31/07/2012 Newsnight


31/07/2012

Can an Olympian be genetically modified? Is anorexia genetic, and so what if it is? Plus, does Mitt Romney have a coherent foreign policy? With Kirsty Wark.


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Tonight, will Olympic athletes soon have genetic engineering at their

:00:12.:00:18.

fingertips. This unexpected gold medal has won top one top swimming

:00:18.:00:24.

coach suggesting one -- this might be already a possibility. Can such

:00:24.:00:28.

engineering even been done. Better, stronger, faster, it is possible if

:00:28.:00:32.

you are a mouse, but humans? If we know what the key genes are, and

:00:32.:00:36.

many people in sports genetics believe they have a list of around

:00:37.:00:40.

100 genes they think are very important, theoretically, they

:00:40.:00:44.

could all be manipulated. scientist, an athlete, and bioet

:00:44.:00:47.

cyst, discuss what kind of modification is happening and

:00:47.:00:51.

whether we can test for it. Also tonight, we have been given

:00:51.:00:55.

new figures of the scale and causes of anorexia, does that change the

:00:55.:01:00.

way we see its victims. I would make myself run in the snow when I

:01:00.:01:07.

have chill blains, and I wouldn't touch food in case it went through

:01:07.:01:14.

my skin. A writer recovering joins the chair of the health Select

:01:14.:01:18.

Committee. Was there it all a Romney shambles, as his foreign

:01:18.:01:22.

tour jets home from Poland, what has it told us of the foreign

:01:22.:01:32.
:01:32.:01:35.

policy of the man who could be US President in a few weeks time. Ye

:01:35.:01:40.

Shiwen has done it again, tonight she won gold in the 200ms medley,

:01:40.:01:47.

with the shockwaves still rerating from her gold in the 400 individual

:01:47.:01:51.

medley. In that race she took five seconds off her previous best time.

:01:51.:01:55.

Resulting in one of the US senior coaches labelling her performance

:01:55.:01:58.

immediately after heroin as "disturbing", there was no evidence

:01:58.:02:02.

of doping, and according to the chair of the Olympic Association in

:02:02.:02:06.

Britain, the swimmer deserves recognition for her talent. She

:02:07.:02:10.

also has particularly large hands and feet, which is not a crime.

:02:10.:02:17.

Imagine in the future if athletes could be genetically modified. We

:02:17.:02:22.

have news into research into this field? In the midst of this row,

:02:22.:02:26.

the idea of genetic manipulation, or gene doping in sport has sur

:02:26.:02:30.

Fayeed. We looked at this last -- if you are faced, we looked at this

:02:30.:02:34.

last week, some of the enhancing coming along in the future, the

:02:34.:02:40.

idea of epigenetics, a road athlete turning up or down useful genes. It

:02:40.:02:45.

turns out this very idea of how our genes and our environment interact

:02:45.:02:49.

will be the legacy of the Olympic testing lab. The Olympic testing

:02:49.:02:53.

lab, where they look at all the samples of athletes, we should hear

:02:53.:02:58.

from the Government tomorrow, will become a multimillion pound medical

:02:58.:03:02.

research centre, where we will look at the interaction between our

:03:02.:03:06.

genes and environment, to try to find new treatments. The way that

:03:07.:03:10.

our genes and environment interact determines how well we respond to

:03:10.:03:14.

certain treatments. So, for the time being, this lab is going to be

:03:14.:03:24.
:03:24.:03:37.

focusing on keeping these Olympic It looks like it will be Ye Shiwen.

:03:37.:03:41.

Tonight Ye Shiwen was in the pool again, winning her second golgd in

:03:41.:03:50.

the final of the women's -- gold, in the final of the women's 200ms

:03:50.:03:56.

individual medly setting an Olympic record not a world record. The row

:03:57.:04:01.

was fuelled by outspoken reaction to that performance, byed leading

:04:01.:04:05.

American swimming coach, who described it as "unbelievable",

:04:05.:04:11.

today there has been huge support for the young young swimmer, by

:04:11.:04:17.

officials and athlete. These are athletes competing at the highest

:04:17.:04:22.

level, we have seen records broken all over the place. In terms of

:04:22.:04:26.

athletes themselves, as you know, in the final, the first five

:04:26.:04:33.

athletes are tested, compulsory, and two others. It is really well,

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we have a very, very strong drug testing programme, we are very

:04:37.:04:40.

confident if there are cheat we will catch them. As we already have

:04:40.:04:45.

done. This morning, the head of spwrin's Olympic Association backed

:04:45.:04:50.

up that position. -- Britain's Olympic Association backed up that

:04:50.:04:58.

position, saying Ye Shiwen had passed WADA tests. She has insisted

:04:58.:05:01.

there is no problem with her performance, because the Chinese

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sticks to the strict antdy doping policies. But there is another

:05:05.:05:09.

possibility, the idea that such outstanding performances might be

:05:09.:05:19.
:05:19.:05:31.

the product of some form of genetic His is a lone voice, and US

:05:31.:05:37.

officials have today distances themselves from his views. But is

:05:37.:05:42.

genetic manipulation in sport possible, can we test for it? And

:05:42.:05:46.

is it happening. When people talk about gene doping in sport, they

:05:46.:05:50.

are not talking about designer babies, with genes hand-picked to

:05:50.:05:54.

create the superathlete of the future. What people mean by gene

:05:54.:05:58.

doping at the moment, is either adding genes to particular cells or

:05:58.:06:02.

organs of an athlete's body, say to increase oxygen uptake in their

:06:02.:06:07.

lungs, or the new science of epigenetics, turning up the power

:06:07.:06:17.
:06:17.:06:18.

of any useful genes an athlete happens to have been born with.

:06:18.:06:23.

Tweaking genes can work in animals, Tweaking genes can work in animals,

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the mouse at the front has been manipulated from birth to carry

:06:28.:06:33.

extra genes to make it run faster, but also to want to run faster too.

