Let them eat cake

On top of a filing cabinet at my company’s offices there is regularly an open tub of chocolates, inviting anyone passing to dip in and grab themselves an Orange Creme, a Golden Barrel, a Mini Flake, or all three. I pass the chocolates en route to the office kitchen to make myself a cup of tea. However, I don’t partake. It’s not that I don’t appreciate the gesture, but for at least the last three years I’ve been Type 2 diabetic and therefore chocolate in all its forms, along with bread, pasta and almost all the foods containing ‘complex’ carbs, are no longer my friend. 

It’s my own fault: I indulged too much in such things and gained a lot of weight that clogged up my pancreas until it stopped working properly. That’s the broad science of it. Now, like an alcoholic never touching another drop for fear of returning to addiction, I mostly avoid carbs to prevent myself going blind, losing my feet or needing kidney dialysis if I let blood sugar levels return to where they were when I was first diagnosed.

You can’t survive by not consuming carbohydrate, however. It’s just that I have to look out for things that contain too much of it and not eat them. Occasionally I’ll have a pint of Guinness, but I’ll stick to just the one before moving on to water or a diet drink. It doesn’t bother me. I can still be sociable, it’s just that I’d prefer to remain sociable for as long as I can. I don’t get resentful, either: I’ve grown used to my own family consuming chocolate around me (usually around nine in the evening), in much the same way as I’ve long rejected any envy over people eating sandwiches, pasta or naan bread in front of me. I know what it can do to me, so I let it go.

However, the chairwoman of Britain’s leading food watchdog has another view. People bringing things like cake into the office for colleagues should be considered, she says, as harmful to their health as passive smoking. “We all like to think we’re rational, intelligent, educated people who make informed choices the whole time,” Professor Susan Jebb of the Food Standards Agency said, speaking in a personal capacity. “I have made a choice, but people were making a choice to go into a smoky pub.”

Whilst not saying the two issues are completely identical, she has combined them into the same thinking. The Times reported her as saying: “With smoking, after a very long time, we have got to a place where we understand that individuals have to make some effort but that we can make their efforts more successful by having a supportive environment. But we still don’t feel like that about food.”

Frankly, I’ve never equated smoking and someone leaving a birthday cake in a communal area at work, even in working cultures where someone is always bringing in confectionary. As an ex-smoker, too, I’m also conscious of what my fumes did for those I worked with when I last smoked, almost 30 years ago (including - ugh - in a small office with two non-smokers). 

I get the point, though. Two-thirds of adults in the UK are classed as overweight and a quarter obese. Worse, Type 2 diabetes now accounts for one-in-twelve UK adults, with cases in children and young adults quadrupling in Britain since 1990 - a faster increase than anywhere else in the world (rubbishing the idea that it is a condition of middle-age). Type 2 diabetes is mostly lifestyle-induced, too and - to some extent - self-inflicted. And I’m more than conscious that my own lack of self-restraint now contributes to the £6 billion obesity-related health conditions cost the NHS.

Politicians have argued for and against other measures to curb unhealthy lifestyles, such as banning the advertising of junk food, much as cigarette marketing was outlawed years ago, or stopping retailers from offering two-for-one deals on treats. Jebb, too, has added to this debate, telling The Times: “Advertising means that the businesses with the most money have the biggest influence on people’s behaviour. That’s not fair. At the moment we allow advertising for commercial gain with no health controls on it whatsoever and we’ve ended up with a complete market failure because what you get advertised is chocolate and not cauliflower.”

At the end of the day it is all about choice. And that choice requires strength of discipline. The brain is also very clever in prompting temptation, or forgetfulness. We can too easily mindlessly graze our way through a plate of biscuits left in a meeting room, or that box of Celebrations passed around without thinking - if we let ourselves, that is. 

Food brands are obliged these days to include nutritional facts on their packaging, which for someone like me who has to make a smart decision is extremely helpful. But is the solution that bad foods should be outlawed altogether? Of course not. Even I can have that occasional Guinness, though with 18g of carbs per pint, your granny was right in calling it a meal in a glass. Moderation is key which, I know, is often easier said than done. Harder is finding healthier food choices when eating out, and here is where I’d like to see the hospitality industry do more. Some pubs and restaurants do understand: asking to remove potatoes or chips from an order and replace them with salad is increasingly easier. More and more establishments get the idea of ‘bunless burgers’ or ‘burritos-in-a-bowl’, too. But I appreciate that as a  diabetic I remain in the minority. Plus, you can’t vouch for the sugar and salt used in recipes - avoidance is, I’ve accepted, only a mitigation.

