Agenda: The gap left by the missing generation

FIFA has announced plans to invest money from its World Cup Legacy Fund into the education of girls and women in India and Nepal – two countries from which many migrants travelled to work on the building of the stadiums in Qatar, sometimes with fatal results.

Helping girls and women into education in India and Nepal is something EMMS International, Scotland’s oldest healthcare charity, has been working on for several years. Girls in developing countries may not see female role models in careers such as health, so EMMS has been helping girls into healthcare courses that can provide them with a path to a secure job. The hope is many will return to their often remote communities to work there.

One of the particular issues for healthcare in Nepal is the “missing generation”. Many of the workers who left their homes and families for Qatar found it was not the promised land they hoped for. Some five million travelled to the country, but more than 6,000 died – most of them from India and Nepal. The road to the World Cup has been dark and treacherous.

For the families of the workers left at home, the loss of their loved ones can also plunge them further into poverty and vulnerability. Frail and elderly people in Nepal now often don’t have the generation below to look after them if they fall ill. It’s estimated that about a fifth of households need palliative care at any one time, but only 1.7% of families have access to it.

To help tackle these problems, EMMS and partners in Nepal have begun a three-year UK Aid-funded programme, Sunita, to develop palliative care in hard-to-reach places. We have also developed a national palliative care strategy and one of the challenges has been to define what palliative care actually means. To many, it means pain relief but EMMS is doing much more than that. We consider the whole family. It’s about making sure everyone is getting what’s needed. Bringing quality care closer to home can also ease the burden of care which can all too often force girls out of school.

So this is really what our project in Nepal is all about. The rural model we’re developing, at five different sites, is based around hospitals. We’re training people to support their communities as health volunteers and to support patients by offering to do some shopping for example, or a bit of cleaning or cooking, or watching the animals while someone goes to the city for medicines. Because families are lacking that middle generation that left to work in places such as Qatar, you have to get the rest of the community to fill the gap.

The project in Nepal is also a continuation of the work EMMS has been doing for more than 180 years. When the organisation first started, we were training missionary doctors who would establish and work in hospitals mostly in China and India. We no longer send doctors overseas, but build health systems from the ground up; it’s more sustainable and provides a hand up, not a hand out. EMMS still has the India connection almost two centuries later but we’ve added Malawi and Nepal too. Times have changed. But the vision remains the same: a world in which all people have access to good quality and dignified healthcare.

Cathy Ratcliff is chair at EMMS International and Scotland’s International Development Alliance.

EMMS International Festival of Nine Lessons and Carols is at St Andrew’s and St George’s West Edinburgh on December 8th. For more information, see

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Why we are at a ‘historic moment’ in Alzheimer’s research

IT is well over 100 years since Alois Alzheimer first described what he called an “unusual disease of the cerebral cortex”.

The German pathologist and psychiatrist presented his findings at the 37th Congress of Psychiatrists in 1906 after carrying out a post-mortem on the brain of one of his patients, Auguste Deter, who had been plagued by worsening confusion, memory loss, and hallucinations over a period of five years until her death aged 50.

Her brain, he discovered, was riddled by distinctive protein clumps and nerve tangles never previously identified.

READ MORE: Seven things you might not know about dementia

Today, it is thought that these clumps – beta-amyloid plaques – accumulate to a certain “tipping point” which then triggers a rapid spread of another protein, tau, which block neurons from working properly.

It elicited little scientific interest at the time, however, and Alzheimer would die from complications of cold in 1915 long before the disease which bears his name became – thanks to an ageing population – one of the biggest healthcare challenges of our time.

By 2031, it is projected that there will be 102,000 to 114,000 people living with dementia in Scotland – an increase of 75 per cent compared to 2007 levels. Alzheimer’s, the most common form, affects around 60% of sufferers.

HeraldScotland: Alois AlzheimerAlois Alzheimer (Image: University of Munich)

Until now, the only drugs available for the disease have helped to alleviate symptoms rather than tackling the underlying cause – but that could be about to change.

On Wednesday, scientists from around the world will converge in San Francisco for the CTAD Alzheimer Congress – an annual conference which brings together the latest results from clinical trials. The mood has never been more electric.

“I think this is a historic moment,” said Professor John Hardy, chair of molecular biology of neurological disease at University College London who is spending $7000 (£5,800) of his own lab’s money just to attend.

The cause of the excitement? A new antibody drug, lecanemab, which has been shown for the first time to remove amyloid build ups in the brains of Alzheimer’s patients.

This is said to equate to a 27% reduction in decline when given to patients with only mild cognitive impairment, and might be expected to translate into an extra 19 months of independent life on average.

READ MORE: The mystery of falling sperm counts that ‘threatens mankind’

It is a modest gain, but for researchers it marks the first real turning point in the history of the disease.

“Amyloid therapies were first suggested in 1992 so that tells you how long it’s taken to get here,” said Prof Hardy.

“A lot of the earlier amyloid antibodies did not take amyloid out of the brain – they just prevented further build up – and those did not work.

“One swallow doesn’t make a Spring, but I’m excited about this. I think it might be the end of the beginning; I’m optimistic that we are seeing the beginning of Alzheimer’s therapies.”

HeraldScotland: Globally, the burden of dementia is expected to more than double by the middle of this centuryGlobally, the burden of dementia is expected to more than double by the middle of this century (Image: The Lancet/Alzheimer’s Disease International)

Prof Hardy suggested that the breakthrough might eventually lead to a “brave new world” where people are routinely given cholesterol-style blood tests on their 60th birthdays to check their amyloid levels.

Those people whose amyloid is “on the way up” could be given drugs such as lecanemab to slow or prevent the onset of Alzheimer’s, said Prof Hardy.

For now, scientists are just eager to see the full clinical trial data unveiled in San Francisco. So far all we have are press releases from lecanemab’s manufacturer, Tokyo-based pharmaceutical firm Eisai.

It has also yet to be licensed for use. America’s FDA is set to rule on lecanemab in January 2023, with UK and European regulators to follow.