:06:33.:06:38.

It might work in mice, but how might human athletes improve their

:06:38.:06:42.

performance by tweaking their genes. The two areas, strength and

:06:42.:06:46.

endurance. The strength we have genes like insulin growth factor 1,

:06:46.:06:51.

shown in animals, able to increase strength and power of animals

:06:52.:06:55.

models. That is a possibility. The second is the gene you get more of

:06:55.:06:59.

when you go to altitude, we have seen individuals who have mutant

:06:59.:07:03.

genes in that area, they have also enhanced performance in humans,

:07:03.:07:08.

that also would be a possibility. Tim Speckor carries out unique

:07:08.:07:16.

studies on twins, he's looking at how the outside world can help our

:07:16.:07:22.

how the outside world can help our genes being expressed in our body.

:07:22.:07:26.

We know what the key genes are, and sports people believe they have a

:07:26.:07:30.

list of 100 genes they think is important. Theoretically they could

:07:30.:07:36.

all be manipulated and tuned up or down, using these epigenetic

:07:36.:07:45.

methods. He thinks rogue athletes might one day be able to turn these

:07:45.:07:49.

up or down by taking a pill. Scientists at the Olympic testing

:07:49.:07:56.

lab say they have made it harder to cheat, and authorities have banned

:07:56.:07:59.

genetic manipulation. Whether it is being done I think is unlikely. I

:07:59.:08:03.

would show the evidence occurring from gene therapy, where we have

:08:03.:08:09.

tried for over 20 years to make it work and cure diseases like cystic

:08:09.:08:13.

fibrosis, and it is very hard. In practice we know how to do it,

:08:13.:08:16.

actually making it work is very hard.

:08:16.:08:20.

In the end, as other swimmers have said today, it is perfectly

:08:20.:08:26.

possible for a young swimmer to suddenly shine in this way.

:08:26.:08:33.

I'm joined now by Ruta Meilutyte, a bio ethicist in Scotland, and one

:08:33.:08:36.

of the first to write about gene doping.

:08:37.:08:44.

And a Professor of human geneology. And from Stratford, by the former

:08:44.:08:49.

world champion swimmer Karen Pickering, who has competed at four

:08:49.:08:55.

consecutive Olympic Games. First of all, that tremendous performance

:08:55.:08:59.

from Ye Shiwen, as we have said, she has been absolutely cleared. Is

:08:59.:09:04.

it inevitable that there will be talk of manipulation, when there

:09:04.:09:09.

has been such a stunning victory, taking five seconds off her record

:09:09.:09:12.

on Saturday. It is a bit of a shame, actually. I watched that

:09:12.:09:15.

performance, my first thought was what an incredible swim it was by a

:09:15.:09:18.

young girl that we have watched swim for a couple of years now, we

:09:18.:09:22.

have been waiting for her to do something quite impressive. It is a

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shame, and slightly cynical of some people, that they will look at that

:09:26.:09:31.

performance and think that it's not quite legitimate. That wasn't my

:09:31.:09:35.

first thought. We have seen a lot of amazing performances in the pool.

:09:35.:09:40.

Some much more spectacular than her's was. But I think part of the

:09:40.:09:44.

problem is that it was a little bit of sterotyping and a little bit to

:09:44.:09:48.

do with China's history of doping, the reason why she is being singled

:09:48.:09:51.

out. Do athletes expect it? We just heard in the film there, athletes

:09:52.:09:59.

are being tested all the time, so the whole atmosphere round

:09:59.:10:05.

enhancement is very live? I think that we know, unfortunately, there

:10:05.:10:09.

are always going to be some athletes who want to get an unfair

:10:09.:10:12.

advantage, whether that is through doping or through this new idea of

:10:12.:10:17.

gene doping, you know, there is always going to be some people who

:10:17.:10:21.

will try. You have been in the fifth Olympics,

:10:21.:10:26.

seventh, you are watching it very closely this idea that the very

:10:26.:10:29.

thing Karen said, there will always be athlete who is want to get ahead,

:10:29.:10:34.

for all sorts of reasons. That desire to get ahead is legitimate,

:10:34.:10:40.

can it be legitimately met through genetic engineering, or is it

:10:40.:10:43.

always something that will be banned? The challenge for athletes

:10:43.:10:46.

is we put them in a position where they are expected to go faster,

:10:46.:10:49.

higher and stronger, yet restrict the means by which they can do this.

:10:50.:10:54.

I think it is revealing that in 2006 the British Government

:10:54.:10:58.

launched an inquiry into human enhance. Technologies into sport,

:10:58.:11:04.

not anti-doping. It speaks to this broader culture of human

:11:04.:11:07.

enhancement that surrounds the world of sports. The give us an

:11:07.:11:10.

idea of something that would enhance an athlete's performance if

:11:10.:11:15.

it was genetic engineering? Not so much genetic engineering, but the

:11:15.:11:20.

kinds of enhancements are similar. Endurance and power are the two

:11:20.:11:24.

main things. Laser eye surgery is an example, it is one of those

:11:24.:11:28.

modifications that the world of sport can't really ban, but you and

:11:28.:11:33.

I can use them and athletes can use them, it could enhance its

:11:33.:11:36.

performance. That is the bigger challenge sport face, there will be

:11:36.:11:41.

an explosion of enhancements athletes can use. Test or not test,

:11:41.:11:46.

ban or not ban? Medically supervised enhancements is the way

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to go. I disagree with that, it is fundamentally against the nature of

:11:49.:11:54.

sport. That is why we have the Olympic here in London to sell rate

:11:54.:11:58.

that. The world anti-dope -- celebrate that, the World Anti-

:11:58.:12:03.