Actually, the worst place I’ve ever experienced for food is, counter-intuitively, a hospital. When I spent time as in-patient for a diabetes-related condition a couple of years ago my breakfast choices would either be cereal or scrambled egg on white toast. Every morning. I chose a small dollop of the egg every day, with the only bonus being an added sausage on Sundays. Dinner would be whatever meat and vegetables I could extract from a lasagne. 

While I’ve got on top of things, and smugly lost weight to, now, manage my condition, others aren’t so diligent. Obesity and overeating are diseases in their own right. There are psychological reasons why some people eat themselves into being overweight, despite longstanding public information about the risks. But a nanny state is not the answer. Of course, the NHS could be more interventionist, but given pressures on the health service and GP surgeries in general, for a doctor to instruct someone to lose weight probably requires an in-person appointment, and would usually only come about because the individual is there for something else. No one, I suspect, rings up their GP to say “I’m fat - help me”.

“If a doctor comes across somebody with high blood pressure, they would feel, culturally, by training, by guidelines, by practice, that they must offer this patient treatment for their high blood pressure and explain to them why it was important,” Susan Jebb told The Times. “At the moment, if a doctor comes across a patient who is overweight, they mostly ignore it. The status in medicine comes from treating rare diseases with very expensive medicine and technology, and obesity isn’t either of those.”

She has a point. Obesity has, weirdly, been accepted culturally. I used to watch the American sitcom Roseanne and never once thought that Roseanne Barr’s titular character or her screen husband John Goodman were putting their health at risk by being large people. It almost seemed like a blue collar badge of honour. The Sopranos was, more or less, about hefty, masculine men who ate mounds of spaghetti-and-clams, wore oversized untucked shirts, and were more likely to die from a rival’s 9mm bullet than heart failure. Thanks to these cultural references I, too, embraced the large untucked shirt look because they allowed me to be fat without, apparently, consequences. 

When I lived in America, and on my many visits there since, I embraced the drive-through culture that put me literally at arms-length reach of a supersized burger-and-fries combo from the comfort of a car. The contradiction here, though, is that in America there are, actually, plenty of healthy food choices, and healthy lifestyle opportunities are everywhere. In California, where I lived, you worked alongside trim-looking joggers, gym-goers and outdoor junkies whose cars had bike and ski racks permanently mounted on them. Even in “overweight America”, you had a clear choice.

I’ve clearly made some bad ones, and didn’t realise that I had. But today, I walk past that open tub of Roses because I can. It’s another choice. It just shouldn’t have to be everybody else’s.

Postcard from the cuckoo's nest

Picture: Philips

In the midst of all this brouhaha over leaks and flat refurbishments, it's been easy to forget little Matt Hancock, the eager-to-please Secretary of State for Health & Social Care. In the last week or so he's been pushed out of the limelight by the psychodrama surrounding his boss, but that doesn’t mean the erstwhile minister has lost his boyishly obsequious zeal for saying - at any opportunity and usually when a camera is near - how NHS staff are the most amazing people on the planet.

In truth it’s one of the few areas that Hancock and I agree on. Actually, it’s one of the few things that I’ve had much cause for alignment on with any politician, especially over this last year, not being a great fan of the breed. It is, though, the common bond that had us all on our doorsteps, clapping on a Thursday night for those months of spring and summer last year until the custom fizzled out. We did it partly out of community solidarity, but it was more than an empty gesture. Some of us needed to feel good about the rapidly unravelling situation, as COVID-19 took hold, but it was also the realisation that it was carers and NHS workers in particular who were thrust onto the extremely attritional front line of the coronavirus. And while we may have felt ever so slightly smug, clapping with our neighbours, just as Boris Johnson was doing on the front step of 10 Downing Street, or Sir Keir Starmer was doing outside his Camden abode, it was also good PR for an institution that deserved it. 

