Doctors call for car smoking ban

 Dr James Cant of the British Lung Foundation carried out an experiment to measure the amount of toxins passed on to passengers

All smoking in cars should be banned across the UK to protect people from second-hand smoke, doctors say.

The British Medical Association called for the extension of the current ban on smoking in public places after reviewing evidence of the dangers.

It highlighted research showing the levels of toxins in a car can be up to 23 times higher than in a smoky bar.

But a report by a cross-party group of MPs and peers said non-legislative options should be considered as well.

The All-Party Parliamentary Group on Smoking and Health even said calling for an immediate ban could be "counterproductive" as consensus needed to be built across society before taking such as step.

The group said there should be a consultation on tackling smoking in cars which could look at whether it would be better to have an outright ban, or if more could be achieved by raising awareness about the dangers through education campaigns.

It pointed out that policing a ban on smoking in cars could be difficult.

Continue reading the main story Just over a fifth of adults in England smoke; the figure is slightly higher in other parts of the UKIt is estimated that between a third and half of smokers will light up while in a carIf they do so the concentration of toxins is much higher in a car than a smoky bar; some research has put it at 23-fold, although others have suggested lower figuresIf windows are open, the concentration levels can be lowerSmoking is already banned in vehicles that are used for work purposes, such as taxisAs yet no part of the UK has banned smoking in private carsNo part of the UK has yet implemented a ban, although ministers in Northern Ireland have said they will launch a consultation on the issue.

Meanwhile, in Wales a public awareness campaign has begun highlighting the dangers of smoking in cars. Officials have said if that does not succeed over the next three years, a ban will be introduced.

Neither England or Scotland are currently considering introducing legislation at the moment.

But the BMA believes tougher action is needed.

The doctors' union said an outright ban - even if there were no passengers - would be the best way of protecting children as well as non-smoking adults.

It said the young were particularly vulnerable from second-hand smoke as they absorbed more pollutants and their immune systems were less developed.

Research has show that second-hand smoke can increase the risk of a range of conditions, including sudden infant death syndrome and asthma, as well as impairing lung function.

Dr Vivienne Nathanson, head of science at the BMA, admitted introducing a ban would be a "bold and courageous" move.

She added: "The evidence for extending smoke-free legislation is compelling."

International action

While no part of the UK has yet taken such a step, countries elsewhere in the world have.

Some states in Canada, the US and Australia, as well as the whole of South Africa, have introduced legislation, but in each case it has been focused on stopping smoking where children are present.

Your views on whether smoking should be banned in cars

Instead, the BMA said a complete ban would be better as it would be easier to police. It would also have the added benefit of potentially improving safety as smoking could be a distraction for the driver, the report said.

The recommendation, which was produced after doctors' voted at their annual conference in the summer in favour of their union lobbying for a ban, received some support from other health groups.

However, the likes of Asthma UK and the British Heart Foundation said any ban should only cover children.

But smokers' lobby group Forest said there was "no justification" for a ban at all.

Director Simon Clark said: "Legislation is a gross overreaction. What next, a ban on smoking in the home?"

A spokesman for the Department of Health in England said: "We do not believe that legislation is the most effective way to encourage people to change their behaviour."

He said instead a marketing campaign would be launched in the spring which would focus on the dangers of smoking in the home and car.

Ending frayed tempers in A&E

 How one emergency department could be improved by the new design

Designers have come up with ideas to try to stop patients losing their temper with staff at accident and emergency (A&E) departments.

The year-long project explores how the NHS can use cheap solutions to ease patients' frustration.

The emergency department at Southampton General sees 300 patients a day.

Psychologists helped identify why people who are normally calm might flare up in casualty departments.

The Department of Health commissioned the work to find out how the units could become calmer.

Figures published last week revealed there were 57,830 physical assaults on NHS staff in England in 2010-11, a rise on the previous year.

Continue reading the main story

Violence and aggression towards staff and other patients in the emergency department is a major nationwide issue.”

End Quote Dr John Heyworth Southampton General Hospital The Design Council briefed experts to find simple solutions that would make A&E patients feel less alienated, and help them understand why they might be having to wait.

The psychologists helped the designers identify six profiles explaining why patients might become violent (such as being drunk or confused), and nine factors that could trigger violence - such as inhospitable environments.

Solutions include a new approach to greeting patients when they arrive and answering their questions, as well as clearer signs and maps explaining the different stages of A&E treatment.

Another suggestion is to use screens to give live updates about how many cases are being handled by the staff at that time.

There is also specific advice about lighting, decor and seating for managers who are planning major refurbishments.

It's now expected that three hospitals in Chesterfield, Southampton and London will test the ideas.

