political

Aditya Chakrabortty in The Guardian


As the health services endures its biggest squeeze, talk of it being unviable is wide of the mark. We cannot afford to do without it

 

Patients wait for spaces in A&E at Royal Stoke university hospital in Stoke-on-Trent. A&E waiting time targets have been watered down in recent years. Photograph: Alicia Canter for the Guardian


How many times have you read that the NHS is bust? No need for answers on a postcard: I can tell you.

Over 2015, the number of national newspaper headlines featuring “NHS” alongside the words bust, deficit, meltdown or financial crisis came to a grand total of 80. Call this the NHS panic index – a measure of public anxiety over the viability of our health service. Using a database of all national newspapers, our librarians added up the number of such headlines for each year. The index shows that panic over the sustainability of our healthcare isn’t just on the rise ­– it has begun to soar.


During the whole of 2009, just two pieces appeared warning of financial crisis in the NHS. By 2012 that had nudged up a bit, to 12. Then came liftoff: the bust headlines more than doubled to 30 in 2013, before nearly tripling to 82 in 2014. Newspapers such as this one now regularly carry warnings that our entire system of healthcare could go bankrupt – unless, that is, radical change ­are made. For David Prior, the then chair of the health watchdog the Care Quality Commission - and now health minister, that means giving more of the system to private companies.

This means that the press and political classes are now discussing a theoretical impossibility. Think about it for a moment, and you realise the NHS can’t go broke. It’s not an endowment with a set pot of cash, but a giant service with a yearly budget. Unlike a business, it doesn’t need to raise money from sales – as taxpayers and voters, we have the final say over how much funding it gets. This panic isn’t economic at all, but politically created.

The balance to be struck with the NHS, as with all public services, is between how much cash we sink into it and how much we expect in return. Give the NHS less money, get less healthcare. Give it more, and the opposite happens. As Rowena Crawford at the Institute for Fiscal Studies says: “Financial stability just requires that healthcare demand and expectations are constrained to match the available funding.”

And that right there is the rub. Because the NHS is enduring the sharpest and most prolonged spending squeeze in its history – even while the government pretends no such thing is happening and the public expect the same service. Our health service is where all the paradoxes of austerity come home to roost.

This may seem an odd thing to say. Isn’t the NHS one of the very few parts of the public realm to be sheltered from this decade’s cuts? Didn’t David Cameron promise before the last general election to “protect the NHS budget and continue to invest more”?

  David Cameron addresses the Tory conference in October 2014. Photograph: Facundo Arrizabalaga/EPA

The figures suggest otherwise. True, the NHS is seeing a rise in its funding. Between 2010 and 2014, health spending went up 0.8% each year, adjusting for inflation. A plus sign in front, granted, but a teeny-tiny one – since its creation in 1948, the health service has never had it so bad. Over this decade as a whole, that allocation will amount to 1.2% a year, which is way down on the average 3.7% that health spending grew each year between 1949 and 1979. And, coming after the 6.7% extra that Gordon Brown was shovelling in annually by the time of the banking crash, it feels like a recession.

So on the one hand, you have a healthcare system that can cause even the most secular of Brits to get religion, that can drive Telegraph-reading colonels to channel their inner Nye Bevan – hell, that even beats Justin Bieber to a Christmas No 1. And on the other you have a Tory prime minister who wants to cut public spending but knows that harming the NHS will be electoral poison.

Put the two together and what do you get? A dangerous muddle of overspending, frontline service cuts and political self-denial.

Cameron pretends the NHS isn’t on austerity rations and expects it to do the same work to pretty much the same targets. The various parts of the NHS try to do just that with a budget smaller than they need, with the result that they begin missing targets and making cuts even while breaking their budgets.

Take the A&E waiting times. Under Labour, the old rule was that 98% of patients must be seen within four hours. Soon after Cameron moved into Downing Street in 2010, the target was watered down to 95% of patients – even so it is now routinely missed. The number of patients stuck on trolleys in A&E, while staff try to find them beds is now at levels that “no civilised society should tolerate”, according to the Royal College of Emergency Medicine .

