Caffeine is the drug many of us can't live without – but do you have any idea how much is in your daily hit?
Propped up on my desk before me, there is a vacuum-sealed bag of white powder. Chemists would recognise this substance as a methylated xanthine, composed of tiny crystalline structures. It is a drug, and I have been under its influence nearly every day for the past 25 years. It is caffeine, and in moderation it makes us feel good. But it is a drug whose strength is consistently underestimated. You'd need to down about 50 cups of coffee at once, or 200 cups of tea, to approach a lethal level of caffeination – but if you go straight for the powder, you can get a lot very quickly.
On 9 April 2010, 23-year-old Michael Bedford was at a party near his home in Mansfield. He ate two spoonfuls of caffeine powder he'd bought online, and washed them down with an energy drink. He began slurring his words, then vomited, collapsed and died. It's likely he ingested more than 5g of caffeine. The coroner cited caffeine's "cardiotoxic effects" as the cause of death.
How much caffeine is the average person taking on daily? When someone asks about our caffeine habits, we tend to reply in terms of how many cups of coffee we drink. But this is a wildly inadequate measure. One 40ml cup of coffee – the size often used in studies of caffeine consumption – could have less than 60mg of caffeine, while one 450ml cup could have nearly 10 times as much, but both could be considered one cup of coffee.
In an effort to make this easier, I came up with a measure called a Standard Caffeine Dose, or Scad. A Scad is 75mg. This is roughly equal to a shot of espresso, 150ml of coffee, a 250ml can of Red Bull, two 350ml cans of Coke or Pepsi, or a pint of Diet Coke. I take about four or five Scads daily. On a two-Scad day, I will feel slow; on a seven-Scad day, jittery.
Anyone will tell you that the British have remained allied with tea, not coffee, but that is only partly true. While the British still drink more tea, by volume, than coffee, they now get more of their caffeine from coffee than from tea. Surprisingly, colas and energy drinks now contribute nearly as much caffeine to the British diet as tea: 34mg daily versus 36mg daily.
It is not easy to know how much caffeine is in your daily cup of coffee. Forensic toxicologist Bruce Goldberger used to work in Baltimore, identifying lethal drugs in the blood of overdose victims. But he turned his mind to a question with broader appeal: how much caffeine are we getting in our beverages? He and his colleagues analysed the contents of coffee drinks, publishing the results in 2003. They found huge caffeine differences not only between coffee brands but also between coffees from the same shop. He bought a 480ml cup of coffee from one branch of Starbucks on six consecutive days. Each time, he ordered the Breakfast Blend. The cup with the least caffeine had 260mg. One had twice that amount. Yet another clocked in at a whopping 564mg.
For a study published in 2012, Scottish researcher Thomas Crozier and his colleagues bought 20 espressos in Glasgow cafes. They found that the caffeine concentration varied from 56mg to 196mg per 28ml, with four cafes serving up espressos containing more than 200mg of caffeine.
Crozier and Goldberger's studies help to answer a question that many coffee drinkers have asked: why is it that on some days one cup of coffee puts you in absolute equipoise – brilliant but steady, relaxed but energetic – while other days it is not even enough to prop open your eyelids? And on other occasions, that very same cup, from the same cafe, will send you to the moon, jittery and anxious, your heart skittering? It is because the caffeine levels in coffee vary dramatically, depending on the natural growing conditions, the variety of coffee plant and the brewing strength.
Roland Griffiths is a prolific drug researcher. "I'm a psychopharmacologist, so I'm interested in the mood-altering effects of drugs," he says. "Caffeine to me is maybe the most fascinating compound, because it clearly is psychoactive, yet it is completely culturally accepted worldwide, or almost worldwide." While we talk, he sips caffeine-free Diet Coke from a mug bearing the structural diagram of the caffeine molecule.
Even though caffeine is not considered to be a drug of abuse, it has all the features of one, Griffiths says. "That is, it alters mood, it produces physical dependence and withdrawal upon abstinence, and some proportion of the population becomes dependent on it."
When Griffiths started his experiments on caffeine, he was a heavy user: "I think my consumption was probably 500-600mg a day, maybe higher." That's more than one litre of good coffee. When he decided to study caffeine withdrawal, he did it the hard way, personally going from a daily dose of seven Scads down to zero, and paying close attention to the havoc it wreaked on his body and brain. Did he go cold turkey? "No, no! I'm enough of a psychopharmacologist to know that's not how I would want to do it. I tapered back."