Doping Agency is clear about it, it has added gene doping to its list

:12:03.:12:08.

of banned substances for a good reason. Can you test for gene

:12:08.:12:12.

doping, there are 100 different genes said to possibly enhance or

:12:12.:12:15.

improve an athlete's performance, how do you test? The first question

:12:15.:12:20.

is, is anybody doing it, do we have any evidence that anybody is

:12:20.:12:26.

actually using, what effectively is, gene therapy techniques. Do you

:12:26.:12:31.

have the tests to know? The tests are being developed. There are

:12:31.:12:35.

developments in analytical chemistry, sell later and molecular

:12:35.:12:38.

biology, developing all the time. In eight years time, with a blood

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sample, there are likely to be genetic fragments, traces of the

:12:43.:12:50.

investigateors used to get genes into sis -- vectors that are used

:12:50.:12:55.

to get genes into systems. It might be possible. I look forward to the

:12:55.:13:00.

future in seven years when all the medals will be distributeded to the

:13:00.:13:05.

true winners. It seems to me that is the scenario athletes could face.

:13:05.:13:09.

Tell me, if there was something like the laser eye surgery, which

:13:09.:13:14.

actually makes an Archer see better, and it is open to everybody else on

:13:14.:13:18.

the planet. Do you mean to say athletes can't take it because it

:13:18.:13:23.

will give them an unfair advantage? There is a clear distinction

:13:23.:13:27.

between medal exemption for different conditions. What about

:13:27.:13:29.

actively trying to make your performance better? It is a grey

:13:29.:13:33.

area. We could have the same debate about someone, for example, who has

:13:33.:13:39.

a mutation in their mystaten gene, for example, which we know,

:13:39.:13:42.

enhances muscle mass. Do you ban these individuals, who, through no

:13:42.:13:46.

fault of their own, have a genetic mutation. I think you don't. I

:13:46.:13:50.

think actually the future of sport will wrestle with this problem, and

:13:50.:13:54.

find it very difficult to restrict people from participating. On that

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point, you were saying that there will always be some athletes who

:13:57.:14:02.

want to get ahead. What if the advances in genetic engineering are

:14:02.:14:09.

such that athletes can get a -- ahead in a legitimate way. Using it

:14:10.:14:13.

to repair muscles and make them stronger. Do you think that should

:14:13.:14:18.

be outlawed? I think it is up to WADA, the IOC, for governing bodies

:14:18.:14:22.

to look at what those roles r it is our duty as athletes to abide by

:14:23.:14:26.

those rules. We have to hope and know that our governing bodies will

:14:26.:14:32.

do what is ried right, will make the right decisions and -- right,

:14:32.:14:36.

will make the right decisions and clear up that grey area and we

:14:36.:14:40.

stick to the rules. It is unfair to athletes if there is a grey area.

:14:40.:14:44.

If things are changing all the time. Athletes, through no fault of their

:14:44.:14:48.

own, could fall foul of the rules there must be a fear about that?

:14:48.:14:51.

Absolutely. But never going to be black and white. There will always

:14:51.:14:55.

be situations. You have had now in terms of medications as well. If

:14:55.:15:00.

you just have to take, for instance, athletes who are asmathic, and

:15:00.:15:03.

legitimately need some medication, that may be banned in being taken

:15:03.:15:06.

in other ways. I think that there iss always going to be areas that

:15:06.:15:09.

need to be looked at, and unfortunately it is never going to

:15:09.:15:14.

be black and white. But we just have to hope that, with the

:15:14.:15:18.

advancements in technology, and the science behind, and as well, using

:15:18.:15:21.

intelligence testing, as much as possible, to understand what is

:15:21.:15:25.

going on out there, because athletes do hear about things,

:15:25.:15:30.

people do talk, and the knowledge is spread, we just have to hope

:15:30.:15:34.

that using all those techniques we can catch those people and stop

:15:34.:15:38.

them. You are talking about the knowledge being spread, one of the

:15:38.:15:42.

many legacies of the Olympics, is this testing lab for dopg, and

:15:42.:15:46.

presumably for gene testing, is going to be something that will be

:15:46.:15:56.

used, not only for athletes, but for the general population. The

:15:56.:15:59.

point is, science is moving so fast and coaches know, athletes are

:15:59.:16:09.

always on the look out for these things, is it policable? The bigger

:16:09.:16:15.

challenge is five years from now it could cost less than �1,000 to map

:16:15.:16:19.

a genome. There will be such a strong public argument by then from

:16:19.:16:27.

everybody, to have their genome map, that conceivably we will all have a

:16:27.:16:31.

24-hour look at it. And presumably for parents if your kids are going

:16:31.:16:36.

to be good at eightly thes. If there is genome therapy, you can't

:16:36.:16:40.

ban that? Athletic performances are such a beautifully integrated

:16:40.:16:45.

performance, so many factors are involved, it will be incredibly

:16:45.:16:50.

complex to tease out the genetic factors, we don't have gene that is

:16:50.:16:54.

can accurately predict performance, they are only loosely associated

:16:54.:16:57.

with performance. A long way to go. We will see what happens over the

:16:57.:17:01.

next seven years and look at those testings.

:17:01.:17:05.

Anorexia is a killer and dreadful death. It is not too harsh to say

:17:05.:17:12.

it has been dismissed in the past that it is a disease that affects

:17:12.:17:20.

self-obsessed teenage girls. We have news that eating discords are

:17:20.:17:24.

costing billions. And anorexia sufferers are presenting younger,

:17:24.:17:30.

even below ten. And brain scans intricates a strong predisposition

:17:30.:17:36.

to the disease. Doctors are warning that budget constraints are

:17:36.:17:40.

preventing people being referred early enough to get to the root of

:17:40.:17:45.

the problem. This report contains some explicit images.

:17:45.:17:49.

