A senior doctor has been accused of wrongly failing to escalate the care of a 13-year-old girl whose death led to the adoption of Martha’s rule, which gives the right to a second medical opinion in English hospitals.At a disciplinary tribunal in Manchester, Prof Richard Thompson was also said to have provided a colleague with “false and misleading information” about the condition of Martha Mills.Martha died on 31 August 2021 at King’s College hospital (KCH) in south London after contracting sepsis. In 2022, a coroner ruled that she would most likely have survived if doctors had identified the warning signs of her rapidly deteriorating condition and transferred her to intensive care earlier, which her parents had asked doctors to do.Thompson, a specialist in paediatric liver disease, and the on-duty consultant – although he was on call at home – on 29 August 2021, is accused by the General Medical Council (GMC) of misconduct that impairs his fitness to practise.Opening the GMC’s case at the Medical Practitioners Tribunal Service on Monday, Christopher Rose said, based on a review of the case by Dr Stephen Playfor, a medical examiner at Manchester Royal Infirmary, Thompson:

Should have taken more “aggressive intervention” between noon and 1pm on 29 August, including referring Martha to the paediatric intensive care unit (PICU).

Should have gone into the hospital from about 5pm to carry out an in-person assessment of a rash Martha had developed.

Gave “false, outdated and misleading information” in a phone call at approximately 9.40pm to Dr Akash Deep in the PICU team.
Rose told the tribunal that during the call to Deep, Thompson gave a “highly inaccurate description” of Martha’s condition as “stable”. He said Thompson told his colleague that Martha’s systolic blood pressure was at 100mmHg when it had been below that level since 2pm, and did not mention the rash.Thompson also told Deep that a review of Martha by someone from the PICU team would just get her parents “more stressed and anxious”, the tribunal heard.Rose told the disciplinary panel: “Prof Deep said Prof Thompson told him that Martha was stable and did not need a review … Martha was not stable and GMC say it was entirely incorrect for Prof Thompson to have given Prof Deep that impression.”Thompson denies the allegations against him. Rose told the tribunal that Thompson claims that he acted according to established medical literature. The doctor also says that his assessment that Martha did not need a review, as communicated on the call with Deep, was separate to his concern about causing her parents increased stress or anxiety.Martha was transferred to intensive care on 30 August 2021 by which time she had septic shock, according to a serious incident report produced for KCH.She had sustained an injury to her pancreas when she fell off her bike on a summer holiday. Doctors at King’s College did not listen to the concerns of her parents, Merope Mills, a senior editor at the Guardian, and her husband, Paul Laity, including that she could have had sepsis, a significant cause of avoidable death that kills an estimated 40,000 people a year in the UK.Martha’s rule came as a result of pressure on politicians, NHS bosses and doctors after Mills and Laity spoke out about their experience.The hearing in Manchester continues.