READ MORE: NHS executives warn that current model is ‘no longer working’

Already, however, charities and clinicians are warning that a major shake up of how the NHS diagnoses Alzheimer’s will be imperative to maximise any benefit from the drug, which has to be administered at an early stage.

“Most of the patients who get referred to us at the moment have later symptoms because our health system is set up to keep people with early symptoms out of secondary care and out of the memory clinics,” said Dr Liz Coulthard, an associate professor of dementia neurology based in Bristol.


In addition, fewer than 1% of patients seen by UK dementia clinics have a precise diagnosis of Alzheimer’s disease, which is crucial to determining eligibility for lecanemab.

Other forms of dementia, such as vascular or Lewy-Body, are not caused by amyloid build ups.

Currently the only way to achieve a definitive diagnosis of Alzheimer’s is by lumbar puncture to extract spinal fluid which can then be analysed for the amyloid biomarker, or through brain PET scans.

Blood biomarker tests for amyloid are “just on the horizon”, said Dr Coutlhard, and would be “really helpful”.

In the short-term, however, she envisions lecanemab operating as a “parallel service” to existing dementia care.

She said: “I don’t think in the short term there is going to be a reduction in the need for post-diagnostic care so we need new personnel and funding.

“Where that’s going to come from in the current climate, I don’t know.

“It very much depends if there a licence [for lecanemab], who the licence is for, and what the MRI guidance is.

“We’re very likely to have to do one or two MRIs, which is more than most patients currently get, and we’re going to need to do biomarker testing which is currently only done in the major centres.”

HeraldScotland: Imaging of amyloid deposition using PET. Amyloid PET can be used in the diagnosis of Alzheimer disease, as it allows the noninvasive detection of amyloid plaquesImaging of amyloid deposition using PET. Amyloid PET can be used in the diagnosis of Alzheimer disease, as it allows the noninvasive detection of amyloid plaques (Image: Journal of Nuclear Medicine)

MRIs are needed to monitor patients for bleeding and swelling on the brain, which can be a side effect of lecanemab but tends to be symptomatic only in around 3% of patients.

More detail is also needed on who is most at risk of these brain changes, said Dr Coulthard – adding that this will be “really important to look out for at CTAD”.

Whatever the obstacles, we are on the brink of a “momentous occasion”, said Dr Susan Kohlhaas – director of research for Alzheimer’s Research UK – because lecanemab “disproves the myth that Alzheimer’s is an inevitable part of ageing”.

She added: “Getting people diagnosed early and into research early will be really important in the coming years. This is a real window of opportunity.”

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Maternity care in Aberdeen from ‘witches’ to women’s rights

AS a starting point for the history of maternity care in the north-east of Scotland, you would struggle to find a stranger or more nightmarish tale than that of Margaret Bane.

The local midwife – or “howdie” – was strangled and burned at the stake for witchcraft and sorcery in Aberdeen in 1597. Her daughter met the same fate just 10 days later.

Among the 16 charges levelled against Bane, five drew on her role as a midwife including accusations that she had “put the labour pains” onto the husband of one of her patients in during childbirth such that he “went mad and died”.

On another occasion she was accused of “terrifying” a local man sent to collect her by speaking for a “long time” to “the Devil in the likeness of a horse” after the animal appeared en route as they journeyed to the home of the woman whose baby she was due to deliver.

READ MORE: Two in 300 mothers in Scotland having a home birth 

The story underlines a long history of female persecution – from conflating midwifery with witchcraft to the more recent struggles for the right to control childbearing – and sets Aberdeen up as an unlikely trailblazer.

‘Bringing Life to Aberdeen’, due to be published by Edinburgh-based Luath Press on November 30, comes at a time when NHS Grampian is constructing the new Baird Family Hospital – named after one of its most famous pioneers, the obstetrician Sir Duguld Baird.

The facility, which will replace the Aberdeen Maternity Hospital, is expected to open in March 2024 and will provide maternity, neonatal, reproductive medicine, breast and gynaecology services under one roof.

HeraldScotland: An artist's impression of the new Baird Family Hospital, due to open in Aberdeen in 2024An artist’s impression of the new Baird Family Hospital, due to open in Aberdeen in 2024 (Image: NHS Grampian)

It marks the culmination of a journey that began with the founding of Lady Drum’s Hospital in the 1630s, at a cost of 3000 Scottish merks (66 pence), to provide care for “poor widows and aged virgins”.

The Aberdeen Dispensary – the first real precursor to a maternity hospital – eventually followed in 1894, with three “lying-in” beds for pregnant women and childbirth.

It admitted just 46 patients in its first year, but demand grew and in 1912 the 36-bed Aberdeen Maternity Hospital was formally established at Castle Hill.

By the time the maternity hospital relocated in 1937, to its current Foresterhill premises, it was delivering over 700 babies a year and dealing with nearly 200 emergency admissions – although home births still remained the norm.

The book is packed with anecdotes including the wartime “Haddo babies”, born at Haddo House – the the ancestral home near Tarves of Lord and Lady Aberdeen – during the Second World War.

The home, which had once accommodated Queen Victoria, was used as an emergency maternity hospital and “tranquil refuge” where expectant mothers from Glasgow, Clydebank and Aberdeen could escape German bombing raids – though some came from London and even Finland.

They would arrive a month before their due dates and stay for a month after the birth. Between 1939 and 1943, more than 800 babies were born in Queen Victoria’s Bedroom – the delivery suite.

In a Scottish good luck custom, the Marquis of Aberdeen (known fondly as Uncle Doddie) “visited each mother after she gave birth and provided each newborn with a shilling (five pence)”.

HeraldScotland: Primrose Ward at Aberdeen Maternity Hospital in Castle Terrace, circa 1930Primrose Ward at Aberdeen Maternity Hospital in Castle Terrace, circa 1930 (Image: NHS Grampian)

There is also the tale of Dr Alexander Gordon, an Aberdeen obstetrician and trained midwife who pulled together statistics tracking outbreaks of puerperal fever in the city. This was a deadly disease for mothers and newborns, and is now known to be caused by exposure to streptococcus bacteria during childbirth.