Johnson, you could say, had more reason than most, especially as he was visibly in the first throes of COVID when he first took part in the Thursday clap. By the time the prime minister emerged from a very serious encounter with the virus, his appreciation for the NHS should have been enhanced beyond all recognition. That, of course, remains to be seen, given the derisory pay round that has been offered NHS staff. I, on the other hand, have gained my own renewed respect for the NHS frontline. As I write, I’m into my third week in a hospital as a patient. Three Saturdays ago, I had a podiatrist look at what I’d thought was just a stubborn-to-heal foot blister. Thankfully, she knew precisely what she was looking at, and promptly sent me off to A&E at Kingston Hospital, where I’ve been ever since. Evidently the blister had ulcerated and become seriously infected (a perennial risk for people with diabetes like me). The infection was so aggressive and invasive that it had entered the metatarsal, the so-called ‘Beckham Bone’. Three days later I was taken into surgery, where the formidable orthopaedic surgeon (one of the UK’s best, I’m told) worked on the problem at one end with sharp metal, while I relaxed to Coldplay at the other. Post-surgery, I was prepared for what would become a long, steady recovery process, one that has kept me in hospital (albeit in my own room, which is a touch) receiving round-the-clock antibiotics. The wound left by the surgery - a complex procedure to remove a nasty infection that had found its way into the cavities and micro pockets of the foot - is still healing. I’ll spare you the gorier aspects, but the surgery left me with a lot of dead tissue which needed removing to ensure healthy healing overall. At first, this was addressed by wearing a clever ‘vac’ device which, plumbed into the wound, sucked out the dead tissue and gaseous remnants of the infection. It was my ball and chain, requiring 24-hour use and minimal movement, with only a brief disconnection to take a daily shower. However, its progress was slow, which led to an uptick in treatment, and a therapy that is, quite frankly, remarkable: maggots.

There be maggots in there

While you regain your composure at the notion (I know, I had to at first), the premise is incredible: the wound is packed with a ‘tea bag’ containing around 200 larvae - 100 of each gender - who get to work on eating up all the waste. It sounds gruesome, and probably is if I had to watch it, but it’s painless (in fact, it’s completely unnoticeable, save for some discharge - I suppose they’ve got to get rid of ‘stuff’ just as we do). 

According to Swansea University, which cultivates the maggots for this purpose in South Wales, the technique has been used to treat wounds in various indigenous cultures for centuries. During World War One, soldiers’ wounds in the trenches were seen to heal much faster when maggots that had resulted from flies laying their eggs in open injuries got to work. Within the NHS it’s only been in use for the last ten years, but is now sworn by, with clinical trials demonstrating that the maggots are more effective than other treatments to remove wound debris, cleverly cleaning out troublesome hidden microbes that even the best surgeon’s knife can’t reach, and antibiotics can’t kill off.

I won’t dwell too much more on what’s going down there as, tediously but necessarily, it’s continuing for the time being, and I’m still mostly confined to bed, with the extent of travel limited to the toilet and the shower. My view is also somewhat restricted to an imperious sweep of Kingston-upon-Thames out of my 7th floor window (if I sit up and squint I can just about see the very occasional plane taking off from Heathrow). I live a 40-minute walk from here, but I may as well be on Mars with the Ingenuity mission, such is the slow “direction of travel” my stay has required. But I can’t complain, even if the boredom is mind-sapping. 

This has only been my second inpatient experience in 53 years on this planet. Some go their whole lives without seeing the inside of a hospital, save perhaps for the maternity unit where they entered the world. My stay, however, has been truly profound. Who knows what would have happened had I not been admitted to A&E three Saturdays ago, but I’m assuming it would have ended with losing a foot, or worse. That’s not a gloomy self-assessment, but a reflection of the grave tone the surgeon took in the days after she’d performed her magic. But, from the moment my girlfriend dropped me off at the front door, I entered an incredible system, a complex and dynamic clinical care machine that has had me surrounded, from the get-go, by a vast pit crew of doctors, nurses, surgeons, caterers, porters, cleaners and many more that I've never been exposed to. 

Throughout each day I've had fresh drugs plumbed in, my blood pressure, blood sugar and temperature checked at various times of day, my bloods extracted for analysis of infection markers, injections for blood thinners, tablets for this, tablets for that. When you add it all up, I have been the beneficiary of an enormous clinical and service resource. I’d hate to think what it has all cost. I can’t begin to imagine what the bill would have been if I’d been in the American healthcare system. I am living proof of what a burden Type 2 diabetes is on the health service. All of this because of a foot blister, ironically caused by a new pair of trainers bought to further enable the exercise regime that has been key to managing my condition. Of course, this has been a wake-up call: just as I’d thought that I had everything under control, with the three-monthly HbA1C checks showing excellent blood sugar management, the critical arbiter of maintaining my health. And, yet. I’ve had to drain an almighty resource, adding to the estimated £8 billion diabetes costs the NHS every year.