One of the saddest things that my brother, who is 16 now, doesn't

:17:49.:17:54.

remember me without this illness. I feel I have lost my innocence, it

:17:54.:17:58.

has taken everything. Ffion Jones last had a birthday cake when she

:17:58.:18:04.

was 11, that is when she developed anorexia. Now 22, it stole her

:18:04.:18:08.

childhood. At first I felt like I was in control, I felt like it was

:18:08.:18:12.

something that I could have as my own. That I was good at, because

:18:12.:18:15.

nobody else could not eat. I felt quite invincible and powerful at

:18:15.:18:20.

that point. That changed really quickly. I just felt like

:18:20.:18:24.

completely consumed, I got taken over. Not only did she stop eating,

:18:25.:18:30.

to the alarm of her family, she refused to drink. I developed all

:18:30.:18:35.

these obsessive tendencies, I was a compulsive exerciser, I would make

:18:35.:18:41.

myself run in the snow when I had chillblanes, I wouldn't eat or

:18:41.:18:45.

drink, I became phobic of food, I wouldn't touch food in case it got

:18:45.:18:51.

be a surbed through my skin. She is being treated at one of the

:18:51.:18:55.

specialist centres at Cotswold House, intensive support is helping

:18:55.:19:01.

her eat regularly. The latest research suggests a strong genetic

:19:01.:19:05.

predisposition of anorexia, she will always have to live with its

:19:05.:19:11.

consequences. I have a lot of long- term implications which I was quite

:19:11.:19:14.

ignorant of and didn't want to acknowledge as part of the illness.

:19:14.:19:18.

They are a lot of serious side- effects, it is not a case I will

:19:18.:19:28.
:19:28.:19:28.

not eat for a while and put on weight. I got diagnosed with

:19:28.:19:36.

osteoporosis at 18. I went for an X-ray on my spine, my back is

:19:36.:19:39.

crumbling because of calcium depletion, and my spine is

:19:40.:19:44.

crumbling. I'm not sure if I can have children or note. By the time

:19:44.:19:48.

people are diagnosed with anorexia, their weight is so low, their

:19:48.:19:51.

general health is severely compromised. They are at risk of

:19:51.:19:55.

organ and heart failure. This is especially true in younger patients.

:19:55.:19:59.

Newsnight has seen new figures from the charity, Beat, which reveal the

:19:59.:20:05.

true costs. In the UK more than 1.5 million people suffer an eating

:20:05.:20:09.

disorder. Most cases start in adolescence, affecting seven out of

:20:09.:20:18.

1,000 girls, and one in a thousand boys. In England their ill-health

:20:18.:20:22.

costs �1.26 billion, a figure expected to double over the next 20

:20:22.:20:28.

years. Of all the psychiatric illnesses, anorexia is the most

:20:28.:20:31.

deadly. It kills more people than depression, and alcohol and drug

:20:31.:20:35.

addiction. Half the people who get it doesn't recover, while a fifth

:20:35.:20:42.

will die from it. This is a few years later.

:20:42.:20:48.

This is rosary Marston, during her 30 -- Rosemary Marston, during her

:20:48.:20:52.

30-year struggle with the illness. I thought I was living a lifestyle

:20:52.:20:57.

that suited me. Today she says she's finally recovered. In one

:20:57.:21:02.

crisis, when her funding support specialist treatment was withdrawn,

:21:02.:21:08.

she expected to die. I saw my reflection in the mirror, and took

:21:08.:21:14.

photographs of my reflection in the mirror. I thought this is what I

:21:14.:21:19.

want to leave behind, that people know that this illness isn't just

:21:19.:21:24.

about vanity, it is not about looking good on the beach. This is

:21:24.:21:33.

serious. I then went into a coma. I was taken into hospital that day.

:21:33.:21:38.

Stopping the symptoms themselves, damaging the brain more, is very

:21:38.:21:41.

important.... Her consultant, a world renowned

:21:41.:21:45.

expert in eating disorders, explains why people with anorexia

:21:45.:21:50.

are simply unable to think straight. The symptoms themselves, because

:21:50.:21:53.

they interfere with nutrition, that means the body and brain are

:21:54.:21:58.

damaged, because the brain is one of the hungryist organs in the body.

:21:58.:22:05.

It uses more calories per gram than muscles even. If you are depriving

:22:05.:22:14.

the brain of calories, it doesn't function as well. The brain is the

:22:14.:22:20.

focus of ground-breaking research into possible genetic causes for

:22:20.:22:26.

the illness. Professor Bryan Lask says photo imaging technology, has

:22:26.:22:32.

allowed his team to study part of the brain, the insula, which in

:22:32.:22:34.

anorexic patients is not working properly, changing our

:22:34.:22:37.

understanding of the disease. so long people thought this was

:22:37.:22:42.

just people choosing to go on a diet and rather manipulating people

:22:42.:22:46.

around them, by saying they are footoo fat. It was seen as this --

:22:46.:22:50.

they are too fat. It was seen as spoilt middle-class girls getting

:22:50.:22:54.

it. It is not like that at all. It is not a choice. You inherit a

:22:54.:22:59.

particular profile of genes, not one gene, there isn't an anorexic

:23:00.:23:04.

gene, but a combination of genes, that render you vulnerable to the

:23:04.:23:09.

development of anorexia, when exposed to other factors.

:23:09.:23:13.