Gordon’s research, published in 1795 – some 70 years ahead of Lister’s work on antisepsis – argued that the condition was not caused by ‘bad air’ as doctors then believed, but only affected women cared for by a medic or nurse who had previously attended another patient with the disease.

READ MORE: Lister, X-rays and nursing – how Glasgow Royal Infirmary changed medicine

The book notes: “He argued that spread could be prevented by attendants carefully washing their hands and wearing clean clothes after attending patients with the disease. His views were ridiculed by medical and nursing colleagues and his theories received a hostile response both locally and elsewhere.”

More than a century later, Sir Duguld Baird – appointed the regius professor of midwifery in Aberdeen in 1937 – was another physician not afraid to challenge the medical and societal norms of the day.

HeraldScotland: Painting of Sir Duguld Baird Painting of Sir Duguld Baird (Image: NHS Grampian)

Ayrshire-born Sir Duguld, who died in 1986, is described by the authors as “unusually aware of the social factors in obstetrics”.

This drove him to take the “unprecedented step of introducing dieticians, sociologists, psychologists and statisticians to his department”.

He oversaw falling rates of maternal and perinatal mortality during the 1940s and was a staunch supporter of family planning, having previously demonstrated through research in Glasgow that a third of maternal deaths occurred in women who had had six or more children already.

As the book notes, Baird’s determination to “allow women to have a healthier life by reducing the burden of unwanted pregnancy through contraception, sterilisation and abortion were effective in reducing maternal and perinatal deaths in Grampian and this example was followed in the rest of the country.”

Controversially, Aberdeen was the first place in UK to remove all charges for advice and contraception at its family planning clinic in 1967.

Its 30-cot neonatal unit, which opened in 1963, was also among the first in the world – matched only by Toronto – to start ventilating newborn and premature babies.

HeraldScotland: IVF being processed at Aberdeen maternity hospital in 1989 in a laboratory created from a converted officeIVF being processed at Aberdeen maternity hospital in 1989 in a laboratory created from a converted office (Image: NHS Grampian)

In 1917, Professor Matthew Hay – a public health doctor in Aberdeen – was responsible for one of the first known reviews of maternal mortality in the UK when he investigated every death that had occurred in Aberdeen’s maternity units.

It provided a blueprint for the UK’s eventual Confidential Enquiry into Maternal Deaths, which launched in 1952 and continues to this day to monitor deaths of women in pregnancy, childbirth, and the first six weeks after delivery.

“What started off as a local hospital-based audit in Aberdeen was adopted by the whole nation as part of the newly started National Health Service,” states the book.

READ MORE: Tayside had UK’s second highest stillbirth rate in 2020

Aberdeen was also the birthplace of a novel classification system for stillbirths, devised by Sir Duguld in 1941 and still in use.

The city also led the way on research into pre-eclampsia – a potentially life-threatening increase in blood pressure during pregnancy.

Professor Ian MacGillivray – the head of department for obstetrics and gynaecology in Aberdeen created the classification system for the condition that remains the international standard.

The north-east of Scotland was one of the first regions to develop cervical screening, following a trial led in the early 1960s by Dr Betty Macgregor.

HeraldScotland: Dr Betty MacgregorDr Betty Macgregor (Image: NHS Grampian)

In an article published in the British Medical Journal, Macgregor noted that “within five years of the screening service being established, there was a significant decrease in cervical cancer in the Aberdeen area. Such was the success of the programme in Aberdeen that it led to cervical screening services being introduced throughout the UK”.

Aberdeen was also a pioneer in reproductive medicine: it generated the first babies born in Scotland from cryopreserved embryos, and in 1995 the first baby born in Scotland as a result of micro-assisted fertilisation was conceived thanks to Aberdeen’s adoption of intra-cytoplasmic sperm injection (ICSI) – a laboratory technique whereby a single sperm is injected directly into the egg using a microscopic needle.

George Youngson, co-author and emeritus Professor of Paediatric Surgery at Aberdeen University, said he had been inspired to chart the history of neonatal medicine in the north-east following his own brush with death two years ago, but found resources lacking.

He said: “There came a point that when I tried to look into the history of the maternity hospital – because the neonatal unit is in the maternity hospital – and there was no source to go to.”

‘Bringing Life to Aberdeen’ is the first single book to bring together the region’s whole history, from early midwifery to reproductive medicine.

HeraldScotland: Celebrating the 10th birthday of Aberdeen Reproduction Unit in 2009Celebrating the 10th birthday of Aberdeen Reproduction Unit in 2009 (Image: Dr Mark Hamilton)

Prof Youngson said there had been “some seminal figures”, but that he hopes the book will also shine a light on some lesser known heroes.

“There were quite a lot of people, particularly women, who had got no real recognition for their contributions,” said Prof Youngson, citing the example of Fenella Paton who founded and personally bankrolled Aberdeen’s first birth control clinic for married women in 1926 “amidst a storm of controversy”.

He added: “She was a wealthy woman – she didn’t need to have a job, but my goodness she did a job”.

Of Sir Duguld, who helped found Aberdeen’s first neonatal unit, Prof Youngson describes him simply as “a giant”.

“He was a really staunch advocate for the health of women in pregnancy, during delivery and beyond. His instinct would be to look at the world now and condemn the US going retrogressively back on the rights of women.”

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Gary Innes on why Lamlash on Arran holds special memories

Where is it?

Lamlash on Arran. With the village situated around Lamlash Bay looking out towards the Holy Isle, it boasts outstanding views while still offering so much to see and do on the promenade and pier, as well as lots of lovely places to eat and drink.

Why do you go there?

Lamlash was where we would go for our summer holidays when I was a wee boy. My great grandma and grampa lived there in a beautiful house with the most incredible garden and views across to the Holy Isle. It holds so many wonderful memories for me and my brothers and I like to go back as often as I can.

How often do you go?

I usually manage to get over a couple of times a year and feel such a sense of calm as soon as I step off the ferry. There must be something in the air.

What’s your favourite memory?

