Nurofen addict cost drug company £2.4m

Christopher McGuire, 31, was behind a major scare last year after he inserted strips of the prescription drug Seroquel into £7 packets of Nurofen Plus at three Boots stores and an independent pharmacy. Two men mistakenly “overdosed” on the 50mg Seroquel tablets, which are used to treat schizophrenia, bipolar disorder and mania. It led to the manufacturer of Nurofen, Reckitt Benckiser, ordering a nationwide recall of products that resulted in a £2.4million loss, Southwark Crown Court in London was told. Yesterday, McGuire, a penniless drifter from Glasgow, appeared in court after admitting causing a public nuisance. The court heard that he had filled empty packets of Nurofen Plus 32 — a combination of codeine and ibuprofen — with his prescription drugs, before going to chemists and switching them with genuine packets of the over-the-counter painkiller. He would go to the counter and attempt to pay for the “dummy” packet using a card that he knew would be rejected, before walking out of the store with the genuine packet in his pocket. The pharmacist would then return the packet containing Seroquel to the shelf.

Serco investigated over claims of 'unsafe' out-of-hours GP service

A leading private health company, poised to win much of the new wave of NHS outsourcing contracts, is under investigation for allegedly providing an "unsafe" out-of-hours GP service, and over claims that it manipulated results where it failed to meet targets. Serco, which runs a large range of outsourced services for the government and local authorities, was subject to an unannounced inspection by NHS watchdogs in Cornwall last month in response to whistleblowers who claim that it: • allowed queues of up to 90 patients at a time to build up at its telephone helpline; • met its targets, in part, by adjusting figures to blame delays on patients; • rang at least one patient who had waited too long to see a doctor to give them a new waiting target instead; • repeatedly took visiting doctors off roving duties in order to operate clinics and hotlines because it had too few staff on duty to cover the county. Many of the concerns appear to be supported by evidence gathered in a Guardian investigation that has drawn on data from computer records, drivers' logs, internal correspondence and interviews with several sources connected with different parts of the Serco operation in Cornwall who have asked to remain anonymous. Serco has also confirmed some of the allegations. But it denies that the service is unsafe and says it is acting within the terms of its contract with the local primary care trust, which allows it to adjust waiting time figures according to who was to blame and make "comfort calls" to patients who have waited a long time. It did not comment on the whistleblower reports of how many patients were left waiting to be assessed at its call centre. The Guardian has learned that the health regulator, the Care Quality Commission (CQC) made an unannounced inspection of the service in April, shortly after it took on responsibility for registering out-of-hours GP services under new rules. It was unclear until then who, if anyone, was able to monitor Serco's performance independently of the PCT that commissioned it. Both Serco and the Cornwall NHS PCT vigorously denied that patient safety was ever at risk. They said that the allegations are not new and that the claim that performance data have been manipulated has already been rejected by an independent audit for the PCT. They added that they have been advised that if the CQC had serious or urgent concerns for patients' safety they would have been raised immediately, and that they have not been raised. The PCT remains confident that the service is adequately resourced and meeting national standards. Bridget Sampson, director of primary care for Cornwall, said: "We are disappointed that rumours still persist around the quality of service provided by Serco. Patient surveys show a high level of satisfaction with the service and an independent audit did not find any evidence of data being changed. The contract provides a value for money, high quality service for patients with equitable access to GP appointments out of hours." However, critics of the service said they have been pressured to keep quiet and say Serco has launched an investigation of email traffic to see who has leaked information to the press. Serco said any monitoring of emails was within the law and was to protect patient confidentiality. Dr Gareth Emrys-Jones, a retired BMA council member and former chair of the GP co-operative that used to run the out-of-hours service for Cornwall as a not-for-profit company, was one of several people who contacted the CQC. "I have been approached by a significant number of people representing all classes of