Picture: Philips

It’s not, though, just the cost that’s giving me a form of survivor’s guilt. It’s the people looking after me. And looking after me they are. Over the course of two weeks you become familiar with everyone, even with ever-changing 12-hour shifts of day teams and night teams. One even joked this morning “You still here?!”, which despite its relative inappropriateness, was the kind of levity I appreciate (especially as my now-tired joke with anyone who’ll listen is that if I remain here any longer I’m going to redecorate). Each and every one who has been looking after me has been a hero. God knows what they must think of my folly, after the year they’ve had. 

We all know how these people have been, literally, on the frontline of the pandemic. The roll call of casualties, drawn across the spectrum of NHS functions has been nothing short of appalling. In January, the Mirror newspaper reported that some 52,000 NHS staff were off sick with the coronavirus and that 850 healthcare workers in the UK were thought to have died from COVID-19 between March and December last year. The attrition rate was horrendous. Just as a war cemetery depicts a given battle, with captains and corporals lying alongside each other in the date order in which they were felled, the rollcall of NHS staff of every rank makes the organisation look like unwitting cannon fodder as the virus raged through corridors unabated. While the health service didn’t completely collapse under the strain of admissions at the pandemic’s peak - the feared premise for lockdown to begin with - it was close. What the people who’ve been looking after me have been through, I can't begin to imagine. Wards normally devoted to routine conditions were effectively turned into field hospitals. Staff were redeployed to cope, regardless of their area of specialist expertise. Doctors, surgeons and nurses of every level of experience and capability were retasked with working the wards just to cope. It’s almost hard to fully understand just how a health system that was struggling before COVID-19 has coped under it. 

So why did they allow themselves to succumb? Simple: dedication. The same dedication that has been treating me. There’s nothing altruistic about this. To a worker, the nurses and doctors have clocked on for their shifts because there’s been a job to do that they’ve been highly trained for. While my foot was under the knife, I had an enjoyable chat with the young doctor monitoring my vital signs. He told me how at the peak of battle, he was put on general clinical duties within the hospital, and rather than finding it a chore - even though it was - actually found it quite rewarding. He said that while he might have specialised in orthopaedic surgery, he was still a doctor, he still had invested in an education that could be reapplied. He wasn't alone: no matter what your area of expertise was, if you had a medical degree you were put to good use triaging the COVID-sick as they came in. 

My admiration was undimmed before, but having been in the NHS's midst now for a while my admiration has only been emboldened. The NHS must never be a political football. It must never be treated as a matter of convenient doctrine. It’s birth, on 5th July 1948, almost three years into the austerity of post-war Britain, instigated an institution like no other in the world. Yes, it may be flawed; yes, there will be inefficiencies as there will be in any public body of its size and scale. But what it delivers, the innovations that it relentlessly applies, and the supreme dedication that its chronically underpaid and, invariably, under-appreciated staff deliver is something to truly behold. 

When I’m eventually discharged I will continue for a while as an outpatient. At a time when there is much to gripe about in our country - our economy, our politicians, choose your target - we should never take for granted, nor fail to appreciate what the National Health Service represents: one of the best, if not the best things about Britain. 

Shields down!

It's the first of June. How did that happen? One minute we're in the depths of winter, hearing news of a nasty bug in China, the next, we've barreled through the sunniest, most relentlessly blue-skied spring in living memory. In that time, I have been diagnosed with Type 2 diabetes, started a new job, lost over a stone in weight and watched the world go by, mostly through the living room windows. I have diligently stayed at home, protected the NHS, and saved lives. My own, probably.

There was a time when COVID-19 was seen as a mere irritation affecting somewhere else. "The Chinese," we scoffed, "and their wet markets." And then it came to Europe, and we cast a concerning eye on News At Ten as alarming reports emerged from, first, Italy and then Spain. On 24 March, a few days after HMG's chief scientific adviser, Sir Patrick Vallance, said that keeping the COVID-19 death toll below 20,000 would be "a good outcome", I received a text message from the government itself (whom I didn't remembering ever giving my mobile number), telling me ominously: "New rules in force now: you must stay at home". This was followed by a helpful reminder of Dominic Cummings' latest slogan: "Stay at home. Protect the NHS. Save lives." Well, I was, already, doing just that. A week or so later I received another SMS, this time from my GP surgery, telling me that I'd been "identified as high risk" and to "STAY at HOME & avoid contact with anyone except your carers or healthcare workers for at least 12 weeks". So I have. I've been pretty diligent: my girlfriend, to her infinite credit, braves the supermarket so I don't have to, and on the few times that we have gone out for exercise since rules on how far you can go have relaxed a little, we've done all the right things about avoiding proximity to others. But even then, I've been nervous. Actually, I’ve been scared shitless.