Long summer days. fish and chips and bread with lashings of butter. Crab fishing down at the pier in Lamlash with my two wee brothers. Those days were filled with so much laughter and nonsense. I always seem to remember the sun splitting the skies and there being a never-ending picnic provided by our mum.

Who do you take?

When I was younger, we would usually go as a family – my mum, dad and two brothers. But recently I visited with my own young family. Our oldest daughter is three and our second daughter was born last year.

We visited a few weeks ago and I had a wee moment that I had always dreamed about since having the girls and that was walking down the very same pier and going crab fishing with my wife and daughters. It was such a special moment and a lovely trip down memory lane.

What do you take?

A wardrobe for all weathers. We have the buckets and spades, the waterproofs, the suncream, the shorts and the wellies. I always bring the crab line too, of course.

What do you leave behind?

Even from visiting a few weeks ago, I leave behind another wonderful and memorable moment – a memory that I carry with me for the rest of the year until we can return.

Sum it up in five words.

Beautiful. Nostalgia. Family. Peaceful. Recalibrating.

What other travel spot is on your wish list?

I’ve been very fortunate to travel and perform in many wonderful places around the world with my job in music.

However, somewhere that is definitely on the bucket list – a place I so nearly got to visit when I was booked to perform but then couldn’t go – is Tokyo in Japan.

So, if anyone knows someone in Japan who fancies a concert, or even a ceilidh in their living room, just holler. The bags are packed.

Gary Innes is organiser of Hoolie in the Hydro – the “world’s biggest ceilidh” – at the Ovo Hydro in Glasgow on December 17. For tickets visit

Yousaf: UK-India trade deal poses ‘real risk’ to NHS

FREE trade negotiations between the UK and India pose a “very real risk to affordable drug prices” and could see access to lifesaving medicines curtailed, Scotland’s Health Secretary has warned.

Humza Yousaf called on UK ministers to provide assurances that “nothing in the proposed Free Trade Agreement [FTA] with India will be allowed to jeopardise access to affordable medicines for NHS patients in Scotland and indeed the rest of the UK”.

In a letter sent to UK Trade Secretary Kemi Badenoch on November 15, and seen by the Herald, Mr Yousaf said the Scottish Government “has been clear that the protection of the NHS is a red line and that our public health service must not be threatened by UK Government trade deals”.

READ MORE: No plan for ‘two-tier’ NHS where wealthy pay, says Yousaf 

He added: “I am therefore concerned by the very real risk to affordable drug prices that is posed by the reported provisions of the Intellectual Property chapter contained in the India FTA.

“We recognise that IP protections are an important way to protect healthcare companies’ innovations. However, developments on IP can also impact the rights of individuals and limit access to affordable, lifesaving essential medical products.

“It is essential that the NHS in Scotland, and throughout the UK, continues to be able to access medicines for patients in need, and to do so in a way that is affordable – the UK Government’s proposals, as currently stated, put that core principle at serious risk.”

HeraldScotland: Humza Yousaf Humza Yousaf (Image: PA)

It comes after campaigners raised the alarm over leaked documents which suggest that current proposals relating to potential changes to intellectual property laws would enable pharmaceutical firms to ramp up prices for generic drugs.

Around four in five drugs used by the NHS are generics, and a third of these are manufactured in India.

Generic medicines are are identical in terms of dose, safety and strength to more expensive branded versions, but can only go on sale after a set exclusivity period for the original branded product has expired.

READ MORE: Highland ordered to apologise after patient waits over three years for bowel op

This is designed to reward pharmaceutical firms for investing in the research and development of new medicines.

Draft text from UK-India trade negotiations, leaked in October, indicate that the UK is pushing for tighter IP measures that could boost profits for British drug companies but would at the same time require India to introduce more monopolies on medicines.

HeraldScotland: Kemi BadenochKemi Badenoch (Image: PA)

The proposals state, for example, that each party “shall” allow a new use of an existing medicine to be patentable, reversing India’s current patent law which has ensured that old and repurposed drugs are not eligible for renewed monopoly protection.

Critics of the move include the humanitarian NGO, Médecins Sans Frontières (MSF).

Leena Menghaney, MSF’s South Asia head warned that introducing “more and more intellectual property hoops for generic manufacturers in India to jump through will have a chilling effect on the country’s ability to supply millions of people around the world with affordable, lifesaving generic medicines”.

READ MORE: NHS Forth Valley placed in special measures amid concerns over leadership and safety

In a joint letter to Ms Badenoch dated November 2, a number of NGOs including MSF, Global Justice Now, Oxfam and Health Poverty Action also warned of the potential impact for the NHS, stating that “any action that curtails India’s ability to produce quality, cost-effective medicines also threatens the financial sustainability of our health service, and ultimately puts patients’ lives at risk”.

They argued that the current proposals would allow pharmaceutical corporations “to extend their monopolies and keep prices artificially high for years beyond the end of the original 20-year patent term”, adding that the UK’s approach “is only beneficial to one group – the pharmaceutical industry and their shareholders”.

The UK Government said it does not comment on alleged leaks or the details of live negotiations.

A spokesman said: “We will never agree any provisions that would increase the cost of medicines for our National Health Service. The NHS, its services, and the cost of medicines are not on the table.

“Protecting the NHS is a fundamental principle of our trade policy, and our commitment to this will not change during our negotiations with India.

“Chief Negotiators routinely meet with officials from the Scottish Government to engage them on negotiations.” 

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Innovation in health can help people and deliver investment returns

The human body is an amazing machine. Central to this is our genetic code, with genes forming the basic building blocks of life.

Different genes determine the different traits

of an organism, and allow human cells to function and help control how the body grows and operates.

Equally, changes or mutations to these genes, either inherited or otherwise, can be the cause of a great number of diseases. As such, it is helpful for researchers to understand as much as possible as soon as they can.

Imagine a world where you or a loved one can be screened for multiple types of cancer, using genetic traces from a single drop of blood, at an early stage when it is more likely to be cured. This breakthrough technology may not be far away.

In the Liontrust Sustainable Investment team we believe the theme of innovation in healthcare provides an important lens to identify market leading healthcare companies.