Figures for those with anorexia are stable, but clinicians report they

:23:13.:23:19.

are seeing younger patients, some below the age of ten, making

:23:19.:23:25.

earlier intervention and treatment vital. It is definitely not taken

:23:25.:23:29.

seriously enough. You could talk to any number of parents who have a

:23:29.:23:32.

daughter with anorexia, and they will tell you about the struggle

:23:32.:23:35.

they have, not only with trying to help their daughter themselves,

:23:35.:23:39.

which is another story, it is so difficult for parents, but getting

:23:39.:23:44.

informed help. They so often get palmed off with it is just a phase,

:23:44.:23:48.

or they will send her to a dietician, they are wonderful if

:23:48.:23:52.

you need one, but this isn't about what you eat, it is about what you

:23:52.:23:55.

can't eat. We are really depriving our children of an essential

:23:55.:23:59.

treatment. This specialist centre is run by

:23:59.:24:04.

the private sector for younger patients. Traditional treatment of

:24:04.:24:08.

anorexia involves restoring a sufferer's weight. But it is

:24:08.:24:13.

recognised it takes far more to restore a healthy attitude to

:24:13.:24:18.

eating. To avoid the disruption anorexia brings to a young person's

:24:18.:24:23.

life. Eating will have left them with a lot of high emotions, high

:24:23.:24:28.

levels of anxiety, feeling very angry, post-meal support is about

:24:28.:24:32.

sitting with a young person after a meal, for a period of time, so they

:24:32.:24:39.

can go past the most dangerous part of that anxiety. But the most

:24:39.:24:44.

complex cases require long-term treatment. This centre include an

:24:44.:24:48.

Ofsted-approved school toe try to replace the education that is -- to

:24:48.:24:51.

try to replace the education that is sometimes otherwise lost. The

:24:51.:24:56.

average stay at this home is about 20 months. Such specialist centres

:24:56.:25:01.

are, of course, expensive, it is worth it, say staff, if repeated

:25:01.:25:07.

hospital admissions can be avoided. But the pressures on health budgets

:25:07.:25:10.

means people are much more ill, their weight much less, before they

:25:10.:25:15.

can be referred to places like this. Clinicians warn of a revolving door,

:25:15.:25:21.

where patients are pushed into and out of treatment, to save money.

:25:21.:25:26.

will see more revolving door cases because we're not getting to the

:25:26.:25:30.

root of the problem, we are addressing the symptoms quite

:25:31.:25:36.

effectively, but we're doing so over and over again. In turn, as I

:25:36.:25:41.

said, that will mean that a certain percentage of those cases will keep

:25:41.:25:48.

coming back, and I think that actually a well intended strategy

:25:48.:25:55.

to keep people out of hospital, will actually lead to more chronic

:25:55.:25:58.

and severe and enduring cases. People say you are not thin enough

:25:58.:26:04.

to need specialist services, and that's awful, that, you know,

:26:04.:26:08.

people have to get more ill before they warrant specialised services.

:26:08.:26:15.

So I think that needs to be changed, the fact that early signs and

:26:15.:26:19.

intervening before people need intensive care, such as in-patient

:26:19.:26:24.

care, is very important. Last year, Bryan Lask noted a

:26:24.:26:28.

dramatic fall in referrals for in- patient treatment, caused by cuts

:26:28.:26:34.

in spending. He was alarmed by the effect on patients. So the cutbacks

:26:34.:26:39.

are leading to really deteriorating patients? Absolutely. The cutbacks

:26:39.:26:42.

have not only deprived the children of treatment, but they have

:26:42.:26:47.

actually made them worse. As a young woman, Rosemary Marston

:26:47.:26:53.

didn't recognise she had an illness. This is her at 37. By then,

:26:53.:26:59.

anorexia had her in its grip. would go into hospital, my weight

:26:59.:27:03.

would be restored, but I left not feeling too much better about

:27:04.:27:07.

myself or my prospect. And so, it was only a matter of time before I

:27:07.:27:12.

would be back in hospital again. As I got older, the periods of time

:27:12.:27:18.

between admissions were shorter and shorter. I think I worked out that

:27:18.:27:28.
:27:28.:27:30.

in the last 20 years of the illness, I spent 18 years as an in-patient.

:27:30.:27:36.

Tests like this one, used by Bryan Lask's team, are used to identify

:27:36.:27:42.

some of the characteristics associated with anorexia, like a

:27:42.:27:45.

tendency to obsessiveness, and attention to tail. They hope it

:27:45.:27:49.

will lead to new treatment -- detail. They hope it will lead to

:27:49.:27:52.

new treatment, and prevent the illness becoming chronic,

:27:53.:27:58.

interrupting people's lives. Even now, those of us who work in the

:27:58.:28:02.

area of eating disorder, with this younger population, we are

:28:02.:28:05.

struggling with the idea that once their weight is restored they are

:28:05.:28:10.

cured, it is nonsense, they are not at all. I realised how rich an

:28:10.:28:15.

illness it had been. Rosemary describes the process of recovery

:28:15.:28:20.

as being harder than the illness, she works as a mentor with others

:28:20.:28:25.

with eating disorders. I know there are God knows how many other people

:28:25.:28:29.

out there going through exactly the same thing that I did. I'm no

:28:29.:28:35.

different to them. If all I can do is offer them the hope that

:28:35.:28:42.

whatever they see in me, as being recovered, and something that they

:28:42.:28:50.

would like, then it is doable. It is possible.

:28:50.:28:54.

Ffion is planning to go to university next year, to train as a

:28:54.:29:00.

psychiatric nurse. I want to be able to order a take-away, or have

:29:00.:29:05.

a meal, without a panic attack in the toilet. I want to be able to

:29:05.:29:08.

eat a box of popcorn without having to count out how many of them are

:29:08.:29:13.

in my hand. I don't want to be a rocket scientist, or rich, I just

:29:13.:29:19.

want to be "normal", I suppose really, if there is such a thing.

:29:19.:29:25.

Joining me now are Stephen dor reel, the chairman of the Select

:29:25.:29:30.

Committee, and the Times columnist who suffered from anorexia, author

:29:30.:29:36.

of An Apple A Day. First of all, recovering from

:29:36.:29:42.

anorexia, do you recognise that you genetically had a predisposition?