As part of a series of studies, using themselves as guinea pigs, Griffiths and his colleagues went on a steady daily dose of 100mg of caffeine. In one experiment, their caffeine was cut altogether for 12 days. Four of the seven subjects experienced symptoms including headaches, lethargy and an inability to concentrate. In the second phase, the researchers, still on a steady 100mg daily dose, went for single days without caffeine, separated by more than a week. In this case, "each of the seven subjects demonstrated a statistically significant withdrawal effect".
These scientists were not withdrawing from massive doses of caffeine, just the amount in about 150–240ml of coffee, a Scad and a third. That is all it takes to get hooked.
Coca-Cola owes its success to caffeine. Its early formulation had 80mg of caffeine per 250ml serving, and it was marketed as a pick-me-up. That was in 1909, when the US federal government first tried and failed to corral the emerging caffeine economy, leaving a vacuum that persists to this day. The American Food and Drug Administration (FDA) has long practised a dual regulatory role for caffeine, regulating it when it's packaged as an over-the-counter medication and mostly ignoring it when it is blended into drinks or labelled as a dietary supplement. But the new generation of energy products seems to have caught their attention.
When you crack open a can of Monster Energy, you first hear the hiss of the escaping carbonation. Poured into a glass, Monster is about the colour of a pale ale. On the tongue, well, it's an acquired taste: slightly metallic, syrupy sweet, a faint hint of orange and cream. No, it's not a hot cup of Colombian, but you could get used to it. Millions have. With a striking logo of three neon green claw marks and the slogan "Unleash the beast", Monster seems to be everywhere. In 2011, it surpassed Red Bull in US energy drink sales, by volume, according to Beverage Digest.
Monster evolved from a product called Hansen's Energy, introduced by the juice company Hansen's Natural in 1997. Sales took off in 2002 when they came up with the Monster name, its memorable slogan and distinctive logo. (The claw-mark logo is now a popular tattoo, even among high school students.) Hansen's made its Monster cans twice the size of a Red Bull, but charged the same price. They developed a marketing strategy like those of other energy drinks, targeting young males with an energetic blend of heavy metal bands, action sports festivals and bikini models. Within seven years, it was a billion-dollar brand, with sales of nearly $2.4bn in 2012.
In the summer of that year, New York state attorney general Eric Schneiderman started to look at the marketing and advertising practices of companies who make energy drinks. Meanwhile, several US senators were putting pressure on the FDA to better regulate the industry. In August, FDA assistant commissioner for legislation Jeanne Ireland responded to the senators' concerns with a five-page letter outlining the regulatory framework for energy drinks. She also discussed a death that was getting some attention.
Anais Fournier, a 14-year-old from Hagerstown, Maryland, drank a can of Monster on 16 December 2011. The next evening, with her friends at the Valley Mall, she drank another can of Monster Energy, bought from a sweet shop. Each can contained 240mg of caffeine (three Scads). A few hours after leaving the mall, Fournier was at home watching a movie with her family when she went into cardiac arrest and fell unconscious. At the hospital, doctors put her into a medically induced coma. Six days later, she was taken off life support and died. The coroner listed the cause of death as "cardiac arrhythmia due to caffeine toxicity complicating mitral valve regulation in the setting of Ehlers-Danlos syndrome" (a pre-existing medical condition).
In November 2012, the FDA released a comprehensive list of nearly eight years of what they call "adverse event reports" (consumer complaints) related to Monster, Rockstar and 5-Hour Energy products. It was a list of 93 events, including 13 deaths. There is no way of knowing whether the energy products caused the deaths, but it was enough to scare the public and prompt the FDA to announce an investigation. They advised that people should consult their doctor before consuming energy drinks or shots. This seemed notable – dramatic, even – particularly considering the fact that the agency does not recommend checking with GPs before drinking colas or coffee.