Even while falling short, arm after arm of the NHS is now in the red: 95% of hospital and other acute care providers in England plunged into deficit in the first half of the financial year starting in April, joining 80% of ambulance providers and 46% of those in mental health.

Demoralised staff can resign, go on an agency book, pick their shifts and earn more

You might treat all this as argument for NHS staff to be more productive. Except that, as John Appleby of the King’s Fund thinktank argues, they are. He calculates that, had NHS activity only gone up in line with government money, between 2010 and 2015 it would have treated 3.7 million fewer outpatients and 4.5 million fewer A&E patients than actually got seen.

This is productivity as doing more with less, which is almost always unsustainable. A real increase in productivity would come from doing things differently. There’s certainly scope to do that – by doing more phone consultations with GPs, perhaps, or upgrading technology. One joke among NHS professionals runs that, in all of China, there’s but one factory left still making fax machines, and that its only client is the NHS. But this sort of change is never going to come in an organisation now in a frenzy of cost-cutting.

One example of NHS austerity’s screwy logic is its sudden reliance on expensive agency staff. This, says Anita Charlesworth of the Health Foundation charity, is a direct result of staff pay freezes and overwork: “If you’re a permanent member of staff and you’ve had no pay rise and you’re demoralised and disengaged you can resign from the NHS, you can go on an agency book, you can pick your shifts, you can pick your wards and you earn more.”

The result is that agency staff costs are rising at over 25% a year.


Meanwhile, NHS England pretends it can cap hospital deficits for the year at £2.2bn – even though in the first six months alone that had already hit £1.6bn . Some of Britain’s biggest and most renowned hospitals are now actively planning on ending the year in the red. And Appleby points out that everything from patient time with doctors and nurses to repairs of your local hospital’s roof is being sacrificed in order to do the same work with less money.

“I can see another Jennifer’s ear coming,” Appleby says, referring to the five-year-old with glue ear who waited a year for a simple operation and ended up being used by Neil Kinnock to attack John Major on health spending. “Only this time it probably won’t be something as innocuous as glue ear. It might be a child who dies of cancer because their medical care has been so drastically cut.”

As societies get richer and older, they spend more on healthcare. Compared with nearly everyone else in western Europe, the UK spends much less of its national income on health. By the end of this decade, we will be even further behind. Meanwhile, pundits will continue to claim the entire system is unaffordably expensive, even while the public still want and need doctors and nurses, their medicines and operations.

This is the paradox of austerity: pretending that you can scrap and scrimp on the services and institutions that make you a civilised country, without making your country less civilised.

Travelling to work 'is work', European court rules

BBC News

Time spent travelling to and from first and last appointments by workers without a fixed office should be regarded as working time, the European Court of Justice has ruled.

This time has not previously been considered work by many employers.

It means firms including those employing care workers, gas fitters and sales reps may be in breach of EU working time regulations.

BBC legal correspondent Clive Coleman said it could have a "huge effect".

"Thousands of employers could now find themselves in breach of working time regulations," he added.

'Falling below minimum wage'

Chris Tutton, from the solicitors Irwin Mitchell, agreed the ruling would be "very significant" and could have an impact on pay.

"People may now be working an additional 10 hours a week once you take into account their travel time, and that may mean employers are falling below the national minimum wage level when you look at the hourly rate that staff are paid," he said.

The court says its judgment is about protecting the "health and safety" of workers as set out in the European Union's working time directive.

The directive is designed to protect workers from exploitation by employers, and it lays down regulations on matters such as how long employees work, how many breaks they have, and how much holiday they are entitled to.

'Bear the burden'

One of its main goals is to ensure that no employee in the EU is obliged to work more than an average of 48 hours a week.

The ruling came about because of an ongoing legal case in Spain involving a company called Tyco, which installs security systems.

The company shut its regional offices down in 2011, resulting in employees travelling varying distances before arriving at their first appointment.

The court ruling said: "The fact that the workers begin and finish the journeys at their homes stems directly from the decision of their employer to abolish the regional offices and not from the desire of the workers themselves.