:29:42.:29:45.

didn't develop anorexia until I was about 19. I certainly wasn't born

:29:45.:29:49.

with it. But I think that the genetic predisposition must come

:29:49.:29:54.

into it, having seen obviously the research from Professor Lask. It is

:29:54.:29:58.

absolutely fascinating for someone like me. I think that there is a

:29:58.:30:04.

variety of things that come together, the stresses and the live

:30:04.:30:08.

expeerences and then going on a diet, and starting to lose weight,

:30:08.:30:13.

and then I think the genetic thing is part of that. I don't think it

:30:13.:30:18.

is you are born with anorexia, but when we see the brain imaging,

:30:18.:30:25.

there are cognative differences in people's brains with anorexia. That

:30:25.:30:30.

does not change after you have restored your healthy weight. That

:30:30.:30:36.

insula, there is still abnormal blood flow to the insula after the

:30:36.:30:41.

weight has been restored. It proves it is not a lifestyle choice.

:30:41.:30:45.

fundamental difference with this research is it shows, often

:30:45.:30:51.

anorexia has been dismissed as a teenage girls obsessed with their

:30:51.:30:55.

looks, narcissism and so forth. This shows it is a mental disorder?

:30:55.:31:01.

Yes, and indeed to a degree, a physical disorder, an identifiable

:31:01.:31:04.

one, according to Professor Lask's research. This is relatively new

:31:04.:31:08.

research, we have to work through the implications from a policy

:31:08.:31:11.

perspective. The thing that strikes me about this from a health policy

:31:11.:31:18.

point of view, is how similar it is to other conditions, where the

:31:18.:31:22.

opportunity is there to identify a condition early, to intervene early,

:31:22.:31:25.

and to deliver care that is not only better from the point of view

:31:25.:31:31.

of the patient, because it avoids the acute incidence of the

:31:31.:31:34.

condition, but it is better value for the taxpayer, because it

:31:34.:31:40.

doesn't cost as much in pounds. It is a win-win. Actually, the policy

:31:40.:31:44.

is wrong at the moment, because Bryan Lask is saying the cutbacks

:31:44.:31:47.

are not only depriving children of treatment, they are making them

:31:47.:31:52.

much worse, and that Professor Janet Treasure, saying people are

:31:53.:31:56.

not referred to specialists because of the cuts because they are not

:31:56.:31:59.

thin enough. You are stoking up far more problems financially, because

:31:59.:32:03.

you haven't the right policy to intervene early, and have, as it

:32:03.:32:08.

were, a holistic approach, to dealing with anorexia. It is a

:32:08.:32:13.

familiar problem in the health service, that you put it off.

:32:13.:32:17.

just to press you on this, as a result of this fairly new research,

:32:17.:32:22.

very new research, you do think there should be a change in policy

:32:22.:32:25.

towards anorexia? I absolutely think that in anorexia and other

:32:25.:32:30.

conditions as well, there ought to be ach greater emphasis on

:32:30.:32:33.

identifying the tell tale signs that show where a condition is

:32:33.:32:38.

going to rise, interintervening early, that is where you deliver

:32:38.:32:42.

better care and better value care. Later you deliver savings later,

:32:42.:32:46.

but tell me about the importance of early intervention? I always say to

:32:46.:32:49.

people, you know if you have a problem. And deal with it as soon

:32:49.:32:55.

as you can, because if you wait ten, fifteen years down the line, it

:32:55.:33:00.

becomes part of you. It becomes part of your identity. Did you, you

:33:00.:33:04.

were quite, in a sense you were quite old at 19, did you know, were

:33:04.:33:10.

you able to go for help quite early, I imagine if you are 10, 11, 12 it

:33:10.:33:14.

is a really difficult thing for parents? That is the problem with

:33:14.:33:17.

early intervention. Teenage girls go on diet, young girls

:33:17.:33:22.

increasingly are worried about their weight. The majority of them

:33:22.:33:27.

won't develop anorexia. The 10% or less than that will develop

:33:27.:33:33.

anorexia. There is a problem with early intervention. You need people

:33:33.:33:36.

trained to know the real signs. didn't know, I didn't really talk

:33:36.:33:40.

about it at all until I was, I started writing my column in my

:33:40.:33:44.

early 30s, for the Times. That was coming out about it. I didn't get

:33:44.:33:49.

help for the first couple of years. It is a terribly shameful illness,

:33:49.:33:53.

there is something terribly hidden about it. Is there a way that

:33:53.:33:58.

actually, you know, that anorexia, we know from the statistics, that

:33:58.:34:03.

1.5 million, are suffering from it just now. Many more. It is

:34:03.:34:06.

essentially hidden, and really not fully diagnosed. That actually

:34:06.:34:10.

because it is such a dreadful thing, by and large that it hits younger

:34:10.:34:13.

people, it should be a priority for this Government? I think it should

:34:13.:34:18.

be a priority for any Government, and for the people who decide the

:34:18.:34:20.

priorities within health expenditure, which is the

:34:20.:34:24.

Government at a global level, but it is actually decisions taken at

:34:25.:34:30.

the local level. The provision of service. The other key thing here,

:34:30.:34:35.

is public health information. So that families and individuals can

:34:35.:34:40.

identify with it. The revolving door is costing more. Can I tell

:34:40.:34:46.

but the waiting lists, the waiting lists to get cognitive behaval

:34:46.:34:51.

therapy for anorexia is absolutely horrendous. I have gone out of the

:34:51.:34:53.

health service. The waiting lists would be different in different

:34:53.:34:59.

parts of the country? I stopped having psychotherapy four years ago,

:34:59.:35:05.

and started begin two years ago, I was able to get on a trial, and my

:35:06.:35:09.

waiting list was only six months. It can be much longer than that,

:35:09.:35:14.

six months to a year for people who are seriously ill. I agree with

:35:14.:35:18.

that. The point is that if you wait and delay the intervention, it is

:35:18.:35:24.

back to the resolving door. -- the revolving door is bad and expensive

:35:24.:35:28.

care, it is unaffordably bad. You are on recess, but you will go

:35:28.:35:32.

straight back to the health select in the new research? It is

:35:32.:35:35.

something that will come up with the health Select Committee, it

:35:35.:35:39.

doesn't meet when parliament is in recess. If you want details of

:35:39.:35:43.

organisations which offer advice and support on eating disorders, go

:35:43.:35:53.
:35:53.:36:08.