The other day, I tried to read an email on my phone while in the backseat of a moving car. Almost immediately, I was overwhelmed with nausea. Next to me, my boyfriend was happily scrolling through news articles. He tried to show me a headline, but I was too busy staring out the window, breathing deeply and trying not to vomit.This happens basically any time I am in a moving vehicle that I am not personally piloting. It’s a little embarrassing. But I’m in good company: approximately one in three people are considered “highly susceptible to motion sickness”.What exactly is motion sickness, and why do some people experience it so much more than others? We asked experts.What is motion sickness?Motion sickness is a generic term that encompasses all sorts of travel sickness, including sea sickness, air sickness and car sickness, says Dr John Golding, professor of applied psychology at the University of Westminster, in London.But you don’t need to travel to experience its unpleasant symptoms, which can include nausea, vomiting, burping, drowsiness, dizziness, headaches and blurred vision. When the Lumière brothers first screened a motion picture for the public in 1895, some people in the audience started feeling dizzy and sick, says Golding. This is known as “visually induced motion sickness”.Science isn’t entirely sure what causes motion sickness, experts say, but the most widely agreed-upon explanation is the “sensory conflict theory”. Your body uses visual stimuli, proprioception (the body’s ability to perceive itself in space) and the vestibular system (structures inside the inner ear that help you maintain a sense of balance) to sense where your body is and how it is moving.Usually, these three mechanisms are in sync. But when one of them isn’t – say, you’re reading a static page in the car, but your vestibular system still senses that you’re moving – this sensory conflict confuses the brain. “This neurological tension is what triggers common symptoms such as nausea, dizziness and vomiting,” explains Dr Safia Debar, a general practitioner and executive health physician at Mayo Clinic Healthcare in London.In the case of the Lumière brothers’ first audiences, their vestibular systems and senses of proprioception told them they were still, but their eyes told them they were moving. Today, many people experience this sort of visually induced motion sickness when using virtual-reality headsets.What kinds of movements cause motion sickness?One of the most common misconceptions about motion sickness is that the strength of the movement determines the severity of the reaction, says Golding.But people don’t tend to get motion sickness when they’re bouncing up and down on horseback; that is a “higher frequency” movement, says Golding. Slower-frequency movements, like the rocking of a ship at sea, or the swaying of a bus, are more likely to result in motion sickness.Why do some people experience motion sickness more than others?So why can one person read endlessly in a car while even a quick glimpse at a phone turns another person green?A number of factors seem to influence one’s proneness to motion sickness, says Dr Behrang Keshavarz, senior scientist at the Kite Research Institute and professor in the department of psychology at Toronto Metropolitan University.One is age: motion sickness tends to peak in children between the ages of 8 and 12. “Adults are usually better than kids with motion sickness,” says Keshavarz. But that’s not true for everyone, he clarifies.Research suggests people assigned female at birth are more likely to experience motion sickness than those assigned male at birth, says Keshavarz, though no one’s quite sure why. Genetics may also play a role, says Golding, adding that studies indicate motion sickness might be 50-70% heritable.Some individuals may also be better at adapting to strange new motions than others, suggests Dr Thomas A Stoffregen, emeritus professor of kinesiology at the University of Minnesota.“Some people are ‘naturally coordinated’ and can learn new motor skills quickly,” he says over email. “Others (like me) are klutzes and take forever to learn new movements.” The latter are more at risk for motion sickness, he argues.skip past newsletter promotionafter newsletter promotionOne thing is certain: motion sickness is not a sign of weak character. (I would like to see this printed on the little airplane vomit bags I so often end up breathing into during landings.)“It’s not about being delicate or anxious,” says Debar. “Some people are simply more sensitive to motion.”About half of novice astronauts get space sick during training, Golding adds. “They’re very fit, very highly motivated and not weak-willed,” he says.I nod. Sitting in the back of a Kia Sorento is a lot like going into space, I tell myself.Is it possible to reduce the effects of motion sickness?There are two approaches to dealing with motion sickness: behavioral and pharmacological.Behaviorally, a number of easy measures can help. Sit in the front seat of a car when you can, keep your eyes on the horizon, and avoid reading and screens, says Debar. She also notes that ginger has some natural anti-nausea effects.Pleasant music, fresh air, nice smells and a generally pleasant ambiance may be able to distract you, says Keshavarz. He also suggests car passengers copy the movements of the driver. Drivers rarely get motion sickness because they can anticipate the movements of the car and lean into turns, for example. “If you mimic what the driver does, that helps,” Keshavarz says.Unfortunately, the most effective way to combat motion sickness is also the least pleasant: habituation. In other words, doing the activity over and over again until it doesn’t give you motion sickness anymore.“This is by far the most effective countermeasure,” says Golding, who used it to help desensitize Royal Air Force pilots to air sickness. “It doesn’t have side effects, but it’s very time consuming and can be stimulus specific,” he says – meaning that habituating to car sickness won’t necessarily help you with sea sickness.Over-the-counter anti-nausea medication can be effective, experts say, but they often cause drowsiness. Transdermal patches such as Scopolamine are also helpful for up to three days, but can take six to 10 hours to take effect.Timing is important for such medications, says Golding. Even pills might take 30 minutes to an hour to take effect. And you must take them before you start to feel sick, because once you start to experience motion sickness, your stomach goes into gastric stasis, meaning it is no longer emptying its contents into the gut. “That means you might have taken the pill, but it’s not going anywhere,” says Golding.Finally, you can always “vote with your feet”, says Golding. “Avoid situations where you get sick.”