"Requiring them to bear the burden of their employer's choice would be contrary to the objective of protecting the safety and health of workers pursued by the directive, which includes the necessity of guaranteeing workers a minimum rest period."

Hospital patients to be asked about UK residence status

BBC News

Patients could be made to show their passports when they use hospital care in England under new rules introduced by the Department of Health.

Those accessing new treatment will be asked questions about their residence status in the UK.

Patients may need to submit passports and immigration documents when this is in doubt, the department said.

Hospitals will also be able to charge short-term visitors from outside Europe 150% of the cost of treatment.

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UK TOURISTS BEWARE – Cambridge Hospital Staff Demand Instant Money from Sick and Ailing Indian Tourist

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The department said the new rules came into force on 6 April for overseas visitors and migrants who use NHS hospital care in England.

Primary care and A&E care will remain free.

There will also be financial sanctions for trusts which fail to identify and bill patients who should be charged, it said.

The plans are part of a crackdown on so-called "health tourism".

Andrew Bridgen, the Tory MP for North West Leicestershire in the last Parliament,told the Daily Mail: "This is not the International Health Service, it's the National Health Service.

"Non-UK nationals seeking medical attention should pay for their treatment.

"The NHS is funded by UK taxpayers for UK citizens and if any of us went to any of these countries we'd certainly be paying if we needed to be treated."

Most foreign migrants and overseas visitors can currently get free NHS care immediately or soon after arrival in the UK but they are expected to repay the cost of most procedures afterwards.

The charges are based on the standard tariff for a range of procedures, ranging from about £1,860 for cataract surgery to about £8,570 for a hip replacement.

Non-UK citizens who are lawfully entitled to reside in the UK and usually live in the country will be entitled to free NHS care as they are now.

Homeopathy not effective for treating any condition, Australian report finds

Report by top medical research body says ‘people who choose homeopathy may put their health at risk if they reject or delay treatments’

 

Australia’s National Health and Medical Research Council hopes report will discourage private health insurers from offering rebates on homeopathic treatments. Photograph: Alix/Phanie/Rex Features

Melissa Davey in The Guardian

Homeopathy is not effective for treating any health condition, Australia’s top body for medical research has concluded, after undertaking an extensive review of existing studies.

Homeopaths believe that illness-causing substances can, in minute doses, treat people who are unwell.

By diluting these substances in water or alcohol, homeopaths claim the resulting mixture retains a “memory” of the original substance that triggers a healing response in the body.

These claims have been widely disproven by multiple studies, but the National Health and Medical Research Council (NHMRC) has for the first time thoroughly reviewed 225 research papers on homeopathy to come up with its position statement, released on Wednesday.

“Based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective,” the report concluded.

“People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.”

An independent company also reviewed the studies and appraised the evidence to prevent bias.

Chair of the NHMRC Homeopathy Working Committee, Professor Paul Glasziou, said he hoped the findings would lead private health insurers to stop offering rebates on homeopathic treatments, and force pharmacists to reconsider stocking them.

“There will be a tail of people who won’t respond to this report, and who will say it’s all a conspiracy of the establishment,” Glasziou said.

“But we hope there will be a lot of reasonable people out there who will reconsider selling, using or subsiding these substances.”

While some studies reported homeopathy was effective, the quality of those studies was poor and suffered serious flaws in their design, and did not have enough participants to support the idea that homeopathy worked any better than a sugar pill, the report found.

In making its findings the NHMRC also analysed 57 systematic reviews, a high-quality type of study that assesses all existing, quality research on a particular topic and synthesises it to make a number of strong, overall findings.

Glasziou said homeopathy use declined in the UK following a House of Commons report released in 2010 which found the treatments were ineffective, and that he hoped the NHMRC report would have a similar effect in Australia.

Dr Ken Harvey, a medicinal drug policy expert and health consumer advocate, said private colleges were charging thousands of dollars for courses in homeopathy, and he hoped students would reconsider taking them.

The government’s Tertiary Education Quality Standards Agency (TEQSA) should stop accrediting homeopathic courses, he said, while the private health insurance rebate should be not be offered on any policies covering homeopathy and other unproven treatments.