He could be the leader of the free world in matter of weeks. But after

:36:08.:36:13.

a mini-three-country tour, gaffes and all, are we getting a flavour

:36:13.:36:18.

of what Mitt Romney's foreign policy will look like. He upset

:36:18.:36:22.

Palestinians by comparing their weak economic performances to that

:36:22.:36:28.

of their Israeli hopes. On a visit to London he warned our Olympic

:36:28.:36:32.

Games running the risk of becoming a flop. Beyond the insults, what of

:36:32.:36:42.
:36:42.:36:43.

his grand vision, and how might he contain countries like Iran.

:36:43.:36:47.

The Republican challenger has been racking up air miles, with a

:36:47.:36:51.

foreign tour intended to bolster his credentials as a statesman. His

:36:51.:36:54.

first stop was Britain, where a remark about preparations for the

:36:55.:36:59.

Olympics was deemed insulting by his critics. It is hard to know

:36:59.:37:04.

just how well it will turn out, there are a few things that were

:37:04.:37:07.

disconcerting, the stories about the private security firm not

:37:07.:37:11.

having enough people, the supposed strike of the immigration and

:37:11.:37:14.

customs officials, that obviously is not something which is

:37:14.:37:19.

encouraging. But that was a relatively minor

:37:19.:37:23.

faux pas, the striking thing about the Romney campaign, is it's focus

:37:23.:37:27.

on the US economy, and other domestic issues, has so far

:37:27.:37:31.

prevented the world from getting much of an idea about how far a

:37:32.:37:38.

Romney foreign policy might differ from President Obama's. Mitt Romney,

:37:38.:37:41.

until last week, had had only delivered one foreign policy speech

:37:41.:37:45.

of the campaign, that was nine months ago. He doesn't have a

:37:45.:37:49.

senior staffer whose portfolio is solely foreign policy. He had had a

:37:49.:37:53.

foreign policy spokesman who lasted just two week, this is not a

:37:53.:37:57.

priority for Romney. It conveys a lack of seriousness, both on his

:37:57.:38:01.

part, but also in tune with his party, when it comes to America and

:38:01.:38:05.

the re- of the world. That, is quite a substantive difference with

:38:05.:38:08.

Barack Obama. It was on the way to his second

:38:08.:38:15.

stop, Israel, that things started hotting up. On board the flight,

:38:15.:38:19.

Romney's spokesman told reporters that they would back an Israeli

:38:19.:38:23.

strike against Iranian nuclear facilities. Once there, he

:38:23.:38:28.

delighted the Israeli right with a pledge to relocate the US embassy

:38:28.:38:32.

to Jerusalem. I think it is long been the policy of our country to

:38:32.:38:36.

ultimately have the embassy in the nation's capital, Jerusalem. The

:38:36.:38:39.

decision to actually make the move is one, if I were President I would

:38:39.:38:44.

want it take. Perhaps the most revealing statement on his trip was

:38:44.:38:48.

the candidate's observation that the disparities in wealth between

:38:48.:38:58.
:38:58.:39:03.

Israelis and Palestinians could be One American politician said a

:39:03.:39:06.

gaffe is when the politician tells a truth, a gaffe is when a

:39:06.:39:09.

politician reveals what he really thinks. I think there was something

:39:09.:39:16.

revealing in that remark of Mitt Romney, it did suggest a kind of

:39:16.:39:23.

colonialist mentality that some how seemed to think that the oriental

:39:23.:39:27.

people, Palestinians, were some how culturally inferior, to the

:39:27.:39:30.

Israelis, who are more western and more like the Americans.

:39:30.:39:35.

headlines from the Palestinian comment followed the candidate to

:39:35.:39:37.

Poland. REPORTER: Governor Romney do you have a statement for the

:39:37.:39:42.

Palestinians. The press vented their annoyance at

:39:42.:39:48.

getting so little access to him. And quickly put down by Romney's

:39:48.:39:52.

staff. This is a holy site for the Polish people, show some respect.

:39:52.:39:56.

That was unfortunate, and has left even those on the right questioning

:39:56.:39:58.

the achievements of Mr Romney's trip.

:39:58.:40:05.

In terms of sending out very clear messages about what kind of foreign

:40:05.:40:07.

policy president he would be, strong support of Israel, very

:40:08.:40:13.

concerned about the Iranian issue, strong supporter of their allies in

:40:13.:40:19.

Eastern Europe, strengthening that relationship. Strong believer in

:40:19.:40:21.

the special relationship between Great Britain and the United States.

:40:21.:40:25.

In terms it of the public relations and the press managment, it has

:40:25.:40:31.

been utter and complete amateur hour. There are aspects of the

:40:31.:40:34.

President's foreign policy over Russia and Iran, that provide

:40:34.:40:39.

plenty of ammunition to the Conservative who say the incumbent

:40:39.:40:44.

has made America look weak. But President Obama's stepping back

:40:44.:40:48.

from foreign entanglements is part of a response to the American

:40:48.:40:53.

crisis. It will be hard for a Republican challenger to campaign

:40:53.:40:56.

on a world's policeman ticket, or concede the country can no longer

:40:56.:41:01.

afford to do that. Mitt Romney has flown home to concentrate on

:41:01.:41:04.

economic issues. But looking presidential requires a confident

:41:04.:41:08.

grasp of world affairs too. If the Romney campaign doesn't raise its

:41:08.:41:14.

game, it will simply give the President a key advantage.