The cancer has metastasized to the bone, according to a statement from Mr. Biden’s personal office.Former President Joseph R. Biden Jr. was diagnosed on Friday with an aggressive form of prostate cancer that has spread to his bones, his office said in a statement on Sunday.The diagnosis came after Mr. Biden reported urinary symptoms, which led doctors to find a “small nodule” on his prostate. Mr. Biden’s cancer is “characterized by a Gleason score of 9” with “metastasis to the bone,” the statement said.The Gleason score is used to describe how prostate cancers look under a microscope; 9 and 10 are the most aggressive. The cancer is Stage 4, which means it has spread.“While this represents a more aggressive form of the disease, the cancer appears to be hormone-sensitive which allows for effective management,” according to the statement from Mr. Biden’s office, which was unsigned. “The president and his family are reviewing treatment options with his physicians.”Mr. Biden, 82, left office in January as the oldest-serving president in American history. Throughout his presidency, Mr. Biden faced questions about his age and his health, ultimately leading him to abandon his re-election campaign under pressure from his own party.Prostate cancer experts say that Mr. Biden’s diagnosis is serious, and that once the cancer has spread to the bones — where it tends to go — it cannot be cured. But Dr. Judd Moul, a prostate cancer expert at Duke University, said men whose prostate cancer has spread “can live five, seven, 10 or more years.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Reading about ways to foster joy last week (I know, most of us would settle for waking without lingering dread, but why not dream big occasionally?), I was captivated by the memoirist and cancer survivor Suleika Jaouad’s suggestion: live each day like it’s your first. When Jaouad’s leukaemia returned last year, well-wishers urged her to live each day like it was her last, but the pressure to carpe each second of every damn diem left her feeling panicked and exhausted. Instead, she cultivated a sense of freshly hatched curiosity and playfulness, which she says helped.I loved this, but doubted the feasibility – can you really convince your tired, cynical self to feel joyful astonishment? I tried living yesterday as if it were my first; not like an actual newborn (red-faced, frequently crying, utterly incompetent – I’m all that already), but with childlike wonder. I had some success being captivated by my breakfast banana – great design and colour – and even more with the magical elixir that makes me not hate everyone (coffee).Then I opened the postbox with Christmas-stocking levels of anticipation: a window cleaner’s card and an HMRC letter about Making Tax Digital! After lunch, confronted with our dishwasher’s habit of popping open whenever I try to shut it, I attempted to cultivate curiosity rather than rage: surely this helpful marvel has its reasons? What might they be? I was left no wiser but marginally calmer.Living a dental hygienist appointment as if it were my first proved more challenging: my body remembered this was not my first scratchy hook and humiliation rodeo, whatever my brain tried to tell it. But a sense of playful discovery did help, sort of. I distracted myself beforehand, flicking in wide-eyed amazement through tooth makeovers in the waiting room brochure. Then, in the chair, I surrendered, childlike, to the transporting strangeness of cold gritty stuff blasting my molars, my tongue getting accidentally sucked into the spit-hoover and what I chose to tell myself was the “intensely interesting sensation” of manual plaque removal.I wouldn’t call it a joy, exactly, but it was absolutely less of an ordeal. Jaouad is right: a sense of wonder can be, well, wonderful.