“I have no problems with private colleges wanting to run courses on crystal-ball gazing, iridology and homeopathy, and if people are crazy enough to pay for it, it’s their decision,” Harvey said.

“But if those courses are approved by a commonwealth body, that’s a different story and a real problem.”

Approved courses are reviewed by TESQA every seven years, with its own guidelines stating the content of a course should be “drawn from a substantial, coherent and current body of knowledge and scholarship in one or more academic disciplines and includes the study of relevant theoretical frameworks and research findings”.

A TESQA spokesperson said independent experts were used to assess whether or not a course complied with its standards. He said homeopathy courses already accredited would not be re-evaluated in light of the NHMRC’s findings, and would only be reviewed when their accreditation was next due for renewal.

In a statement responding to the NHMRC report, the Australian Homeopathic Association (AHA) claimed around a million Australians used homeopathy.

However, the NHMRC states there are no reliable estimates of Australians’ current use of homeopathic medicines, though a 2009 World Health Organisation review found Australians spent an estimated $9.59m on the industry annually.

“The Australian Homeopathic Association recommend to the NHMRC that it take a more comprehensive approach to the analysis of homeopathy’s efficacy, and consider a large-scale economic evaluation of the benefits of a more integrated system and one which respects and advocates patient choice in healthcare provision,” the AHA said.

Cuba’s extraordinary global medical record shames the US blockade

From Ebola to earthquakes, Havana’s doctors have saved millions. Obama must lift this embargo

• 
• • Seumas Milne
  • The Guardian, Wednesday 3 December 2014 20.07 GMT

Illustration: Eva Bee

Four months into the internationally declared Ebola emergency that has devastated west Africa, Cuba leads the world in direct medical support to fight the epidemic. The US and Britain have sent thousands of troops and, along with other countries, promised aid – most of which has yet to materialise. But, as the World Health Organisation has insisted, what’s most urgently needed are health workers. The Caribbean island, with a population of just 11m and official per capita income of $6,000 (£3,824), answered that call before it was made. It was first on the Ebola frontline and has sent the largest contingent of doctors and nurses – 256 are already in the field, with another 200 volunteers on their way.

While western media interest has faded with the receding threat of global infection, hundreds of British health service workers have volunteered to join them. The first 30 arrived in Sierra Leone last week, while troops have been building clinics. But the Cuban doctors have been on the ground in force since October and are there for the long haul.

The need could not be greater. More than 6,000 people have already died. So shaming has the Cuban operation been that British and US politicians have felt obliged to offer congratulations. John Kerry described the contribution of the state the US has been trying to overthrow for half a century “impressive”. The first Cuban doctor to contract Ebola has been treated by British medics, and US officials promised they would “collaborate” with Cuba to fight Ebola.

But it’s not the first time that Cuba has provided the lion’s share of medical relief following a humanitarian disaster. Four years ago, after the devastating earthquake in impoverished Haiti, Cuba sent the largest medical contingent and cared for 40% of the victims. In the aftermath of the Kashmir earthquake of 2005, Cuba sent 2,400 medical workers to Pakistan and treated more than 70% of those affected; they also left behind 32 field hospitals and donated a thousand medical scholarships.

That tradition of emergency relief goes back to the first years of the Cuban revolution. But it is only one part of an extraordinary and mushrooming global medical internationalism. There are now 50,000 Cuban doctors and nurses working in 60 developing countries. As Canadian professor John Kirk puts it: “Cuban medical internationalism has saved millions of lives.” But this unparalleled solidarity has barely registered in the western media.

Cuban doctors have carried out 3m free eye operations in 33 countries, mostly in Latin America and the Caribbean, and largely funded by revolutionary Venezuela. That’s how Mario Teran, the Bolivian sergeant who killed Che Guevara on CIA orders in 1967, had his sight restored 40 years later by Cuban doctors in an operation paid for by Venezuela in the radical Bolivia of Evo Morales. While emergency support has often been funded by Cuba itself, the country’s global medical services are usually paid for by recipient governments and have now become by far Cuba’s largest export, linking revolutionary ideals with economic development. That has depended in turn on the central role of public health and education in Cuba, as Havana has built a low-cost biotech industry along with medical infrastructure and literacy programmes in the developing countries it serves – rather than sucking out doctors and nurses on the western model.