We look for companies with unique intellectual property that offer positive outcomes for patients alongside strong returns for investors.

Innovation in gene sequencing expands our understanding of the human genome whilst reducing the cost. Large cap US-listed Illumina,

a first mover in the market and one of our holdings, has driven this. It is a company with strong research and development investment and

a unique portfolio.

International scientific research project the Human Genome Project was able to sequence our genetic code at a total cost of $3 billion in 2003 after a 13-year effort. Thanks to continued innovation, this figure has drastically fallen over time. Illumina recently unveiled new technology designed to reduce the cost of sequencing a genome to $200.

This is a remarkable change, achieved by reading genes in bulk with large batch

systems, requiring samples to be processed in well-resourced, centralised labs.

However, the future will be far more flexible than this.

Another of our holdings, UK-based Oxford Nanopore, has pioneered portable devices that can sequence genes both cost-effectively and without the need for travel. This has amazing promise, with the business forecast to grow in the order of 30 per cent per year.

This not only has a positive impact in terms of speed of sequencing, but also increases access to isolated areas or emerging markets where large scale labs are hard to come by.

For example, Nanopore’s devices have mapped genes underwater, in a remote Ecuadorian rainforest, and even on the International Space Station.

The point of all of this genetic sequencing information, and its relevance to us all, is that it can help diagnose and treat disease.

Looking first to diagnosis, if we know the genetic markers of a disease or pathogen, we

can have more confidence on what the patient faces. It follows that if we can achieve this diagnosis earlier in the disease’s progress,

we can aspire to much better patient outcomes.

Consider the example of liquid biopsy. Here we search for genetic traces of early cancer within the blood, with the aim of spotting the disease much sooner than the conventional paradigm of waiting for the tumour to grow large enough to be seen with a CT scanner. Grail, a company owned by Illumina, is one of our exposures to this nascent industry.

In terms of treatment, therapies are increasingly targeting genetic subsets of individuals within a given disease. The strongest example of this is where the patient is given a corrected version of the gene to cure the disease at source.

Oxford Biomedica and Syncona are examples of holdings that are exposed to this paradigm.

There is a huge growth opportunity within this space benefiting both humanity and investors. Remember that only 0.05% of humans have had any of their genome sequenced. The innovation in healthcare theme across our Liontrust Sustainable Future investment process enables our view that it is early days in the opportunity for humanity, science and the companies that enable this progress.

Laurie Don is an investment manager on the Liontrust Sustainable Investment Team.

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Scots environmental health expert warns of home mould risks

The public is being bombarded with energy efficiency advice which could increase the risk of damp and deadly mould, a Scots environmental health expert has warned.

Keeping windows permanently shut, sealing trickle vents and turning heating off can create the ideal conditions for the fungus to thrive, said Andrew Campbell, who inspects properties on behalf of Edinburgh City Council.

He said it would be very difficult for some households to strike a balance between keeping costs down, staying warm and maintaining a safe living environment.

The UK Government announced it is to strip funding from a housing organisation responsible for a property where a two-year-old boy died after prolonged exposure to mould.

Awaab Ishak died in December 2020 from a respiratory condition caused by mould in the one-bedroom housing association flat where he lived with his parents in Rochdale.

His father repeatedly raised the issue with Rochdale Boroughwide Housing (RBH) but no action was taken.


Mr Campbell said serious cases like that were rare but said the council had experienced a recent rise in call-outs for problems including damp, mould and vermin in flats owned by social landlords.

Inhaling mould fragments or spores can inflame the airways, causing nasal congestion, wheezing, chest tightness, coughing and throat irritation.

According to the World Health Organization (WHO), a considerable proportion of the world’s 300 million cases of childhood asthma is attributable to exposure to indoor dampness and mould.

READ MORE: ‘Beggars belief’: Fury at Scots housing group over damp and mould failures 

“The only positive that comes out of a case like the toddler’s death is that it brings it to the front of peoples’ minds,” said Mr Campbell.

“In the vast majority of cases it’s the lifestyle of the people living in the properties which is the biggest contributory factor to mould growth,” he said.

“It’s all down to heating and ventilation.

“You need to heat the property adequately but you also need to let it breathe, which goes against some of the messages and advice that so-called experts are giving out in terms of sealing the property and cutting out draughts.

“You can get mixed messages which is problematic.

“I genuinely don’t know how some people are going to be able to cope with it and balance things out.

He added: “If you are seeing [black mould] you should be doing something about it.”

He said inspectors often come across trickle vents above windows [which lower humidity in a room] which have been sealed over.

He said: “With the cost of heating, people are starting to do more of these things but the trickle vents are there for a reason – to let the building breathe.”

He said wet rooms such as bathrooms and kitchens were generally most at riskof damp and mould and and said those without extractor fans should be opening windows while having a shower “even if its freezing cold” 

READ MORE: Glasgow scam alert after scammers targeted pensioner in £7000 con

He said:”If the mirror is wet with condensation, that’s your indicator. When that clears, that’s when you can close your window over.

“But it goes against what we are being told.

“If you are drying your clothes, don’t dry them inside, dry them outside which seems impossible right now.”

Other advice includes keeping the lid on pots when cooking and pulling bedroom cabinets away from the wall to ensure that air can circulate.

“You just want to minimise any moisture going into the air,” he said.

“If you are getting condensation on the inside of your windows that’s the first sign.

He said some newer buildings were designed to ensure all draughts were kept to a minimu which could create problems.

He suggests keeping bedroom doors open, if possible when sleeping and trying to maintain a “consistent temperature” in the home.

He said: “Heating and cooling homes is one of the things you are seeing in these forums but you should try to keep your home at a consistent temperature so you are not creating really hot and cold surfaces.

“It means the moisture in the air won’t condense in the fabric of the building as easily.”








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Lennie Pennie: Time to end a stigma that all women face

I TRY my hardest to choose topics which I think are important. Ones I think people should talk more about, so on that note I am going to spoil the ending for you now and say this week we’re going to be discussing issues related to the vagina.