I was moved to read of the grief expressed by so many at the brutal felling of the Sycamore Gap tree. I found it surprising. Not the crime itself: I know well the unconscious drive we all have within us to destroy good things – the most valuable, the most beautiful, the most life-affirming things. What took me by surprise was the capacity that so many people found within themselves to express their devastation and anger at this painful loss, not only to us as individuals, but as a nation.On the day the perpetrators were found guilty, I was reeling in my own private grief. I’d just read a different news story that told of another brutal cutting-down: again the destruction of something beautiful and valuable with deep roots, that stood for growth and possibility and life. The article, on this website, told how among other “savings”, talking therapies services are to be cut “as part of efforts by England’s 215 NHS trusts to comply with a ‘financial reset’”.As a patient in psychoanalysis that I pay for privately because I am privileged enough to be able to afford it; as a psychodynamic psychotherapist working in the NHS because I passionately believe that people should have access to good, sustained mental health treatment regardless of their means; and as your columnist writing about how to build a better life – I find this to be morally wrong.Just as I was not surprised by the felling of the Sycamore Gap tree, I am not surprised by these further cuts to talking therapy on the NHS. The flesh is so thin on the bone already, there is precious little now to cut, with patients facing the (bad) luck of the draw of patchy, postcode lottery-style provision. Many of us as individuals have a tendency to diminish our own mental anguish – to feel that physical pain is somehow more worthy. This is why it is unsurprising that we tolerate such meagre offerings of sustained psychotherapy on the NHS. It is why we have to have a law that mental health and physical health should be treated with parity of esteem – because deep down, we do not do this within ourselves.That law, incidentally, is the Health and Social Care Act 2012, which states it is the Secretary of State for Health’s duty to “continue the promotion of a comprehensive health service designed to secure improvement […] in the prevention, diagnosis and treatment of physical and mental illness”. How can he possibly fulfil this duty if the already limited offer of psychotherapy is reduced even further?Whether talking therapy services are scrapped altogether, or treatments are shortened and cheapened and replaced with “interventions”, it seems important to see the truth of what is happening here. There will be cuts to psychotherapy. Psychotherapy in its different modalities is a potent treatment that has been proven again and again, in study after study and in patient after patient, to be effective for many people suffering with mental illness – and, in the case of sustained psychodynamic psychotherapy, to grow more effective over time after treatment ends. Patients can use it and get better. Do we understand this? That psychotherapy works? Of course it doesn’t always work, and it is not always indicated for everyone – like any other treatment. But for many, it works. It saves lives. It keeps people out of hospital. It enables people to get back into work. It can repair relationships. It can restore self-respect. It can allow people to stand tall when they have previously had to drag themselves along the ground. It is a treatment that works, and it is being cut, so people will have even less chance of being offered it than they do now.We need to find within ourselves the kind of anger and sadness at cutting down our mental health services that some have found within themselves at the cutting down of the Sycamore Gap tree. This tree found its home in an empty hollow and grew strong and true and beautiful. Psychotherapy can help people do that too. And what will fill the gap left when psychotherapy is cut down? The usual things people turn to when they are struggling and they feel hopeless, uncared-for and forgotten – none of them good. Suicidality; addiction; relationship and family breakdown.If we want to build a better life, for ourselves and our families and our fellow citizens, we need to do something about this. We need to fight for our cause; we need to protest in the streets and bring legal challenges and write (politely and firmly) to our MPs. We need to demand the Health Secretary fulfil his responsibilities outlined by the Health and Social Care Act 2012. We need to stand up and make it politically impossible for this government that talking therapies provision be further diminished; the NHS must offer psychotherapy treatment for anyone who needs it and who can use it.Receiving and offering psychotherapy has taught me that we all have it in us to cut down and destroy beautiful things – but we also have it in us to come together in our grief, to repair, to help each other, to do good things, to stand up when we see that something is deeply morally wrong. That is how we build a better life not only for ourselves but also for each other. Moya Sarner is an NHS psychotherapist and the author of When I Grow Up – Conversations With Adults in Search of Adulthood

Some of the sunscreen you slather on this summer will end up in lakes, streams or the ocean, even if you don’t go swimming. And a growing body of evidence suggests that ultraviolet filters, the active ingredients in sunscreens, can harm creatures that live in the water.Some products are marketed as “reef safe” or friendly to aquatic life. But has that been proved? We talked to a dermatologist, several ecologists and toxicologists, and a chemical engineer to find out the best way to protect your skin and the environment, too.Your sunscreen optionsThere are two kinds of UV filters in sunscreens on the market today.Mineral sunscreens create a physical barrier on your skin that reflects UV rays like a mirror, while chemical sunscreens are absorbed into the skin and convert the UV radiation into harmless heat. (Chemical sunscreens are also sometimes labeled “organic,” but that’s a chemistry term, not a claim of environmental friendliness.)Any sunscreen you apply will eventually end up in water. Researchers estimate that between 25 and 50 percent of sunscreen comes off during a dip. The rest goes down the drain when you shower or enters the wastewater system through the laundry when you wash your beach towels.Most standard treatment plants aren’t effective at removing trace levels of UV filters from wastewater, said Dunia Santiago, a chemical engineer at the University of Las Palmas de Gran Canaria in Spain who studies how treatment plants process contaminants. That means the chemicals are still in the water that flows out of the plant and into the world.And, since many UV filters don’t biodegrade well, levels can build up over time in the environment, floating around, settling into sediment and being eaten by animals, especially in shallow areas popular with swimmers.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.