The head of the Design Council, David Kester, said: "This is design at its best - solving a long-standing, high-cost problem through creativity, simplicity and collaboration.

"For not much more than £60,000 hospitals can now quickly and easily install this system which could significantly reduce the burden of aggression from patients."

Practical solutions

Attacks on NHS staff are thought to cost at least £69m a year through victims needing time off work and legal costs in pursuing cases.

The health minister, Simon Burns, said: "Despite an increase in the sanctions taken against people who assault NHS staff, more needs to be done - and we are taking action.

"These are practical solutions - and are ways in which hospitals can easily redesign the environment according to their budget.

"Difficult situations can be diffused by simply giving patients more information."

A consultant in the emergency department at Southampton General Hospital, Dr John Heyworth, said: "Violence and aggression towards staff and other patients in the emergency department is a major nationwide issue.

"It has been getting worse and has not shown any signs of letting up in recent years.

"While there will always be a small minority intent on causing trouble, there are others who can resort to aggressive behaviour because they don't feel they have been communicated with effectively and they don't know what to expect.

"Some emergency departments haven't changed since the 1960s and 70s. Improvements in the design can help to take the tension out and create a calmer environment."

Girl's heart transplant after dad

Heart transplant patients Dan Collingswood and his daughter Maia, nine, with Maia's mother Hannah Carter A nine-year-old girl has undergone a heart transplant, 14 years after her father had the same operation.

Doctors realised Maia Collingswood needed the transplant after her father Dan revealed he also had the procedure in 1997.

Maia, from Barmouth, Gwynedd, had the transplant at London's Great Ormond Street hospital in August after a three-month wait for a new heart.

She has now been welcomed back to her school, Ysgol y Traeth.

Continue reading the main story

Dan's family, my family, the school, friends and indeed the whole community... Telford have been magnificent and supported us”

End Quote Hannah Carter Maia Collingswood's mother Maia, a year five pupil, fell ill at Easter while visiting her grandparents in Telford, Shropshire.

"Maia was out of breath and could not move," said her mother, Hannah Carter.

"She was taken to the local hospital and then transferred to the Birmingham Children's Hospital where a heart problem was diagnosed."

But Maia's father said when he questioned doctors and revealed he had undergone a heart transplant, the medical team realised her condition was serious.

She was transferred to the London Children's Hospital, where surgeons confirmed she also needed a heart transplant.

Her condition continued to deteriorate over the next three months, until she finally received the donor heart she needed on 15 August.

Maia returned to Ysgol y Traeth in Barmouth seven weeks ahead of schedule

It was three months of desperate worry for her parents, who are are separated, but remain friends. The local community rallied around to ensure they could spend as much time as possible with their daughter in London.

"Dan's family, my family, the school, friends and indeed the whole community here in Barmouth and in Telford have been magnificent and supported us throughout the summer after Maia was taken ill," said Mrs Carter, who works for the Gwynedd home care team.

Collection tins

Mr Collingswood, who works at a private care establishment near Dolgellau, added: "I am with the local lifeboat here in Barmouth and the RNLI helped us out financially when we had to visit Maia in hospital in London.

"The community has been great, there were collection tins everywhere for Maia and it helped us out. We could not have managed without the support of the community."

On Tuesday, Maia was greeted by pupils and the head teacher as she returned to class, seven weeks ahead of schedule.

Continue reading the main story

When I was in hospital I met the singer Adele, racing driver Lewis Hamilton, Alexandra Burke from the X Factor and two American astronauts”

End Quote Maia Collingswood "Maia would have liked to have gone back to school last week but we had to travel to Great Ormond Street for check-ups," said her mother.

"She asked if she could go back to school after returning home from London and the expert medical team said that it was OK. Maia was delighted."

The long wait for the transplant meant Hannah's mother had to give up her flat in Barmouth to be with her daughter, but she has now moved into a new home with Maia after being rehoused by housing organisation Cartrefi Cymunedol Gwynedd.

Mrs Carther added: "I started back to work this week, Maia has started school, we have a new flat, it is all coming together.

"It has been a long and traumatic summer and without the support of family, friends and the community and the medical team, I don't know how I got through it."

Maia herself said she was delighted to be back in the classroom, and revealed how she had coped with her long stay in hospital.

"I used to talk to my school friends on Skype when I was in hospital in London and the headmaster visited me a couple of times."

She also had a number of special visitors while on the hospital wards.

"When I was in hospital I met the singer Adele, racing driver Lewis Hamilton, Alexandra Burke from the X Factor and two American astronauts, " she said.

How would you cope with trauma?

Pam Warren says she is "fascinated" by the effects of trauma on individuals Few of us can imagine how we would react if the train we were travelling in crashed and turned into a fireball.