Internationalism was built into Cuba’s DNA. As Guevara’s daughter, Aleida, herself a doctor who served in Africa, says: “We are Afro-Latin Americans and we’ll take our solidarity to the children of that continent.” But what began as an attempt to spread the Cuban revolution in the 60s and became the decisive military intervention in support of Angola against apartheid in the 80s, has now morphed into the world’s most ambitious medical solidarity project.

Its success has depended on the progressive tide that has swept Latin America over the past decade, inspired by socialist Cuba’s example during the years of rightwing military dictatorships. Leftwing and centre-left governments continue to be elected and re-elected across the region, allowing Cuba to reinvent itself as a beacon of international humanitarianism.

But the island is still suffocated by the US trade embargo that has kept it in an economic and political vice for more than half a century. If Barack Obama wants to do something worthwhile in his final years as president he could use Cuba’s role in the Ebola crisis as an opening to start to lift that blockade and wind down the US destabilisation war.

There are certainly straws in the wind. In what looked like an outriding operation for the administration, the New York Times published six editorials over five weeks in October and November praising Cuba’s global medical record, demanding an end to the embargo, attacking US efforts to induce Cuban doctors to defect, and calling for a negotiated exchange of prisoners.

The paper’s campaign ran as the UN general assembly voted for the 23rd time, by 188 votes to 2 (US and Israel), to demand the lifting of the US blockade, originally imposed in retaliation for the nationalisation of American businesses and now justified on human rights grounds – by a state allied to some of the most repressive regimes in the world.

The embargo can only be scrapped by congress, still stymied by the heirs of the corrupt US-backed dictatorship which Fidel Castro and Guevara overthrew. But the US president has executive scope to loosen it substantially and restore diplomatic ties. He could start by releasing the remaining three “Miami Five” Cuban intelligence agents jailed 13 years ago for spying on anti-Cuba activist groups linked to terrorism.

The obvious moment for Obama to call time on the 50-year US campaign against Cuban independence would be at next April’s Summit of the Americas – which Latin American governments had threatened to boycott unless Cuba was invited. The greatest contribution those genuinely concerned about democratic freedoms in Cuba can make is to get the US off the country’s back.

If the blockade really were to be dismantled, it would not only be a vindication of Cuba’s remarkable record of social justice at home and solidarity abroad, backed by the growing confidence of an independent Latin America. It would also be a boon for millions around the world who would benefit from a Cuba unshackled – and a demonstration of what can be achieved when people are put before corporate profit.

Important Health Warning

As many as 8 lakh international students, including about 96,000 Indian students, are at a huge disadvantage in the USA for no health insurance will pay more than 80 percent of their medical bills—that too after a one-time deductible of $500 (Rs 30,000) on first visit to a clinic.

ABHIJIT MAZUMDAR in Outlook India

Dushyant Kumar, a student at the University of Illinois in the U.S., was having bouts of intermittent spasms in his stomach but a visit to the university hospital made him double up in pain on learning about staggering amount of money he would have to spend on medical tests. As an international student, Kumar said, “Despite having student health insurance cover, I was supposed to shell out $600 (Rs 36,000) for only an ultrasound.” 

Healthcare remains a concern for Indian students as well as citizens of the U.S. While U.S. citizens have health insurance cover that would pay a substantial portion of their medical bills, as many as 8 lakh international students, including about 96,000 Indian students, are at a huge disadvantage for no health insurance will pay more than 80 percent of their medical bills—that too after a one-time deductible of $500 (Rs 30,000) on first visit to a clinic. 

Procedures such as an ultrasound or a CT scan cost upward of $1000 (Rs 60,000) in the U.S, which essentially means an international student first pays $500 (Rs 30,000) one-time deductible and another $100 (Rs 6,000) as 20 percent of the total cost he is supposed to shoulder. All this after he pays a huge sum for being insured for the year.