employees at Serco who felt unable to whistleblow directly but who perceived the service to be unsafe because of a lack of clinicians and inadequate cover for the needs of the patients of Cornwall," he said. "They have cited incidents where it appears that data has been altered in order to achieve compliance with quality standards that they knew had been missed. These related to an extended time period and were not one-off incidents. I was concerned for the staff and for the service because if the allegations are true it would have serious implications." The CQC investigation comes as the NHS undergoes radical restructuring now that the government's controversial health and social care bill has been passed. Under coalition policy, all 52 newly formed PCT clusters in England are required this year to identify at least three of their community services to put out to competitive tender in a process that will lead to a rapid increase in private sector involvement in the NHS. Serco, which generated revenue of £4.6bn in 2011, is likely to bid for many of the NHS contracts. Serco first won the Cornwall contract in 2006 with a bid that valued it at approximately £6.1m a year over five years. It was awarded a further five-year contract last October, valued at £6.4m a year. The out-of-hours service had previously been run by a company set up by a co-operative of local GP practices for a cost of approximately £7.5m a year. Staff allege that shifts for doctors and nurses have repeatedly been unfilled in the past few months, so that target times for visiting the sickest patients at home have been missed repeatedly. They claim that staff shortages in the call centre — where patients' calls are first received and their urgency is assessed in a return call by a clinician as part of a "triage" stage – have resulted in long queues building up. They also allege that clinicians have been pressed to downgrade the priority of calls when assessing them because there are not enough doctors available to make home visits. To deal with the queues, GPs allocated to home visits have repeatedly been pulled in from being out on the road to triage phone calls in the call centre instead. On 28 January patients queuing for a triage phone call faced waits of up to four hours at some points, they say. Staff have alleged that on the Thursday before Easter more than 50 calls were waiting for triage for part of the evening. On Good Friday, a long wait built up for out-of-hours clinic appointments and the only slot available for some patients meant a one and a half hour drive across the county, they said. On Easter Saturday they alleged staff shortages led to more than 90 calls building up in the queue for triage during the evening. Serco did not comment on the allegations about queue lengths.   Staff also said that the target times for patients to be seen by a clinician are repeatedly missed. Once patients have been assessed, they are allocated a priority depending on how urgent their case is. They are then given either a clinic appointment if they are able to travel, or a home visit, in under one hour, two hours or six hours, according to their need. On 14 February, they say, because shifts were unfilled, a clinician who had been assigned to home visits for the Penzance area had instead to cover for clinics in two areas for part of the night and for the home visits for two other additional areas while another clinician was called off the road to triage calls. Several calls waiting for urgent home visits in under two hours missed their target that night. A distressed terminally ill cancer patient who had been warned on calling the service that no GP would be available for up to six hours had to wait for nearly seven hours to be seen. The GP who visited the patient's home allegedly said he was the only doctor available for home visits for the whole county west of Bodmin.  Correspondence seen by the Guardian suggested that another GP believed he was in a similar position on a different night last year. Further correspondence reveals that senior clinicians have repeatedly expressed concern to Serco management about staff shortages jeopardising the safety of the service. Serco rejected any allegations that just one or two GPs were covering the whole of the county on any occasion. It said that the contract does not dictate how many GPs should be on the road. "Serco employs a range of skills across Cornwall to meet patients' needs and the PCT's requirements. These include nurse practitioners, emergency care practitioners and GPs. It is typical to use a range of roles to provide out-of-hours services and there is no service requirement for Serco to supply all cars, clinics or the call centre solely with GPs." Serco pointed out that a national benchmarking exercise looking at data from 104 PCTs found Serco's out-of-hours