You might have one, or know someone who does, and you might even have come from one yourself. Regardless of your subjective experience with this particular body part, I believe that everyone should understand the manner in which stigma, shame and prejudice intersect and can have harmful consequences, not just socially, but medically.

If you think this sort of subject should be left private and not spoken about outwith the home, you are exactly the type of person I am hoping to reach. There is a shocking lack of general knowledge about vaginas, the care they require, and the issues which often arise as a result of neglecting this care.

Gaps in knowledge can quickly become a fertile breeding ground for stereotypes, rumours, and stigma, and it seems as though the people who are usually excluded from the discussion are those who need to be made a part of it the most. It is essential for parents, caregivers, partners, and friends to be adequately educated on the facts, as the best antidote to ignorance is education, and it is only through dispelling harmful preconceptions and stereotypes that stigma can be overcome.

I really want to avoid using cutesy euphemisms to describe one of the most stigmatised body parts out there, so today there will be no references made to hoo has, foofs, vajayjays or flowers. I think it’s important to say the word vagina just as we would any other part of the human body, and if it makes you uncomfortable then I’d invite you to unpack the reasons for that.

If you’ve ever needed to purchase period products, either for yourself or on behalf of someone else, you might have experienced the weird feeling that you’re doing something illicit. When HM Treasury announced the removal of tax on menstrual products, the image of a (clean) cartoon tampon in their marketing was branded ‘obscene’ by those who opposed it.

Adverts for menstrual products tend to emphasise discretion; although billions of people will experience menstruation as a healthy natural bodily function, heaven forbid we acknowledge it. Blue liquid is used in advertisements to protect the sensibilities of those watching, many of whom do not have the luxury of avoiding a monthly blood ritual.

A bubbly character in stark white shorts gleefully tells the audience through euphemisms and metaphors how quiet the wrapper is, and we hear how with the addition of an expertly blended, carefully curated scent, even the person using the products will forget they are menstruating. Some products even include a night-time scent in their range, which one can only assume is intended to lull the vagina to sleep.

These products were not created in a vacuum, they have been designed to capitalise on the stigma that vaginas, especially during menstruation, smell bad, and that smell should be masked at all costs. As with many products on the market, creation of a problem necessitates a profitable solution. If we convince people that their vagina is dirty, and smells bad, we can market scented products to counteract this.

These products aren’t just ineffective, they also have the potential to do substantial harm. The vagina is self-cleaning, it has a delicate microbiome and pH which, when left to its own devices, is pretty low maintenance.

The introduction of perfumes and other chemicals designed to mask scent can cause and exacerbate issues such as yeast infections, bacterial vaginosis, and contact dermatitis, none of which are fun. Often, a change in vaginal scent is a symptom of an issue which does require attention or medical intervention; ignoring or covering it up with perfumes can mask a concern which will not resolve itself and can worsen if neglected. Without adequate education on which products are best to use, combined with the shame felt in accessing help, people can be stuck experiencing unnecessary pain and discomfort for years.

The vagina should never be a sterile environment, like the gut it is full of healthy essential bacteria which work hard to fight against disease and infection. Douching, the practice of spraying water or chemicals inside the vaginal canal in order to clean, disinfect, or kill bacteria has been linked to an increased risk of cervical cancer as a result of HPV.

Lysol, a common American household disinfectant spray was marketed for years as the perfect product for people to use inside the vagina to avoid their ‘intimate neglect’ which could ‘mar a marriage’ and ‘lose a husband,’ a stigma which has somehow survived to this day. The use of chemical douches on the sensitive skin and delicate balance of the vagina can lead to people experiencing everything from allergic reactions to chemical burns. If in doubt, experts recommend leaving the internal genitalia alone and using warm water externally, with the addition of a mild soap or cleanser if desired.

People should be educated on proper vaginal hygiene and given information which is essential to maintain their health and safety, and the health and safety of those around them and in their care.

Despite the stigma which remains, thankfully the tide is turning. People are being increasingly open and honest about menstruation and the importance of vaginal health.

The Scottish government pledged to help overcome period poverty with the provision of free menstrual products, bringing vital exposure to issues which affect millions of people every day. The stigma and shame associated with both menstruation and vaginas in general cannot be overcome until open and honest discussions are held, including people with no prior experience of either.

It doesn’t matter if you have never, or will never experience a period, if everyone is given the proper opportunity to learn the facts, we can help address harmful and stigmatising stereotypes and alleviate the shame that people have been conditioned to feel. Period.

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Herald View: The founding principles of NHS should be up for debate

IT did not last for very long, this glimmer of grown-up debate about the sustainability of the NHS. No sooner was it detected than the shutters came down, and the earnest shibboleths about founding principles were dusted down and hurried into the open.

Leaked minutes of a meeting of NHS Scotland directors included the suggestion that the Scottish Government create a two-tier NHS, with wealthier patients paying for NHS care. Other proposals included the funding of new drugs, and hospitals potentially discharging patients more quickly than is currently the case.

Two key phrases stood out from reports of the leaked document; the group had been granted the “green light to present what boards may feel reform looks like”; and “areas which were previously not viable options are now possibilities”. Additionally, a lack of clinical output in the SNP’s political decision-making had left Nicola Sturgeon’s administration “divorced from reality of life and purpose of service”.

The sensitivity of the matter stems in part from the fact that the directors had been briefed about recent conversations with Caroline Lamb, chief executive of NHS Scotland, who works closely with the Scottish government’s health secretary, Humza Yousaf.

Ms Sturgeon swiftly asserted her opposition to the notion that wealthier people might pay for NHS treatment . The founding principle – free at the point of delivery – was not up for discussion (Rishi Sunak said the same thing at the CBI). Cybernats predictably then rounded on BBC Scotland, which had exclusively reported the leaked document. BBC bosses at Pacific Quay were commendably quick to defend their right to report on NHS matters.

People are wearyingly familiar with news stories about waiting lists, widespread patient dissatisfaction, delayed ambulances, overcrowded A&E departments, and grievously over-worked doctors and nurses. NHS Forth Valley has even been placed in special measures amid worries about its leadership, out-of-hours service and unscheduled care.