Mounting healthcare cost is a bane on a society that has over 5,500 hospitals and 8 lakh doctors to cater to a population of about 31 crore. Sample this—a woman delivering a kid, and that too without complications, will pay about $30,000 (Rs 18 lakh). 

Unlike in India, where purchasing medical insurance is still not in vogue due to a variety of reasons, few in the U.S. can afford the spiralling costs of healthcare without medical insurance whose monthly premium jacks up the expenditure for a family of four by several hundred dollars each month, with a sizeable chunk of the population—totalling over 2 crore—remaining uninsured. This is in sharp contrast to the fact that the U.S. spends over 10 percent of its Gross Domestic Produce (GDP) on healthcare, making it one of the few nations to do so, according to the World Health Organization (WHO).

The recently instituted Patient Protection and the Affordable Care Act (PPACA), better known as Obama Care—a derisive reference by President Barak Obama’s trenchant opponents—aims at lowering the uninsured rate and making insurance more affordable for all. However, its real achievement lies in having insurance providers include pre-existing conditions of those seeking insurance cover—a feature that was, until recently, non-existent. Also, the Act makes it mandatory for companies having more than 100 employees to provide them with insurance cover, irrespective of their race, gender and orientation. 

However, it does not change the ground realities for international students, who will still pay 20 percent of their medical bills, and the over 80 lakh illegal immigrants in the country for whom there will be no insurance cover. They would have to fend for themselves, their only solace being their inclusion in emergency care. Vocal support for this Act pales into insignificance in Republican bastions such as Tennessee and Mississippi, where its mere mention triggers angry rebuttals and baleful predictions. “It would make the monthly premium significantly go up,” said Paul Sanderson, a Tennessee-based insurance agent. Also, the one-time deductible that a person pays on first visit to a doctor would increase, he warned. 

But those are not the only issues plaguing the healthcare industry. Getting to see a doctor on time and paying medical bills are hurdles most people face, bringing to the fore broader issues of healthcare and its reform for a country that boasts of cutting-edge technology and state-of-the-art research. Li Chang (name changed), a teacher of library science, landed at the JFK Airport in New York, USA, ill at ease with the weather after visiting her sister in Canada. Suffering acute lung infection, she rang up a doctor for an early appointment to control the bouts of coughing and fits of wheezing as she doubled in distress. “The doctor gave me a date one month down the line, forcing me to fight on—unaided and alone,” Chang said.

Buying a medical insurance is not a guarantee that all will be well. Doctors refusing to treat patients having insurance policies of certain companies, a variety of alternative forms of medicine, including Ayurveda and Homoeopathy, not being included despite recognition from the federal government, many emergency-room doctors not under the ambit of insurance companies and being termed “out-of-network” doctors, and thus having to be paid by patients over and above the hospital bill, have left many with no option but to mortgage their property. Oftentimes, and funnily, though, a person will have to enquire about both the hospital and the doctor he will most likely seek an appointment with being on the right side of his insurance provider. There have been incidents of a doctor not being registered by an insurance provider despite the hospital he was working with being registered with it.

Adding to the woes of the sick is “drive-by doctoring” where patients have had to pay consultants and assistants to doctors, too, at times out of their own pockets after their insurers refused to pay them. These assistants are called in at the discretion of the doctor, often with questionable motives in doing so. This translates into specialists being called in—and increasing the medical bills—when even a resident or a nurse can handle the situation in the emergency room. Sometimes doctors split the profit with such assistants or consultants, experts said.

The politics of the system too has a role to play in the way things are moving in the healthcare industry. With upbeat Republicans gaining control of the Senate, Obama supporters fear that the government-initiated reforms in the health sector may be halted by the Republicans who do not support the health policies of the U.S. government.