service to be one of the best performing in the country. (The exercise was conducted by the Primary Care Foundation, a business consultancy that counts Serco and the Department of Health among its clients and was based on data for the financial year 2010-2011 supplied by the services themselves.) Sources also alleged that calls that are in danger of not meeting their targets have been retriaged to "start the clock" again. On 25 February a call logged at 9.34am, and triaged at 9:37am, was given a home visit time of "before" 3.37pm. When it became clear that the target time could not be met the call was retriaged with a call at 3.12pm, completed at 3.16pm. A new target time of 9.16pm was then allocated to the visit, it is alleged.  Sue Matthews, regional officer for the Royal College of Nursing in Cornwall, said: "I have expressed concerns to Serco management on a number of issues. Our members have reported waiting hours being extended by several hours, and that the current reporting system is being manipulated so that it does not reflect accurate activity or the time of visits or callback times." Serco said it recognised the example the Guardian gave on 25 February and had reported the matter to the PCT after an internal audit, "indicating that the call had failed". The company stated that "calls back to patients are only made when Serco believes it may exceed the timeframes set by the Department of Health, and they are deemed 'comfort calls' rather than retriages and are made to assess if conditions have worsened or improved to ensure patient safety is not compromised." Among the most serious allegations being investigated by the CQC are that Serco management altered logs tracking response times and targets. The PCT said that its audit found no evidence of this and showed that the systems used by Serco would not allow data to be altered after the fact. Computer logs, seen by the Guardian, of data-tracking calls to the service and response times measured daily and weekly against targets, show one set of figures at the end of 12 February for the number of calls meeting or failing to meet targets in various priority categories on 11 and 12 February. But different figures for the same dates appear in the log as displayed on 15 February. The effect of the altered figures is to remove some of the "red" failed targets and make them "green" achieved targets, and to alter the percentage of targets met in other categories. Explaining the apparent discrepancy in figures, Serco said that it "audits all calls daily to understand areas in which issues are highlighted and where these may have fallen outside its control, including where a patient is deemed to have caused delay. Such cases are then reported to the PCT and changed accordingly on the internal management systems." This enables the company to give the PCT two reports, one with figures that include "cases where patients have caused delays" and one without. This promotes greater transparency and does not constitute the wrongful alteration of data, it said. Among those who have reported the service to the CQC are Sarah Newton, Conservative MP for Truro and Falmouth and Andrew George, Lib Dem MP for St Ives. "The out-of-hours service provides GP services for two-thirds of the full week," said George. "People don't just fall ill during surgery opening hours. There has been a pattern of complaints and concerns that have come to me particularly over the last year that give rise to question over the safety of the service alongside other information that suggests the service is being run on the very margins of what is clinically safe. "I have contacted the PCT and Serco but the concerns have continued, which is why I have blown the whistle to the CQC to get the issues properly investigated." Newton said she contacted the CQC after receiving concerning reports from her constituents. Serco rejected any suggestion that clinicians were under pressure to downgrade calls and said that it met all required standards. "All staff have been trained to prioritise cases individually and as per the clinical judgment of the clinician. In addition, Serco uses decision-support software to ensure consistency of triage and prioritisation. "Serco has consistently achieved the target times for home visits. For January 2012 Serco reported that 97.5% of patients were seen face to face by a clinician within the Department of Health timeframes. For 11 Febrary, 88.37% of patients were seen face to face by a clinician within the timeframes. On 14 Febrary, there were four GPs covering west Cornwall until midnight. "The area was also fully staffed after this time until 8am the following day. The contract requirement is for the service to be able to respond to patients' needs within set timeframes and does not dictate car allocations across the county."