Further accounts of bed shortages and waiting-lists will emerge as we move deeper into winter. The exceptional NHS response to the global pandemic naturally impacted upon its ability to carry out elective services; but can this lost ground ever be recovered?

You can’t blame NHS workers from seeking better lives abroad. Our health correspondent, Helen McArdle, has spoken to one nurse, from Perth, who is now enjoying a much more rewarding life in Perth, Australia. Others will assuredly follow in his wake.

Would that such serious problems were all that the NHS has to deal with. The SNP government might have rebuked the directors for having that contentious discussion about a two-tier NHS, but we are fast approaching the point – if, that is, we are not already there – when we really need to have a frank national discussion about the sustainability and future of the health service.

What exactly do we want from it? Are its 1948 principles now out of date? What, if anything, are we willing to pay for? Would we be willing to countenance higher taxes, especially in the light of the tax rises unveiled by the Chancellor? Should we, as a retired consultant surgeon pondered in a letter to The Herald this week, write off the founding principles and adopt a European model supplemented by social and top-up private insurance?

There’s evidence that Scotland already operates a two-tier NHS system, with 40,000 patients undergoing private procedures in the last year. At an average cost per patient of £12,500, hip and knee surgeries are formidably expensive but they indicate that for many people it’s better to bear the cost of going private than waiting for the NHS to help, even it means remortgaging your home.

To a degree, initiating an honest national debate about the health service – and, more importantly, agreeing in advance to give serious thought to any of its conclusions or recommendations – would be a genuinely bold political move. The mere act of establishing it, and agreeing its frame of reference, would take considerable time and effort. But anything has to be better than doing nothing, better than the inane repetition of cries to ‘save the NHS’, whatever that means in these straitened times. And, in the meantime, services such as dentistry will continue to be reduced without any big fanfare.

Would any government in Edinburgh or London have the courage to say that we should adopt some kind of insurance model, pointing to the success of such programmes on Europe or Australia, which tend to have better outcomes on such matters as cancer survival? Or would they write off such an idea as an instant vote loser?

We do at least need an urgent reappraisal of NHS spending. Part of the vast sums devoted to healthcare could be diverted into social care or preventative healthcare, in order to ease pressure on the NHS in the first place. Complicating this, however, is the fact that Britain has an ageing and increasingly obese population, which means that demand is likely only to increase in the next decade or two.

In the immediate term, the workforce is the biggest problem facing the NHS. One quick fix that the UK could make is to address the pension tax problem that is driving senior doctors to slash their hours and retire early. Doing more to retain existing staff should be the top priority for Edinburgh and London, especially as it is more expensive to have staff quit then NHS and return as agency staff.

This might be a more easily attainable solution than publicly debating the sustainability of our national health service. But surely it is time that those founding principles, jealously guarded for so long and at such expense, came up for debate.

Keeping the indy dream alive

IN the light of this week’s UK Supreme Court decision Nicola Sturgeon hopes that a pro-independence majority at the next election will help her pressurise London to begin talks on ending the Union. This assumes, however, that London will pay any heed.

Should such a majority fail to materialise, where can the independence movement go from there? Unionists may hope that the issue simply withers, especially if Keir Starmer as Labour PM devolves further powers to Scotland. But independence will remain the defining political question of the age. How can the SNP keep its independence diehards onside when there’s no prospect of a second referendum? Some activists say, darkly, that the Union cannot be a voluntary one if there is no way out. They have a point. But keeping the dream alive will take considerable ingenuity.

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Letters: Indy campaign will go on even if General Election plan fails

ANDY Maciver is the most astute and reasoned of the unionist commentariat in my view. I agree with much of his article (“Will SNP see that a new unionism can work for us all?”, The Herald, November 25), but with a couple of quibbles.

The “Hail Mary” de facto election referendum (like Boris Johnson’s “get Brexit done” in 2019) is a gamble, but it won’t be the end for pro-independence supporters. As we see with the No 10 revolving door, mandates can be stretched to infinity and with that example set, a new SNP leader with public support would carry on fighting for independence.

I am unaware of any polling which points to voters in Scotland leaving the SNP for Labour (a common boast among unionist commentators), and why would they? Perhaps we could now see the “private” polling the UK has done in Scotland, funded by our taxes?

Labour under Sir Keir Starmer appears anything but radical, and any hope that Gordon Brown can bring new “significantly enhanced” constitutional proposals to the table seems slim: press reports claim he has already had to water down his plans to assuage sentiment in England. A confederal solution, with shared sovereignty among equals could be a winner, but I fear that Anglo-British nationalists would never thole that.

GR Weir, Ochiltree.


ACCORDING to Nicola Sturgeon “our independence movement becomes Scotland’s democracy movement” (“First Minister’s spin doctor condemned after ‘Unionist election deniers’ rant”, The Herald, November 25). Was it democratic for Ms Sturgeon to say “I detest the Tories”?

Was it democratic for a woman to be ejected from Holyrood for wearing a scarf in Suffragette colours? Was it democratic for Ms Sturgeon to have misled the Scottish Parliament over the Scottish Government’s handling of the Alex Salmond inquiry? Is it democratic for the SNP’s rulebook to state: “No MP shall publicly criticise a group decision, policy or other member of the group”?

Scotland could do with more democracy, more transparency, less flag-waving and zero inflammatory rhetoric.

William Loneskie, Lauder.

• IT would appear that Nicola Sturgeon’s official spokesman is struggling to come to terms with which Scottish politician is currently behaving most like Donald John Trump. For help with this he need look no further than Dr Johnson’s dictionary of 1755 for the definitive definition of trumpery: “Something fallaciously splendid, something of less value than it seems, falsehood, empty talk, trifles.” Sounds like a fair description of the official spokesman’s boss to me.

Michael J Laggan, Newton of Balcanquhal.


AS a voter, the greatest challenge is what to believe in what politicians say, and to have faith that what is said is sincere and honest. The greatest despair is discovering that what you were told was a lie.

With the Supreme Court ruling against the Scottish Parliament holding a new independence referendum, Nicola Sturgeon has declared that the next General Election would be a “de facto referendum” on independence. A vote for the SNP would be a vote for independence.