The shielding programme gave the impression that the coronavirus was out there, ligging about in the air, stuck to pavements that would end up on shoes you brought into the house, thriving on door handles and embedded in fabric, just waiting for you to brush past or even walk straight into it. This probably hasn’t been the case, but then again, how do we know? I live in a borough with the least number of coronavirus cases in London. What has made us different from, say, the north-west, where the dreaded ‘R’ rate remains stubbornly high? Even if cases in this locale have been low, I’m not going to assume it’s any safer. Frankly, my diagnosis coming around the same time as COVID-19 announced that it was here in the UK rendered me paranoid, and I’m not easing up on that point of view just because the lockdown is.

Even though diabetes wasn’t specified as an "underlying health condition" when the pandemic arrived it has certainly proven to be one of the highest risks to mortality since. Of the 39,045 deaths recorded up until today, one-in-four have been attributed to diabetes. Britain’s place in the COVID fatality league table is nothing to be proud of at roughly 10% of the worldwide total. True, the rates are coming down, but with the daily average still around 300, we're still seeing the equivalent of a fully loaded Boeing 777 crashing every single day. That's better than the three 777s coming down per day that the coronavirus death rate peaked at here in Britain, but still. 

So, forgive me for being a bit of a Negative Nelly at news that, from today, everything is, apparently, back to normal, but if, like me, you regard the death rate as the key metric of this virus (let's face it, if you know something is capable of killing you, you're going to do your level best to avoid it), I don't share the enthusiasm about lockdown restrictions being lifted. I get it that we need the economy to be restarted, but that shouldn't mean hundreds of people packing themselves onto beaches and into parks (and buying Pringles and gallons of Pepsi from Tesco Express for picnics does not constitute the economy being brought back to life). My other half is a primary teacher, and even if children are less likely to pass on the virus, their clothing could. Exponentially, the risk goes up with every potential encounter my girlfriend has with anyone or anything from outside our house. Now scale that up with all the other activities returning to some semblance of normality.

We can all understand the desire for it but I'm still not convinced that now is the right time. In fact, no amount of colour-coded terrorism alert-style Government charts can convince me that the time is right. I don't think the Government's own scientific advisers are convinced, either. On Saturday, the well-respected Professor Jonathan Van-Tam, England’s deputy chief medical officer, warned of the "potential dangers if we go too fast," adding that if people didn't behave sensibly, there was a high risk of the pandemic worsening. He’s not alone: members of the UK’s SAGE committee of scientific advisers have also expressed the concern that easing is going too quickly. Interesting, then, that on Saturday night at around 10pm news leaked from 10 Downing Street to a conveniently primed Sunday newspaper that the Government was about to ease the lockdown on 2.2 million of the most vulnerable who'd been under virtual house arrest "shielding". In principle, that includes me. Firstly, I was surprised that there were 2.2 million people in this category as, since shielding had begun, we'd been told that 1.5 million came under this regime. Secondly, the leak of a feelgood story on a Saturday night to a Sunday tabloid is a classic piece of spin. By the time Robert Jenrick, the communities minister, fronted yesterday's No.10 press conference (and he was already under a cloud over allegations of cronyism related to a property deal he sanctioned), we were already in the midst of the surprise news that those who were medically shielding, having spent weeks cooped up in bedrooms and unable to even mingle with other members of their households, were suddenly going to be allowed out into the fresh air. Clearly, that nasty little virus, with its trumpet-like horns, was no longer lurking right outside the door. I've worked in the media my entire professional life, and I can spot a confected story when I see one. I can smell one, too.

So here we are, first of another hopefully gloriously sunny month and suddenly everything is looking up. Schools have reopened, street markets have set up shop again, and you can now test drive a car you still won't be able to go anywhere in. We can also gather in others' gardens, guilt-free. Millions of people who have been forced to live hermit-like for almost three months can now get outside for the first time, as long as they follow the rules. Ah, yes, the rules. They're all open to interpretation, right? Just tell that to those evil, microscopic droplets still ligging about, even if they're not ligging about as much as they were...