What is catnip, and why do felines love it?

Catnip drive felines crazy, causing them to roll around on the floor and paw at invisible birds flying in their vicinity, but why? Humans have used catnip for recreational purposes, as smoking the substance produces some interesting effects. How does catnip affect felines and why does it cause such wild responses? Are cat owners willfully doping their pets? Full size Catnip is another name for the herb Nepeta cataria, a relative of oregano and spearmint. Nepeta cataria is a pretty common plant, often found along highways and railroads in North America. Don't feed your cat any Nepeta cataria you might find along the side of the road, as it could contain an array of pesticides or harmful chemicals left over from railway construction like creosote. The active molecule in Nepeta cataria is nepetalactone, which is believed to mimic a cat pheromone. Nepetalactone binds to a cat's olfactory receptors to produce catnip's unique response. Owner's descriptions of the effects of catnip on their pets range from arousal to euphoria to sedation, with some cats drooling during exposure. One veterinarian suggested that the moans cats make while exposed to catnip are the result of chemically induced hallucinations. If a human exhibited these signs, we would likely be concerned, but most cat owners are comfortable with their feline's recreational drug problem. Full size Leaves from Nepeta cataria or nepetalactone oil extracts are used by cat owners to provoke their pets. Owners can crush Nepeta cataria to release the attractant that lies within bulbs of the herb or they can buy toys infused with an extract of the herb. Since the pheromone mimic affects the olfactory receptors, cats don't achieve any positive results from eating catnip. Consumption of the buds sends the active ingredient down the digestive tract, where it is degraded. A little less than half of cats are not attracted to catnip at all, with genetics playing a role in determining a cat's interest in the herb. Catnip, in large enough quantities, will also work as an attractant for large cats like lions and tigers. Europeans in the 1400s regularly drank teas made from catnip, with the herb earning a medicinal application for treatment of colic and flatulence. Nepeta cataria is a member of the mint family, with tea brewed that possesses a flavor and smell similar to mint tea. Smoking catnip became popular as an alternative to marijuana in the 1960s. When the herb is smoked, it produces a low level, legal high complete with audio/visual hallucinations and a relaxed feeling at a fraction of the cost. Concentrated doses of Nepeta cataria brewed as a tea can also produce a mild, short-term sedative effect in humans.

Bankia shares are suspended in Madrid

Trading in shares in the Spanish lender Bankia have been suspended in Madrid. The market regulator CNMV said it was "due to circumstances that may affect the normal share trading". Bankia is reported to be due to ask the government for a bailout of more than 15bn euros ($19bn; £12bn) after a board meeting later on Friday. Bankia, which is Spain's fourth-largest bank, was part-nationalised two weeks ago because of its problems with bad property debt. Any extra government money would be on top of the 4.5bn euros in state loans that the government had to convert into shares in the group in the part-nationalisation process. Shares in Bankia's parent company Banco Financiero y de Ahorros (BFA) have also been suspended. Bankia was created in 2010 from the merger of seven struggling regional savings banks. It holds 32bn euros in distressed property assets.