:41:14.:41:23.

Joining me now from Washington are my guests.

:41:23.:41:28.

Good evening to both of you. What can we tell from the countries that

:41:28.:41:36.

Mitt Romney chose to visit? I think when he planned the trip he chose a

:41:36.:41:40.

deliberate theme. Going to one of our most important allies in Europe,

:41:40.:41:48.

to the UK, go -- going to one of our most important allise in the

:41:48.:41:51.

Middle East, and the focus of attention -- allies in the Middle

:41:51.:41:58.

East, and the focus of attention for Iran, Israel, and Eastern

:41:58.:42:06.

Europe allies, Poland. Is is it the danger that the gaffes overshadows

:42:06.:42:10.

any coherent foreign policy direction? Absolutely. They

:42:10.:42:17.

certainly do not help this trip, that was very finely crafted to be

:42:17.:42:21.

a possibility and opportunity for Mitt Romney to show off his foreign

:42:21.:42:25.

policy experience, and for him to appear presidential. He had plenty

:42:25.:42:29.

of successes on the trips, he had great meetings and great photo

:42:30.:42:33.

opportunities, he specially at the western wall in Jerusalem. But on

:42:33.:42:36.

the way home here we are talking about some of the missteps over the

:42:36.:42:41.

past few days, and the way he snubbed the Palestinian and some

:42:41.:42:44.

British people. Tell me, do you think there has been something

:42:44.:42:51.

emerging of the man that Mitt Romney might be in the White House.

:42:51.:42:55.

Barack Obama was all about diplomacy, is Mitt Romney more

:42:55.:43:00.

directional, there is more clarity in what he's saying in the

:43:00.:43:04.

direction he will take America? has said there is. We don't know a

:43:04.:43:08.

lot about Mitt Romney on the front of foreign policy. We know what he

:43:08.:43:12.

has said and what he would do, which is calling out China on

:43:12.:43:15.

currency manipulation, he has talked about bombing Iran, or

:43:15.:43:19.

stopping that country from acquiring a nuclear weapon. He has

:43:19.:43:26.

talked about Russia and it being our top geopolitical foe. He has

:43:26.:43:28.

talked about all these issues and dealing with them within the first

:43:28.:43:33.

days of office. We don't know exact low what he would do. What would he

:43:33.:43:37.

do? We very well know at that America cannot be the world's

:43:37.:43:40.

policeman, he has been slamming Barack Obama for not doing enough

:43:40.:43:44.

about Iran, but, for example, if he's in the White House, and there

:43:44.:43:49.

is still an issue in Syria, what exactly would a Mitt Romney foreign

:43:49.:43:56.

policy in Syria look like, do you think? First of all, let me go back

:43:56.:44:00.

to the question you just asked Dan. We are talking about this because

:44:00.:44:07.

you, at the BBC, are asking another reporter for another news magazine,

:44:07.:44:11.

Newsweek, what you think about the supposed gaffes that Mitt Romney

:44:11.:44:14.

made on this trip. I think the media of not brilliantly managed on

:44:14.:44:18.

this trip, but the notion that the American people are quite as

:44:18.:44:22.

interested and obsessed on this as you are is simply ridiculous.

:44:22.:44:26.

Unfortunately for me, and you know foreign policy is my business,

:44:26.:44:29.

foreign policy doesn't enter into the top ten issues for the American

:44:29.:44:35.

people in this election. The notion that this is some how doing to be a

:44:35.:44:38.

dispositive question for him, as the American people look at him and

:44:38.:44:42.

see how he questioned the Olympics and whether there was enough

:44:42.:44:47.

security is a little bit ridiculous. Let's set that one aside. Doesn't

:44:47.:44:52.

he have to appear presidential abroad? I think that he needs to

:44:53.:44:57.

have a good trip, and I think in the large part he did. The notion

:44:57.:45:02.

that he can't repeat things that the British press itself has

:45:02.:45:06.

aggressively been putting forward about the Olympics is a little bit

:45:06.:45:10.

silly. The reaction from both Mr Cameron and Boris Johnson were both

:45:10.:45:14.

a little bit sensitive, let as say that. That being said, you never

:45:14.:45:21.

want to get bad press, you want perfect press. On the other hand,

:45:21.:45:25.

the only thing that leads to perpect press is glibness and lying

:45:25.:45:28.

among politician, we have rather had enough of that. Let's talk

:45:28.:45:36.

about Syria? Hang on, the man put out a foo plus, well, let's talk

:45:36.:45:40.

about the foreign policy question, I'm happy to talk about Syria. The

:45:40.:45:47.

plan put out a fifty-plus page White Paper, I don't go back and

:45:47.:45:52.

refer to that eagerly, it is single-spaced and quite long, the

:45:52.:45:55.

view that he hasn't put out his views on a variety of issues is

:45:55.:45:58.

really not quite fair. The American people aren't interested in talking

:45:58.:46:02.

about the Olympic, the Palestinians or Poland at the moment, what they

:46:02.:46:06.

are interested in talking about is unemployment. Let me deal with the

:46:06.:46:09.

fact that he has stated his direction, just briefly? He has put

:46:09.:46:14.

some of these positions on the record. The problem is, none of

:46:14.:46:19.

these have real beef behind them, he hasn't answered the question of

:46:19.:46:23.

logistic, would you really bomb Iran if you could, or confront

:46:23.:46:26.

China on currency manipulation. These are big promises to make,

:46:26.:46:29.

once you become President, and get in the Oval Office, and get

:46:29.:46:33.

classified security briefings, a lot of this is receiptor that he

:46:33.:46:41.

said. We don't have a clear picture -- rhetoric, that what he said. We

:46:41.:46:45.

don't have a clear picture. Foreign policy is not a major issue, with

:46:46.:46:49.

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