It is hard to unravel the health problems attributed to energy drinks. Any of us who use caffeine eventually take more than we want to and might experience the sensation of a pounding heart. A bit too much caffeine is unlikely to harm your heart. Even among those people with arrhythmias – disorders that cause the heart to beat too fast, too slowly or irregularly – caffeine does little harm. A 2011 literature review published in the American Journal of Medicine found no reason for concern. "It is understandable that most physicians are unsure of the advice they can provide about caffeine intake and arrhythmias," Daniel Pelchovitz and Jeffrey Goldberger wrote. "In most patients with known or suspected arrhythmia, caffeine in moderate doses is well tolerated and there is therefore no reason to restrict ingestion of caffeine." It would be easy to be sceptical of this finding: Goldberger is a consultant for Red Bull, and there is the sense that caffeine can feel hard on the heart. But, despite numerous studies, doctors have been unable to find a link between moderate caffeine use and heart disease or disturbance in most people. However, recent research does suggest an association between coffee and nonfatal heart attacks in people with a genetic predisposition to metabolise caffeine slowly.
It would be safe to assume that if a 240mg dose of caffeine, which Fournier consumed, could kill a person, then Starbucks would have seen at least a few deaths from its coffee, which might contain this amount of caffeine in a 350ml or 500ml cup. A person might drink energy drinks and then have a heart problem, but did the former cause the latter, or are they unrelated? It might be that people who suffer a heart attack after drinking an energy shot or energy drink are more likely to associate the heart trouble with the product than are people who suffer heart attacks after drinking coffee. It would be a simple explanation, and one that could hold some appeal for the energy drink industry. But in Fournier's case there was the coroner's report listing caffeine toxicity as the cause of death (although the coroner also mentioned a pre-existing medical condition).
On 17 October 2012, a team of attorneys filed a civil action with the Riverside County Superior Court of California. It was titled "Wendy Crossland and Richard Fournier; individually and as surviving parents of Anais Fournier v Monster Beverage Corporation." The case contained seven complaints, including negligence and wrongful death. The lawyers sent out a press release, quoting Fournier's mother. "I was shocked to learn the FDA can regulate caffeine in a can of soda, but not these huge energy drinks," Wendy Crossland said. "These drinks are targeting teenagers with no oversight or accountability. [They] are death traps for young, developing girls and boys, like my daughter Anais."
Monster is defending the case. It is questioning the medical evidence and claims Fournier regularly drank energy drinks and Starbucks coffee. It says the autopsy report of caffeine toxicity was based only on Fournier's mother's report of her drinking an energy drink, not on a blood test. It has also detailed her heart conditions.
On 1 May 2013, a gaggle of food industry honchos from Wrigley, Mars and legal and lobbying firm Patton Boggs, which represents the soft drink industry, rushed in to see Michael Taylor, the FDA's deputy commissioner for foods and veterinary medicine. On 29 April, Taylor had announced the agency would be investigating the safety of adding caffeine to food products for the first time since 1980. Surprisingly, the item that finally spurred the FDA into action was not any of the more extreme energy products, but a gum.
In April, Wrigley had introduced Alert Energy Caffeine Gum. But a week after the delegation met with the FDA, on 8 May, Wrigley said it was pulling the product from the market. "After discussions with the FDA, we have a greater appreciation for its concern about the proliferation of caffeine in the nation's food supply," Wrigley announced. "We have paused the production, sales and marketing of Alert."
A month later, I went to Maryland to interview Taylor. He told me that the new energy products have broken out of the typical boundaries around caffeine and are a far cry from coffee, tea and chocolate. And in the process, the food industry is skirting food additive regulations. Taylor drinks coffee and Diet Coke (sometimes caffeine-free), and understands the challenge of regulating caffeine and the limits regulators might face. "I got asked by somebody, 'Are we going to put age limits on coffee, so if you go to Starbucks, would you have to show ID?' I would consider that not realistic," he said. But he made a distinction between the more traditional uses of caffeine and the new breed of energy drinks. Holding a can of Monster, he said, "This is not a historic, cultural aspect of caffeine… What I found disturbing on this front was that in no case did the companies that are making these decisions come to us... and subject themselves to the scrutiny that would come." The entire energy products industry, worth more than $10bn annually, has grown without the FDA's explicit approval.
The UK is moving ahead of the US in caffeine labelling. Starting in December, the Food Standards Agency will require new labels for energy drinks. Any drinks with caffeine concentrations higher than 150mg per litre must carry this label: "High caffeine content. Not recommended for children or pregnant or breastfeeding women." The label must be placed in the same field of vision as the name of the energy drink and show the quantity of caffeine. It will appear on Red Bull, for example, with its concentration of 320mg per litre, but not Coca-Cola, with a lower concentration of 95mg per litre. In November last year, meanwhile, Morrisons became the first UK supermarket chain to ban sales of high-caffeine energy drinks to children.