Berkshire woman Pam Warren survived the 1999 Paddington rail crash, but suffered severe burns to her face and hands.

She became known to the media as the "lady in the mask", as the burns on her face slowly healed and she was forced to wear a mask to reduce the effect of scarring.

Since the crash, Ms Warren has become fascinated by how people cope with traumatic events.

Today she has learned to live with the physical and psychological effects of her ordeal and has braved the media in her campaign to make railways safer.

'Belch' of smoke

While recovering from her own facial burns, she came to know fellow burns survivor Simon Weston OBE, who was engulfed in fire when his ship was bombed in the Falklands War.

He was the first person she was able to confide in that she was drinking too much in order to cope with the trauma she had experienced.

Following his ordeal Mr Weston said he also became too reliant on alcohol.

Mr Weston said he drank too much to cope with the trauma he experienced in the Falklands

"Anyone who's been through a life-changing event, from bereavement to a terminal illness, all of those things bring a huge amount of trauma," he said.

"For some of us alcohol is a refuge. It's a false refuge, because it's a destructive refuge.

"You want to be lost, you want to be numb.

"When I was filmed drinking out of a bottle, that shook me. It was embarrassing, it was not me, it was something I didn't like."

Mr Weston said a "belch" of smoke and flames as a bomb hit his ship was the last thing he saw without being scarred.

"That's war," he said.

"There's nothing in the manual which prepares you for being on board ship as infantry and being attacked by aircraft."

John Peters is an RAF officer who was held hostage and tortured by Iraqi soldiers for 47 days in 1991.

He had bailed out of a burning Tornado jet near Baghdad after being hit by an aircraft missile and guns.

He was hit with truncheons, deprived of sleep, burned with cigarettes, kept in solitary confinement, subjected to mock-executions and threatened with gang rape before being paraded on TV.

'Contain horrors'

He said a combination of his personality and training helped him recover from his experience.

"I am a shallow, arrogant, fast jet pilot," he said.

"A certain character wants to fly jets. I spent ten years preparing myself to go to war.

The 7 July attacks killed 52 people in attacks on three Tube trains and a bus

"I could contain my horrors, it was in Iraq, it was in war, it was an abnormal circumstance."

He said returning to normal life had been "easy" for him, despite a "media circus" on his return to the UK.

However, civilians with no military training such as Tim Coulson must call on reserves of inner strength to remain calm in a crisis.

Mr Coulson smashed a train window and forced his way into a tube carriage along with two others to help injured people caught up in the 7 July tube bombings in 2005.

He was travelling in the adjacent carriage to the one blown up by Mohammad Sidique Khan as it left Edgware Road tube station.

Businessman Michael "Stan" Brewster died in his arms and he saved the life of a young Australian office worker, Alison Sayer.

However, the former teacher from near Henley-on-Thames said he did not feel "heroic".

"I felt it was critical to comfort Stan in any way I was able to and to ensure what I truly believe, that nobody should die on their own.

"Working with Alison, I was determined she wouldn't die"

Mr Coulson and Mrs Warren both said they had experienced an "eerie calmness" in the aftermath of the crash.

"There was a recognition we don't know what has happened to us but we need to work together to make it a better place. There was a distinct peace at that time," he said.

Mrs Warren agreed. "One thing I remember from the crash was how calm everybody was, how calm and helpful," she said.

Inside the brain of a psychopath

 Scans of serial killer Brian Dugan's brain showed limited activity in the area processing emotions When Brian Dugan pleaded guilty to the brutal rape and murder of a seven-year-old girl, Jeanine Nicarico, he seemed to be the very sketch of a brutal serial killer.

She had been murdered in 1983, though Dugan only pleaded guilty in 2009. By then, he had also been convicted of rape several times over, and the murder of two others - another seven-year-old girl and a 27-year-old nurse whom he ran off the road before raping and killing her.

If the death sentence had not been withdrawn in Illinois, Dugan would have been executed.

Yet strikingly, he showed no remorse for any of his murders or crimes. Scientists now believe this lack of empathy may in fact be linked to the reason he committed these acts.

Neuroscientist Dr Kent Kiehl of the University of New Mexico scanned Dugan's brain, as part of a unique project to understand how anti-social behaviour is related to brain structure and function.

"He struggles to try and understand why people even care about what he did," says Kiehl, describing his time interviewing Dugan. "Clinically, it is fascinating."

Psychopathy Continue reading the main story 

I tend to see psychopaths as someone suffering from a disorder, so I wouldn't use the word evil to describe them”

End Quote Dr Kent Kiehl Neuroscientist, University of New Mexico Dr Kiehl is seen as a pioneer in a cutting-edge area of behavioural neuroscience: the attempt to understand psychopaths' brain functions and use this to develop treatments for their condition.