UK Jobseekers who reject help for alcohol and drug addiction face benefits cut

Unemployed people suspected of suffering from alcoholism or drug addiction will have their benefits cut if they refuse treatment for their condition, the work and pensions secretary, Iain Duncan Smith, will signal on Wednesday. In a sign of the government's new benefits regime, which lies at the heart of Duncan Smith's cost-cutting welfare changes, staff in Jobcentre Plus offices will be encouraged to cut the jobseeker's allowance of claimants who reject treatment for addiction. The new rules will come into place in October 2013 when the universal credit, which is designed to wrap benefits into one payment, is introduced. A new claimant contract lies at the heart of the universal credit reforms. Claimants will have to sign a contract in which they agree to look for work in exchange for an undertaking from the government to support them while they do so. Government sources said the contract would allow Jobcentre Plus staff to say that a suspected addict is in breach of their commitments if they refuse help for alcoholism or drug addiction. Duncan Smith will give a flavour of the new rules when he addresses an event in parliament organised by Alcoholics Anonymous (AA). He will say: "The outdated benefits system fails to get people off drugs and put their lives on track. We have started changing how addicts are supported, but we must go further to actively take on the devastation that drugs and alcohol can cause. "Under universal credit we want to do more to encourage and support claimants into rehabilitation for addiction and starting them on the road to recovery and eventually work. Getting people into work and encouraging independence is our ultimate goal. Universal credit will put people on a journey towards a sustainable recovery so they are better placed to look for work in future and we will be outlining our plans shortly." It is understood that the work and pensions secretary will not make a formal announcement on Wednesday of the powers that will be handed to Jobcentre Plus staff. Duncan Smith wants to use the event to focus on what he regards as the positive work AA does in helping to treat alcoholism. A government source said: "Iain wants to focus on the brilliant work Alcoholics Anonymous does in changing people's lives. He really wants to encourage people who have drink problems to go to AA for treatment. It will transform their lives and will help them into work." The source said Duncan Smith believes it is right to give jobcentre staff powers to cut benefits if an addict refuses treatment because they can detect signs of trouble. The source said: "The universal credit will allow staff in Jobcentre Plus offices to say: this person has been unemployed for some time. The staff know if people are addicted to alcohol. They know the people they are dealing with. "But we want this to be positive and to be about signposting people to superb organisations that can help them. This is about changing their lives. It is very important to support addicts into the workplace." But if claimants refuse they will have their benefits docked. "There will be sanctions," the source said, citing cuts to the jobseeker's allowance as an example. Ministers believe that one indicator Jobcentre Plus staff can use to see whether a claimant is an addict is the amount of times they apply for a crisis loan. "If you are applying for that up to 10 times a year then that is a sign of a chaotic life," one source said. Analysis by the Department of Work and Pensions shows that almost 40,000 people claim incapacity benefit with alcoholism declared as their "primary diagnosis". Of these, 13,500 have been claiming for a decade or more. There are about 160,000 "dependent drinkers" in England who receive one or more of the main benefits. There are 1m violent crimes a year that are related to alcoholism and 1.2m admissions to hospitals a year related to alcoholism. Universal credit is the most important element of Duncan Smith's welfare reforms, developed during his years in opposition through his Centre for Social Justice, which is designed to achieve his central goal of encouraging people into work. It will integrate tax credits and out-of-work benefits into one payment, with the aim of smoothing the transition to work. Labour has given the universal credit a cautious welcome, though it has taken issue with the scale of benefit cuts. Lord Low of Dalston, the vice-president of the Royal National Institute of Blind People who sits as a crossbencher, told peers this year: "Though it has some very sensible and progressive things at its core, in the shape of the universal credit, nevertheless it goes too far to most people's consciences in the way in which it takes vital support away from some of the most needy in our society."

9 Best Ways to Support Someone with Depression

If your loved one is struggling with depression, you may feel confused, frustrated and distraught yourself. Maybe you feel like you’re walking on eggshells because you’re afraid of upsetting them even more. Maybe you’re at such a loss that you’ve adopted the silent approach. Or maybe you keep giving your loved one advice, which they just aren’t taking.

Depression is an insidious, isolating disorder, which can sabotage relationships. And this can make not knowing how to help all the more confusing.

But your support is significant. And you can learn the various ways to best support your loved one. Below, Deborah Serani, PsyD, a psychologist who’s struggled with depression herself, shares nine valuable strategies.

 

1. Be there.

According to Serani, the best thing you can do for someone with depression is to be there. “When I was struggling with my own depression, the most healing moments came when someone I loved simply sat with me while I cried, or wordlessly held my hand, or spoke warmly to me with statements like ‘You’re so important to me.’ ‘Tell me what I can do to help you.’ ‘We’re going to find a way to help you to feel better.’”

2. Try a small gesture.

If you’re uncomfortable with emotional expression, you can show support in other ways, said Serani, who’s also author of the excellent book Living with Depression.

She suggested everything from sending a card or a text to cooking a meal to leaving a voicemail. “These gestures provide a loving connection [and] they’re also a beacon of light that helps guide your loved one when the darkness lifts.”

3. Don’t judge or criticize.

What you say can have a powerful impact on your loved one. According to Serani, avoid saying statements such as: “You just need to see things as half full, not half empty” or “I think this is really all just in your head. If you got up out of bed and moved around, you’d see things better.”