Walking out of FDA headquarters, I passed a display case of the agency's notable efforts. There were packages of the drug thalidomide. There were a few patent medicines. The only caffeine was in a bottle of Formula One, an ephedra-caffeine blend that has been linked with heart trouble. (Supplements containing ephedra were banned and Formula One was reformulated.) I wondered what the case might hold in 20 years. Maybe some example of caffeinated excess now on the market – or, more likely, one that has yet to be formulated.
Travelling back to Maine that afternoon, I stopped for petrol. The counter next to the cash register was cluttered with energy shots and energy strips. And there, tucked into the front of the display tray, was a single pack of the Wrigley Alert Energy gum. It was the first I'd seen of the product Wrigley had tried to pull off the shelves. Of course, I bought it. Who knows? It might be worth something some day.
UN assistant secretary general says deadly outbreak, which has been blamed on UN troops, demands decisive action
Haiti needs a "Marshall plan" for water and sanitation to quell a cholera epidemic which poses a major threat to the Caribbean and Latin America, according to the UN assistant secretary general.
Pedro Medrano Rojas, who is co-ordinating the response in Haiti, is visiting European capitals this week to drum up support for the faltering effort to deal with an epidemic that has killed 8,540 since 2010 and infected almost 700,000 people.
Studies have shown the cholera strain was probably introduced to the country by UN troops from Nepal, who were deployed in Haiti after the January 2010 earthquake that killed more than 217,000 people.
Evidence suggests the outbreak of cholera, which is endemic in Nepal, occurred when contaminated sewage was discharged from barracks into a watercourse. Cholera is spread through infected faeces. Once it enters the water supply, it is difficult to contain, especially in a country such as Haiti, which has almost no effective sewage disposal systems.
Cholera cases had previously been rare in Haiti. Survivors of the 2010 outbreak are filing a compensation claim against the UN in a New York court, demanding that billions of dollars in damages be paid to them and the relatives of those killed. The UN maintains it has legal immunity from such compensation claims and rejected demands from affected Haitians. The case is being pursued by the Boston-based Institute for Justice and Democracy in Haiti.
Medrano drew a distinction between the lawsuit and UN efforts to respond to the outbreak. "We cannot link these two things," he said. "One is a legal case with a different path that can take years … we have to respond now."
The first case in the current cholera epidemic was reported in October 2010; the outbreak has since become one of the worst in modern history. There were 65,000 cases last year, Medrano said. This year estimates range from 40,000 to 80,000.
"It all depends on the resources we get," he said. "If we get them, it could be 40,000; if not, it could be 80,000 – maybe more – new cases. It is a major threat for the whole Caribbean and Latin America region."
The 2010 earthquake wrought havoc in the already fragile country. Even before the disaster, basic sanitation coverage had decreased from 26% in 1990 to just 17% in 2008, with rural residents worst affected. Medrano said the main reason donors were not contributing more was because they did not consider the situation in Haiti to be an emergency.
As part of its anti-cholera effort, the Haitian government has set up a high-level committee chaired by the prime minister. It brings together key ministries – finance, health and public works – as well as donors and NGOs including the UN agency for children, the World Health Organisation and Médecins Sans Frontières.
Haiti has introduced a $2.2bn (£1.3bn) 10-year plan for the long-term eradication of cholera though the large-scale development of public health and sanitation services. The UN is appealing for $69m for the next two years as part of this effort. This year, it is asking for $40m, but so far the only funding committed is $6m from the UN central emergency response fund.
"This is vastly insufficient to meet urgent needs," the UN said. "The lack of available funds today risks the departure of cholera actors, which could compromise gains attained so far and lead to resurgence in suspected cases."
Medrano said the current dry season provided an opportunity for a sustained effort, including the vaccination of 500,000 people. Other measures include the supply of water pumps, mobile latrines, mobile health services, water purification tablets and the training of community workers to raise awareness of basic sanitation such as washing hands. But he warned that donors must act now to stem the epidemic.