It is controversial because for thousands of years, men like Dugan have been labelled not as ill, but as evil.

In literature and cinema, the term "psychopath" is not used for a diagnosis for which we might have sympathy, but rather as something we might fear.

Dr Kiehl has a different view: "I tend to see psychopaths as someone suffering from a disorder, so I wouldn't use the word evil to describe them."

So what exactly is a psychopath?

"Clinically, we define it as someone who scores high on traits such as lack of empathy, guilt and remorse," says Dr Kiehl.

"They are very impulsive: they tend not to plan or think before acting. They tend to get themselves in trouble by a very early age."

We have long known that many people in prisons display symptoms of psychopathy, but until now we have had little insight into their condition.

Brain scans

To address that using neuroscience, Dr Kiehl's lab has built a unique mobile brain scanner. It is equipped with the latest imaging technology but fitted into a truck he can drive into high-security prison facilities.

He used this to perform two types of analysis on Dugan's brain: looking at its density and its function.

"Brian's brain has very low levels of density in a system we call the para-limbic system," he explains.

The para-limbic system is a "behaviour circuit" of the brain, including brain regions known as the amygdala and pre-frontal cortex.

Scientists have long known that these areas are associated with the processing of emotions.

Over the past century or so, people with brain damage to these areas have been studied because their behaviour suddenly changed and became anti-social.

"Those systems, we think, didn't develop normally in Brian," says Dr Kiehl. Psychopathy seems to involve a lack of development in these regions - which may be genetically determined.

Dr Kiehl also monitored Brian Dugan's brain's reaction to a number of distressing images, such as the faces of people suffering, which were displayed in front of him while he was in the scanner. By scanning his brain in real time, the aim was to test his brain's function.

The scans showed there was relatively low activity in Dugan's para-limbic system during processing of emotion.

"Brian would come out of the scanner during those studies and he said, wow, I had problems trying to process what you wanted me to do," Dr Kiehl recounts. "He made more mistakes than others would."

According to Dr Kiehl, it is part of a pattern of brain activity which proves that psychopaths simply lack an emotional ability, in much the same way others lack intellectual ability.

He has found similar results in large numbers of subjects, in prisons across the US.

This means Dugan simply has no concept of the harm he has caused. "Talking about his crimes, it's like asking him what he had for breakfast," says Dr Kiehl.

He also admits that in a sense, it is not surprising that the brain of somebody so different and anti-social also looks different from other brains. "But it's only now that we can look at how dramatically different their brains are that people are starting to take notice," he says.

"It has a very powerful influence on the legal system," he adds.

Neuro-law

So what should the legal system do with this knowledge?

Research like Dr Kiehl's has fuelled the debate over how much the legal system should change to accommodate what we now know about how bad behaviour is "hard-wired."

This view of criminal law is often referred to as "neuro-law".

It is a controversial vision of a future in which a moral judgement of criminal behaviour is replaced by a view that some criminals have diseased brains that need to be treated.

But Dr Kiehl does not see his work resulting in any change to the prosecution of violent psychopaths like Brian Dugan. Instead, he argues that understanding psychopathy may lead us to different types of sentencing - in particular an end to the death sentence for psychopaths.

"My hope is that the neuroscience helps the legal system to understand that these individuals have a disorder and this disorder is treatable," he says.

Such treatment should not begin after someone has committed a terrible act, he says. Instead, he is working with other scientists to try and design interventions for children who display the same symptoms, before those symptoms escalate.

Brian Dugan showed no remorse for the crimes he committed, including rape and three murders Treating children

He thinks Dugan's life story shows key moments when interventions could have been made. "Brian suffered at a very early age," says Dr Kiehl. "He did classic things: he set fires, he hurt animals, he injured his brothers and sisters."

Although Dugan was seen by specialist child services, they lacked an understanding of his condition. In fact, children who have symptoms linked to psychopathy often respond poorly to the kinds of techniques used with other badly behaved children.

Because they lack emotional capability, when teachers attempt to get them to feel remorse it may make them confused and more likely to hurt others.

The hope now is to develop a specific diagnosis for these children - callous and unemotional disorder - and to develop programmes and treatments specifically geared to their condition. In essence, these children have to be painstakingly taught reactions which the rest of us have automatically.

Dr Kiehl's work in high security prisons is inspiring other labs, in the US and UK, who are working directly with children. "You could prevent those individuals like Brian from ever developing and escalating into the individual that he is today," he says.

Brain Culture: Brain Science and the Law is on BBC Radio 4 on Tuesday 15 November at 16:00 GMT. Listen again via the Radio 4 website. This is part one in a three part series on Neuroscience and Society and one of several programmes in Radio 4's Brain Season.