Birth is one of the last great mysteries and its awe derives in part from our uncertainty at what will emerge

Birth is one of the last great mysteries, and its awe derives in part from our uncertainty at what will emerge. Eyes, nose, hair, gender, colour of skin: would we want to live with the responsibility of having to choose them all, and of having to justify those choices when our children are old enough to complain that we chose badly? The great virtue of not choosing is that we recognise children as separate entities, beyond our keeping, not as toy models we create piece by piece from construction kits. Dr Stephen Law is a lecturer in philosophy at London University and author of ‘The Philosophy Files’. Blake Morrison is a poet and author of ‘And When Did You Last See Your Father?’ and ‘As If’.. A cosmetic surgery technique for trimming surplus fat from women’s hips, thighs and buttocks is transforming the lives of women suffering from a painful and grossly disabling side-effect of breast cancer treatment.

A cosmetic surgery technique for trimming surplus fat from women’s hips, thighs and buttocks is transforming the lives of women suffering from a painful and grossly disabling side-effect of breast cancer treatment.
The liposuction procedure literally sucks fat from the body. It is being used to remove up to two litres of fat from the arms of cancer patients who have had their lymph glands surgically removed to prevent the disease spreading.Loss of the glands can cause lymphoedema which affects the body’s natural drainage system, inhibiting the flow of colourless lymph fluid, which plays a key role in the immune systemAbout 7,000 British women a year develop lymphoedema after undergoing breast cancer surgery. Some are so badly affected that they become lopsided and cannot find clothes to fit. At present the condition is usually treated with compression bandages and exercise.The new operation has been pioneered in Sweden by Dr Haken Brorson at the department of plastic and reproductive surgery at the University of Malmo.Speaking about the first 64 operations, he said: “We removed, typically, about two litres of fat from the arms of these patients via liposuction. After two weeks, their arm swelling was reduced by 72 per cent, by 80 per cent at one month, 88 per cent at three months, 93 per cent at six months and 98 per cent after one year.”The reduction subsequently continued slowly and at six years it was 104 per cent – the treated arm becoming a little smaller than the healthy arm.

In addition, the range of movement in the shoulder joint increased, and pain and discomfort in the arm and hand diminished.”Dr Brorson added: “I shall always remember one of my patients telling me how much it meant to her to be able to walk into a shop and, for the first time in many years, choose a dress, confident that it would fit her.”But the liposuction patients are still advised to wear compression sleeves permanently to prevent recurrence of the problem.The new operation has been welcomed in Britain by the Imperial Cancer Research Fund as a procedure showing “much promise” .Gloria Freilich, founding President of Europa Donna, the European breast cancer coalition, said that lymphoedema was “a Cinderella condition” which caused extensive pain and distress.Speaking recently at the European Breast Cancer Conference in Brussels, she said: “Commonly, patients are told that nothing can be done to help them and that they should be grateful that they’ve been cured of cancer – that lymphoedema is part of the price they have to pay. This is just not true.”They’re also frequently given inappropriate advice such as being told to buy a mechanical pump for the arm. Used without professional supervision, this can actually cause immense further damage by wrecking any remaining possibilities for drainage of accumulated lymph.”Patients can be helped by timely diagnosis, appropriate treatment, advice and support,” she said.. Patients will lose instant access to their family doctor at night and at weekends under plans by the Government to make NHS Direct – the health telephone helpline service – handle all out-of-hours calls for GPs.

Patients will lose instant access to their family doctor at night and at weekends under plans by the Government to make NHS Direct – the health telephone helpline service – handle all out-of-hours calls for GPs.
In future, patients who ring their GP at night or at weekends will be answered by qualified nurses manning the NHS Direct switchboards.Previously they would have been passed on to another GP or a commercial deputising service.Non-urgent cases will be offered advice and told to seek an appointment with their doctor in the morning, while walking wounded could be asked to seek treatment at local accident and emergency units.For urgent cases, NHS Direct operators will ask doctors to make home visits, but they may call out commercial deputising services rather than patient’s own GPs to respond to requests for treatment.The decision to use NHS Direct to handle out-of-hours calls for GPs alarmed doctors’ leaders, and it is understood that Downing Street delayed the announcement by Alan Milburn, the Secretary of State for Health, in order to seek assurances that the telephone service will be able to cope with the extra demand.Mr Milburn will couple his announcement in a fortnight’s time with extra resources to guarantee that NHS Direct will be able to meet the extra demands being placed upon it. “We are not about to implement a system that cannot cope,” said a ministerial source.The helpline will do away with the traditional image of GPs as “Doctor Finlay” figures, ready to turn out at all times of the night for their patients. However, the Government is concerned that this image was largely a myth in many towns and cities.Ministers are adamant that the changes will improve the service to patients by reducing the reliance on commercial deputising services, which have increasingly taken over the handling of night calls.GPs will remain responsible for the patients on their lists, in spite of the new role taken by NHS Direct, following a review of out-of-hours services by medical leaders.The review was ordered by the Secretary of State after a series of highly critical reports by the Health Service Ombudsman, Michael Buckley, on cases where GPs or deputising services had failed to respond to calls properly.In June the Ombudsman condemned a deputising service in Lancashire for a case in which there was a delay of nearly three hours before the doctor was told about an emergency call.He said it was “totally unacceptable” that the prioritisation of calls was being done by staff who were not clinically qualified. The operator had failed to note that the patient – who died in hospital – was unresponsive, which would have prompted more urgent action.”There is concern that the NHS will not be able to cope with the volume of calls that it has to deal with,” said one member of the review team.”Last Christmas and New Year we heard stories about clerks pretending to be recorded answering messages because the lines were overloaded.