"Last year was the lowest number of cases, which is a tribute to the Haitian government, but we are operating in an environment with less resources and a third fewer actors," he said. "People wrongly feel it's over, but this will take five to 10 years to stop. We have to respond now."Mark Tran
A riverside in Nebraska is a welcome refuelling stop for these elegant birds migrating from Mexico to their breeding grounds
Nebraska is all of a flutter. Over the coming month, more than half a million sandhill cranes will descend on the plains of the midwest where they'll take a breather en route to their breeding grounds in the north. Roosting on the Platte river at night, they take to the wing at sunrise and fill their stomachs with grain from the plentiful cornfields before returning to the banks as the sun sets replete with some much-needed calories for the onward journey.
It's a well-earned break. By the time they touch down in Nebraska, the cranes will have undertaken an epic journey from their wintering grounds in Mexico and the southern states, covering about 200-400 miles a day. And with the breeding grounds of some subspecies as far flung as Hudson Bay and even eastern Siberia, the journey for many is far from over.
Returning to "stage" along the same stretch of the river each year, the weary travellers are not only sure to find food and a spot to sleep, but also the chance to find a partner for life. With 80% of North America's sandhill cranes congregating along the river, the odds are good for the singletons; by the time the birds head off in early April, many will have found a mate.
Sporting grey plumage, white cheeks and a jaunty splash of red above their beaks, these handsome birds make for quite a spectacle as they strut their stuff along the river. And joining them are hundreds of enthusiasts who flock to the region every spring, armed with binoculars and cameras to catch sight of the phenomenon.
For those on the wrong side of the pond, there's no need to get in a flap at the thought of missing out – an online "crane cam", located at the Rowe Sanctuary on the edge of the Platte river, provides a remote glimpse of the action.
Just go to rowe.audubon.org/crane-cam to have a gander.Nicola Davis
There has been a big failure in communicating climate change to the public, but we have to deal with it – before it deals with us
What does the phrase anthropogenic forcing mean to you? Or a carbon bubble – would you be more likely to find one in your bath or in your pension fund? Is the greenhouse effect a better way to grow tomatoes? And what is the difference between global warming and climate change?
Understanding the language of climate science can feel like sitting an exam in an unfamiliar subject. For most scientific debates, the collision between the abstruse nature of expert discourse and our ordinary lives – a collision in which words are always the first casualty – does not matter too much. We can understand that smoking kills, even if we have not read the latest papers on how quickly a lung tumour metastasises compared with other cancers. We know that obesity is bad for us, even if experts are still exploring the addictive properties of sugar.
Not so with climate change. The question of whether we think of fossil fuels in terms of "global warming" or "climate calamity" (as some experts are calling it) goes to the heart of our response. Never has this been more in evidence, as the UN warns of using "weirdo words" on the subject, and politicians from the Liberal Democrat Ed Davey to the Tory Caroline Spelman have said we should listen to the science, and that global warming is a misnomer. There has been a massive failure in how to communicate climate issues to the public.
Part of the problem is that global warming sounds quite nice. A couple of degrees hotter in summer – we could be sitting out on our verandahs of an evening sipping Sauvignon Blanc from our own vineyards. Who wouldn't want that?
Global warming is both an entirely accurate term and utterly misleading. Current projections are for a rise of at least 2C by the end of the century, even if we take drastic action to tackle greenhouse gas emissions, and a rise of as much as 5C or 6C if we carry on as usual. That may not sound a lot, but the difference in temperature between today and the last ice age was only about 5C; and the last time the UK was 5C warmer it was a swamp occupied by proto-hippos.
More importantly, the real effects of warming are not a gentle uniform increase in temperatures, but a move to far more extremes of weather. Meddling with the complex systems that govern our weather will bring disruption to the stability of climate that has aided the rise of modern civilisations. Warmer air holds more moisture than colder air. This means that areas of the world that are currently wet will become much wetter, but those that are already prone to drought will get drier. In the UK, this will mean more storms and floods of the kind that have devastated the country in the past two months. We are just beginning to understand that the melting of the Arctic ice cap may bring colder and wetter temperatures to Europe, even as they bring warmer weather to Greenland. Across the globe it will mean disruption to agriculture, a spread of disease and swaths of land becoming uninhabitable.
Key to this is the word "global" in global warming. The effects of the temperature rises will be felt across the world. Regions on continents as far apart as Australia and sub-Saharan Africa that currently just about support agriculture will get warmer still, making living there next to impossible. People who live there won't just stay where they are to starve; they will move, making global migration one of the most serious consequences of our climate meddling.