Previously Ms Sturgeon has insisted that a vote for the SNP does not amount to a vote for independence. Ms Sturgeon is on record as saying “A vote for the SNP is not a vote for another referendum. It is a vote to have Scotland’s voice heard at Westminster.”

So what does this mean? Are the electorate being manipulated by the SNP? Are the votes for the SNP being misinterpreted?

The electorate have been encouraged to vote for the SNP if they support independence. Also vote for the SNP if you support the party, but not independence.

To be clear – Ms Sturgeon will use the electorate’s vote to say that the people of Scotland have spoken, and they want independence. And that Scotland is being denied its democratic right. So it is critical that the electorate are aware that despite being told otherwise, a vote for the SNP is a vote for independence.

Mark Gray, East Kilbride.

• SEVERAL pro-Scottish independence writers have written letters on the UK Supreme Court decision (November 24 & 25), and I respect their views. But can one of them please answer a question? Should Indyref2 happen and if the unionists were to prevail for a second time, how many years should lapse before Indyref3 happens?

Geoff Moore, Alness.


ANYONE who has met me will know that my knowledge of football is considerably limited, but they will also be aware that, after more than 50 years in public life, I can offer considerable experience of employment tribunals and related matters.

I feel strongly that the findings on footballer Rico Quitongo (“‘Bitter blow’ as footballer loses race case against former club”, The Herald, November 25) are disturbing.

Perhaps I should explain that some years ago I directed an award-winning amateur film based on the story of Queen of the South player Mike Jackson. My rather loose association with the club since then was renewed when I discovered that their players train in the same club in the gym which I use twice weekly. I should declare that I got to know Rico Quitongo quite well and I consider him to be a true professional. I find him highly intelligent, dedicated, and entirely trustworthy. It is not without significance that his claim – which I have never discussed with him – was supported by the Equality and Human Rights Commission (EHRC) and the Professional Footballers’ Association, which are both commendably active on issues on racial discrimination and harassment.

Several comments from the tribunal judge surely lead to some pertinent questions. Presumably following representations, we are told that “while the club carried out an investigation into the matter” it was later dropped due to “insufficient evidence”. Surely this is rather strange? Why would any club go to great lengths to find evidence which could reach the conclusion that they were themselves culpable if they were not discharging their responsibilities? Later we read that a club director “could not be held responsible for the alleged abuse as it was said by a supporter and not an employee or someone for whom either respondent was in law, responsible”. Mr Quitongo was an employee; isn’t there a duty of care?

I very much welcome the chairwoman of EHRC’s comment that “we hope that this is an opportunity for football clubs across Britain to better understand their duty to protect their employees and handle allegations in line with the law”. However, if the tribunal headed by a judge clearly felt that there was no breach of the law I find that worrying. In my opinion if current law allows a player to be treated in the way I believe he was, manifestly current law is insufficient and doesn’t go far enough. I have huge respect for the EHRC and PFA and urge them to campaign, with the influence they have, for the law to be brought up to date. Equality and human rights in modern Britain surely demand no less.

Sir Tom Clarke, Former Labour MP for Coatbridge & District, Coatbridge.

Will the monarchy come under increasing threat as our living standards decline? Picture: PA

Will the monarchy come under increasing threat as our living standards decline? Picture: PA


I SHARE many of the sentiments concerning the monarchy expressed by Tommy Sheppard (“Scotland does not need King Charles”, The Herald, November 23). He is aware, I am sure, that he is going down a well-trod road in stating his dissatisfaction with the existence of the monarchy. He will also be aware that there are three possible methods of dispensing with the monarchy: revolution, legislation and abdication. The majority of the British population have considered that the possibility of the adoption of the first or second of these methods in the foreseeable future as being remote, with the third, as matters currently stand, unlikely.

George VI remarked in 1948 to Vita Sackville-West, the novelist, journalist and poet, after he was informed that her substantial home was being handed over to the National Trust: “Everything is going now, before long I shall also have to go.” He got that wrong so far as the monarchy is concerned, didn’t he ?

During the reign of the late Queen, the standard of living of the British population generally showed consistent and welcome improvement. Might it come to pass that during the demanding years, currently being widely predicted for the UK by so many, the need for and the costs of the monarchy will be subjected to increased questioning and debate?

Ian W Thomson, Lenzie.

• HOW wonderful to see a well-argued republican opinion prominently published in The Herald. We have had weeks of wall-to-wall media covering a family that makes little or no difference to our daily lives. Thanks for publishing this. I hope readers who agree with Tommy Sheppard’s opinions will consider joining Republic, of which I am a proud member.

Sue Lane, Edinburgh.


FURTHER to the letter regarding the Dutch education system (November 11), I wish to highlight my granddaughter’s experience of learning French in Scotland.

Despite doing well in the National 5 exam, she has decided not to continue with Higher French. She took French because she had a passion for the language and wanted to improve her skills.

More than 50 pupils at her school took National 5 French last year, clearly showing many pupils had an interest in and passion for the language as well. However, not one person decided to continue with Higher French this year, which shows how flawed Scotland’s method of teaching languages is. This involves memorising essays and passages to regurgitate in the exam and this could have been in any language.

This disappoints me greatly as, in 1970, I was in the fortunate position of sitting an Oral O Grade French. What has happened in the interim period?

Jacqui Mair, Irvine.


I SUPPOSE it was inevitable that once the World Cup got under way the national news bulletins would open with a visit to the England team’s hotel or training camp to get the latest news of the future winners of the tournament. On Wednesday I was interested to hear that star striker Harry Kane was going for an X-ray to reveal the seriousness of his ankle injury. The reporter advised us that in around two hours’ time the England camp would have the result and therefore would know if Kane could take any further part in the tournament.

It occurred to me that it was good job that the World Cup was not taking place in Scotland, as poor Harry Kane would have had to wait six to eight weeks for an X-ray and a further two to three weeks to get the result. This would mean the tournament was over before the X-ray results were known

Ally Martin, Dundee.

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