These words imply “that your loved one has a choice in how they feel – and has chosen, by free will, to be depressed,” Serani said. They’re not only insensitive but can isolate your loved one even more, she added.

4. Avoid the tough-love approach.  

Many individuals think that being tough on their loved one will undo their depression or inspire positive behavioral changes, Serani said. For instance, some people might intentionally be impatient with their loved one, push their boundaries, use silence, be callous or even give an ultimatum (e.g., “You better snap out of it or I’m going to leave”), Serani said. But consider that this is as useless, hurtful and harmful as ignoring, pushing away or not helping someone who has cancer.

5. Don’t minimize their pain.

Statements such as“You’re just too thin-skinned” or “Why do you let every little thing bother you?” shame a person with depression, Serani said. It invalidates what they’re experiencing and completely glosses over the fact that they’re struggling with a difficult disorder – not some weakness or personality flaw.

6. Avoid offering advice.

It probably seems natural to share advice with your loved one. Whenever someone we care about is having a tough time, we yearn to fix their heartache.

But Serani cautioned that “While it may be true that the depressed person needs guidance, saying that will make them feel insulted or even more inadequate and detach further.”

What helps instead, Serani said, is to ask, “What can we do to help you feel better?” This gives your love one the opportunity to ask for help. “When a person asks for help they are more inclined to be guided and take direction without feeling insulted,” she said.

7. Avoid making comparisons.

Unless you’ve experienced a depressive episode yourself, saying that you know how a person with depression feels is not helpful, Serani said. While your intention is probably to help your loved one feel less alone in their despair, this can cut short your conversation and minimize their experience.

8. Learn as much as you can about depression.

You can avoid the above missteps and misunderstandings simply by educating yourself about depression. Once you can understand depression’s symptoms, course and consequences, you can better support your loved one, Serani said.

For instance, some people assume that if a person with depression has a good day, they’re cured. According to Serani, “Depression is not a static illness. There is an ebb and flow to symptoms that many non-depressed people misunderstand.” As she explained, an adult who’s feeling hopeless may still laugh at a joke, and a child who’s in despair may still attend class, get good grades and even seem cheerful.

“The truth is that depressive symptoms are lingering elsewhere, hidden or not easy to see, so it’s important to know that depression has a far and often imperceptible range,” Serani said.

9. Be patient.

Serani believes that patience is a pivotal part of supporting your loved one. “When you’re patient with your loved one, you’re letting them know that it doesn’t matter how long this is going to take, or how involved the treatments are going to be, or the difficulties that accompany the passage from symptom onset to recovery, because you will be there,” she said.

And this patience has a powerful result. “With such patience, comes hope,” she said. And when you have depression, hope can be hard to come by.

Sometimes supporting someone with depression may feel like you’re walking a tight rope. What do I say? What do I not say? What do I do? What do I not do?

But remember that just by being there and asking how you can help can be an incredible gift.

Millions of GP prescriptions contain dangerous errors: research

A unique study into prescribing errors by GPs found mistakes such as wrong dosages, lack of instructions and insufficient monitoring of patients on dangerous drugs were 'common'. Elderly and young children are twice as likely to be given a prescription with an error because the over 75s are often on several drugs and the correct dose can be difficult to calculate in youngsters because it is usually based on body weight, the study found. Time pressures during GP consultations are thought to be to blame along with complex computer software that makes it easy to select the wrong drug or incorrect dose from drop-down menus and frequent distractions and interruptions. Several GPs said practice nurses who are responsible for managing some long-term conditions often asked them to sign prescriptions without seeing the patient and this made them 'uneasy' and also interrupted them during clinic meaning they may make mistakes themselves. Also repeat prescriptions were often issued without questioning if the patient still needed the medicine, or if superior ones were available and results from separate clinics were often not relayed to the GP meaning drug doses were not adjusted, it was found.