So here are a few exam questions. To make it easy, they're multiple choice:
1) Who do you think has got climate science right?
a) The vast majority of the world's experts who have produced ever more clear warnings on climate change for the past 20 years, based on physical evidence
b) The oil industry
c) The Tea Party
2) Who do you trust to tackle climate change?
a) Governments determined to squeeze the last few drops of economic advantage from their remaining fossil fuel reserves
b) The oil industry
c) Corporate advisers to the tobacco companies, drafted in to put a positive spin on this because they've been through it all before
By now you will have realised that this exam is a sham. The truth is we don't have multiple choices on climate change. We have one choice: we deal with it, or it deals with us. It is the one question we must answer correctly.Fiona Harvey
Athene Donald: Tomorrow is International Women’s Day. It’s a good time to consider what academic success means to women. The University of Cambridge is attempting, through a series of interviews, to find outAthene Donald
It took decades for HIV/Aids drugs to reach the world's poorest – history must not be repeated with hepatitis C treatments
A public health showdown is brewing over a virus that affects the lives of millions of people every year.
The face-off will involve activists on one side and pharmaceutical companies on the other. It will play out in the richest cities in North America and the poorest countries in Africa. The viral scourge at the centre of this brewing confrontation is spread through blood-to-blood contact, but is treatable with expensive medicines.
This scenario may remind some of the decades-long struggle to obtain access to life-saving medicines for HIV and Aids. But here we are talking about another public health threat: hepatitis C.
An estimated 150-180 million people worldwide are infected with hepatitis C, and up to 500,000 die every year. The virus attacks the liver, yet the vast majority of people are unaware they are infected because the initial stages have no symptoms. It is the long-term effects that can be the most devastating: cirrhosis, liver cancer and liver failure.
The showdown is over the cost and quality of medicines. Until recently, the only cure for hepatitis C involved an expensive combination of injections and tablets that lasted a year. In addition to having limited efficacy, this regimen caused serious side effects that deterred patients from finishing the full course. Now, new drugs are poised to enter the market that work more quickly, are more effective and may not require weekly injections. About 10 of these drugs have reached an advanced stage in clinical trials.
But battle lines are being drawn over the cost of the treatments. Two products were approved by the US Food and Drug Administration recently, including the first pill that does not require a complementary injection. The pill, sofosbuvir, costs $84,000 (£50,370) for a 12-week course. Echoing the concerns of HIV activists who demanded cheaper treatment, protesters point out that such prices will keep hepatitis C drugs beyond the reach of those in need.
The similarities with HIV and Aids do not stop there. Hepatitis C is a leading cause of death for people with HIV. Approximately 5.5 million people have both diseases, so just as people with HIV are living longer thanks to powerful medicines, some are being struck down by hepatitis C.
A decade ago, the high price of HIV treatment meant that access was limited in developing countries. Today, almost 10 million people in low- and middle-income countries are able to receive life-saving HIV medicines, thanks to generic competition slashing prices from $10,000 in the mid-1990s to just $140 a year. The success in providing HIV treatment to the world's poorest people can pave the way to ending hepatitis C.
Manufacturers of new hepatitis C medicines are likely to offer the poorest countries a less expensive version. But according to the Lancet medical journal, pharmaceutical firms will not offer discounts to middle-income countries they regard as emerging markets, where about 75% of people with hepatitis C live. For this reason, a diverse alliance of countries – Brazil, Colombia, Costa Rica, Egypt, Moldova and South Africa – sponsored a resolution at a recent meeting of the World Health Organisation, urging the international community to act quickly on hepatitis.
Governments, pharmaceuticals and civil society must work together. We need to learn from our experience with HIV and Aids and negotiate better prices from all manufacturers. Generic competition should be encouraged to bring prices down.
Pharmaceutical firms are starting to realise that they cannot leave people in poor countries behind. Initiatives such as the Medicines Patent Pool have allowed several major companies to share their patents, enabling affordable generic versions of their HIV medicines to be made. We need to see the same spirit of co-operation for hepatitis C.
We must also avoid a prolonged international showdown. Almost 20 years passed since the first HIV antiretrovirals emerged in the 1990s and the moment people in low-income countries began to get access. For the millions with hepatitis C – and for those who are unaware they have the disease – we must act faster.Philippe Douste-Blazy
Elaborate trench network was identified from old aerial photographs on land that is still owned by Ministry of Defence
A few suspiciously straight lines in a corner of a 1951 aerial photograph showing acres of featureless scrubby heath have led archaeologists to a lost first world war landscape.