Why chess is really an extreme sport

The deaths of two players at the Chess Olympiad in Norway shows that it’s time tournaments came with a health warning

• 
• • Stephen Moss
  • theguardian.com, Saturday 16 August 2014 09.00 BST

Chess. 'One false step and you will have lost. This imposes enormous pressure on players.' Photograph: 18percentgrey/Alamy

It seemed to me one of the strangest coincidences of all time: two chess players dying on the same day at the end of the biennial Chess Olympiad in Norway. But when I spoke to a chess-playing friend of mine, he said “Is it really so odd?” There were almost 2,000 players taking part in the event, quite a few of them – especially the men – getting on in years, unfit, sedentary. Healthwise, they were high risk. Are two deaths really so surprising?

My friend is right and wrong at the same time. It is a bizarre coincidence that two players – one from the Seychelles, one from Uzbekistan, the former at the board, the latter in his hotel room after the tournament had ended – should die within hours of each other. That’s why there has been news interest in the case, and why he is wrong in this respect. But he is spot on about the susceptibility of chess players to stress-related conditions. Chess, though the non-player might not believe this, is in many ways an extreme sport.

At the Olympiad, participants were playing a game a day over a fortnight – 11 rounds with just a couple of rest days on which to recuperate. For up to seven hours a day, they would be sitting at the board trying to kill – metaphorically speaking – their opponent, because this is the ultimate game of kill or be killed. In some positions, you can reach a point where both sides are simultaneously within a single move of checkmating the other. One false step and you will have lost. This imposes enormous pressure on players.

These days, some top players use psychologists to help them deal with this stress. They are also paying increasing attention to diet and fitness. I was staying in the same hotel as many of the world’s top players during the great annual tournament at Wijk aan Zee on the Dutch coast in January, and was struck by the regime adopted by Levon Aronian, the Armenian-born world number two, who started each day with a run followed by a healthy breakfast.

These elite players, however, are the exception within the chess world: they have the money and the specialist entourage that allows them to put a high priority on fitness and well-being. They realise that to play top-level chess, you have to be extremely fit and mentally settled. Any physical ailment or mental distraction is likely to stop you playing well. You need to be at the top of your game to perform. In that sense, it is as much a sport as football or rugby; indeed, it has been suggested that in the course of a long chess game a player will lose as much weight as he does during a football match.

Outside the elite – among professional players who are struggling to make a living, or among the hordes of us middle-aged blokes trying to get to grips with this stressful, frustrating, exhausting game – there is far less attention paid to health. Chess clubs often meet in pubs and many players like a pint; the number of huge stomachs on show at any chess tournament is staggering. The game – and I realise this is a wild generalisation, but one based on more than a grain of truth – tends to attract dysfunctional men with peculiar home lives. You can bet their diet will not be balanced; many will be living on bacon and eggs and beer. This is not a recipe for a long, healthy life.

The great Soviet players of the postwar period had the most ridiculous lifestyle: they more or less lived on vodka, cigarettes and chess, and many of them died young. Take Leonid Stein as an example. A three-times champion of the USSR in the 1960s, he dropped dead of a heart attack in 1973 at the age of just 38. Mikhail Tal, world champion in the early 1960s, was dogged by ill health during his career, and died at the age of 55 – a desperate loss to the sport. Vladimir Bagirov, who was world senior champion in 1998, was 63 when he dropped dead at the board while playing in Finland in 2000.

The current crop of top players have learned from the mistakes of their Soviet predecessors, but those outside the world elite haven’t. Too many are overweight, keen to have a drink, too sedentary – and then they try to play this game which makes huge demands on mind and body. I know, because I do it too. I spend a day at work, rush home, bolt down a meal, then go to my chess club and play a three-hour game which often makes me feel ill, especially if I lose. After that, usually around 10.30pm, I go home, go to bed, and frequently fail to sleep as my moves and mistakes revolve around my head.

So next time someone suggests a nice, quiet game of chess, or paints it as an intellectual pursuit played by wimps, tell them they’ve got it all wrong: this is a fight to the finish played in the tensest of circumstances by two players who are physically and mentally living on the edge. We all need to get fitter to play this demanding game, and society should recognise it for what it is – a sport as challenging, dramatic and exciting as any other. Such recognition would be a tribute of sorts to the two players who sadly played their final games in Tromso.