The mock battlefield, used for training soldiers before they were shipped across the Channel to confront the real thing, is complete with zig-zags of frontline, communication and reserve trenches, the enemy's front line, terrifyingly visible less than 200 yards away – and, a little further on, a holiday camp in Gosport, Hampshire.
Browndown is still owned by the Ministry of Defence, but well used by local dog walkers, who knew there were humps, bumps and hollows into which a dog could annoyingly vanish – but had no idea what they were.
Rob Harper, conservation officer at Gosport council, was originally studying the photograph looking for second world war pillboxes, and had to wait several weeks after he spotted the telltale marks – until the head-high bracken and gorse died back – before he could investigate the site.
He thought it was likely the earthworks had been destroyed since the photograph was taken, since Google Earth just showed a confusing jumble of tracks. But when he finally put on his boots and scrambled around the land, he found himself in a perfectly preserved complex covering acres of land.
The front trench was jagged so that even if the Germans broke through, they didn't get a clear line of fire along its entire length, and the communication trenches were wider so more men could be rushed up to the front – or carried back injured. Although very overgrown, the distinctive profile of the trenches is instantly familiar from countless wartime photographs.
"I was completely astonished at what I was seeing," Harper said. "It was quite personal to me too – I have seven relatives buried in war graves on the front, who could well have trained here."
The historian Dan Snow, who is also president of the Council for British Archaeology, which is working to record the site with English Heritage, said: "This is where archaeology and history dovetail perfectly. In a way this is where we have to side with Michael Gove and against the Blackadder view of history.
"This is where you can see on the ground that it wasn't just about rounding up young men and hurling them at the machine guns: they were being incredibly well trained."
Here military tacticians were also trying to invent a new form of warfare, desperate to break the terrible stalemate that the trenches represented. But according to Wayne Cocroft, an English Heritage expert on wartime archaeology, although 20 other trench training sites have been recorded across Britain, many have been damaged by later development, and both the scale and the state of preservation of the Gosport complex is exceptional.
So far no records have been found of the complex, but thousands of soldiers were trained, shipped out, and repatriated to Gosport throughout the war. The peninsula on the Solent is spattered with centuries of military relics, including barracks blocks, airstrips, naval bases, supply depots and a submarine base, which is now a museum.
Graham Burgess, deputy leader of the council – who graciously said that if the MoD would like to present them the land, after checking first for live ordnance, the council would be pleased to accept it – was not surprised, as an ex-navy man, that the site had kept its secrets for so long.
"Gosport was full of things happening behind high walls and barbed wire fences that nobody outside knew anything about – still has a few. You could live next door to one of these places and not have any idea what was going on inside."
Stephen Fisher, one of the archaeologists recording the site, says digging the trenches would also have been training for the men, who would soon have to do it for real, and the little slit trenches scattered across the site, just big enough for one man to cower in, might represent their first efforts.
Volunteers including armed forces members based in the area, including many for whom the site has a personal poignancy since they have just returned safely from active service overseas, will be helping record the site in detail.
The Council for British Archaeology and English Heritage are combining to encourage many more volunteers for the Home Front Legacy – a campaign to identify and record vulnerable sites including camps, drill halls and factories. The information will loaded onto a database to create a map of the social history of wartime Britain.
Cocroft said that records were better for a Tudor house than a 1914 site: one site recently identified, in Newcastle under Lyme, was a hall used as a sewing circle where women gathered to make bandages and knit and sew garments for soldiers on the front.
"There were so many charities for Belgian and Serbian refugees – where were they based, where did they meet? There were factories taken over to make things like wooden boxes for shells. These things aren't recorded on any maps – only local knowledge can help us find them, before the memory is lost forever. The Great War affected everybody in Britain – down to the children who were asked to gather conkers from which a chemical used in making cordite could be extracted – but there is so much of its social history which was never written down anywhere."
Culture secretary Maria Miller said she hoped local and family history groups, schools and parish centenary projects would get involved in the project: "Discovery, preserving and identifying for the public sites and buildings from that era will help bring that part of our national history alive for generations to come."Maev Kennedy