I was saddened today to hear of the death of Japanese actor Ken Ogata.

Although I only know him from Schrader's Mishima, this one work alone has firmly placed him in my memory. The DH and I watch Mishima a couple of times a year - a masterpiece of a film about an amazing, disturbing man. The scene where the walls dissolve as the young samurai goes to kill his teacher is one of those moments in cinema you don't easily forget. 

Ogata himself plays Mishima, seen on his last day on earth, as he attempts a death-or-glory coup that will lead either to the return to a more feudal Japan, or death at his own hand. Driven along by a beautiful, mesmerising score by Philip Glass, Mishima is a triumph of the cinematic art. 

Ogata was the star of many Japanese films with which I'm not familiar, but today's obit in the Guardian makes me want to run screaming to Amazon to find them. In particular, I am fascinated by mention of The Ballad of Narayama, which I am ashamed to say I have not heard of, given that it won cinema's greatest prize, the Palme D'Or.

The story of a man who takes his mother up a mountain to die according to local custom, it sounds like one of those amazing Japanese works of art that make you think again about life and death. I can't wait to see it.

The emergence of right-winger Sarah Palin as John McCain's running mate in the presidential election has brought some uncomfortable issues to the fore.

I met up with a bunch of friends the other night. We range in age from the early 30s to the over-60s, and we're a mix of backgrounds, but one thing we all have in common is that we're western Europeans and are therefore pretty comfortable with the idea of abortion. 

It is a constant, striking disappointment to Europeans that abortion is still such a hot-button issue in a supposedly civilised country like the US and that the religious right have been able to make such terrifying inroads into denying women's rights.

In western Europe abortion is pretty much a done deal and has been for decades, though we are still having to fight occasional resurgences of religious feeling from countries like Poland, which would like to foist their nasty little views on the rest of us in the EU - so far without success, thank heavens.

Abortion is available on demand in much of western Europe up to nine weeks, and is relatively easy to obtain up to 12 weeks. After that, things get more complicated, but the basis for the viability of the foetus and therefore any rights it might have is grounded in science, not religion, even in countries that are nominally Catholic. This is obviously as it should be in a modern society.

Abortion and sin 

In cultures that lack a Judao-Christian tradition, abortion often has no connotations of 'sin' at all, which might come as something of a surprise to westerners. In Japan, for instance, a nation that until recently could never consistently feed and care for its people, abortion has always been, and remains, a commonplace event. It is not something worthy of punishment or moral reprobation - women simply have abortions if their circumstances won't allow them to raise a child well and happily.

In Japan, a woman who loses a child before it is born can visit a Mizuko Jizo shrine and pray to the spirits that protect all who die in a body of water, but there is no distinction between miscarriage and deliberate abortion - they are considered to be equal private tragedies. I find it deeply touching that in such a graceful way, the personal impact of an abortion can be acknowledged in so humane a fashion.

Who and why 

There is still much misunderstanding, even in the UK, about exactly who has abortions and why. For all that the right-wingers would have us believe that it is reckless young women who 'indulge' in abortion because they are a bunch of slappers who screw everything in sight (as if, by the way, that was illegal...), in the UK every year as many abortions are performed on women over 50 as on girls under 16. These are mostly women in long-term relationships, often with grown children or even grandchildren, but who for various reasons decide that it would be foolhardy to go through with a pregnancy at their current time of life and in their current circumstances.

Nor do most women who have abortions do so with a light heart as if it were a walk in the park - another argument often put forward by the forced-pregnancy lobby. Having an abortion is always a fraught decision. One friend of mine, who miscarried just before going in for her abortion, broke her heart over the loss of her baby. But she is adamant that she would have had the abortion all the same - being young and not in a settled relationship, she did not wish to go through with a pregnancy, did not want to keep the child and did not want to launch it into the world to an unknown fate. An abortion, in these circumstances, seemed to her the most responsible answer in a difficult situation.

We would do well to remember that pregnancy is a result of biology, not of choice, and that it affects only women. (I don't believe that abortion is something in which men should have any legal say AT ALL). Throughout history, pregnancy has been the leading cause of female death and even today without effective access to contraception, it can remain a death sentence, as it does in continents like India and Africa, where women continue to bear infants with gruelling frequency. Even in the west, in countries with a free health service, pregnancy and birth exact a serious toll on both your health and your finances. Women have always sought to terminate pregnancies as well as prevent them effectively, and they will continue to do so, no matter what the law, the government or even the church says. We may as well make sure they can do so safely.

Pros and cons 

For those of us who do not have a religious belief, abortion is a simple matter in which you weigh up the pros and cons of the situation logically. Is it better to bring a handicapped child into the world or not? Is it better for an underdeveloped teenage girl to go through a pregnancy or not? Which should have the greater right - the adult who is already here, or the foetus that hasn't yet drawn a breath? In the end, the decision should rest with the woman involved - it is not happening to anyone else.

The parameters on what is permissible naturally shift and change, particularly as science and technology make inroads, and our laws do their best to keep up with a fluctuating situation. For instance, the General Medical Council in Great Britain is currently looking to review at what age 'viable' foetuses should be saved during a miscarriage. In the past few years, many foetuses have been saved at 22 and 23 weeks, but on review, so many have proved to suffer severe handicap and brain damage that the GMI may choose to reset the barrier at 24 weeks - coincidentally, the time-limit for legal abortion where there is not substantial risk to a woman's life or risk of foetal abnormality (in this case, there is no time limit). 

On a personal level I believe that life begins at conception, but that a foetus is only a potential life, not yet a full human being - particularly given that 25 per cent of foetuses under 12 weeks abort spontaneously. There is therefore no way that I would accord a foetus the same legal rights as its mother, who is appreciative of suffering as a full human being right here, right now, on this planet. 

And no more than I would force another woman to have an abortion would I force another woman to go through with a pregnancy that she did not want. Empathy is what we need here, not moralising. 

Access to contraception and to safe, legal abortion should be rights that apply to all women, wherever they are. 

Keeping a food diary could help you shed unwanted pounds, according to a recent study in the American Journal of Preventive Medicine (copyright Reuters).

In a study of nearly 1,700 overweight adults who were being tested in a weight-loss programme, researchers found that those who kept a daily food diary lost twice as much weight in six months as those who did not. The average loss was 13lbs - a slow and steady rate that probably indicates substantial diet and lifestyle changes.

"The more food records people kept, the more weight they lost," said Dr Jack Hollis, the lead researcher on the study. The diaries were combined, for both the diary group and the control group, with exercise and group meetings where dieters were encouraged to lose weight.

A food diary need not be a formal affair, added the researchers in this study.  Simply making a list of all the food and drink consumed each day can help people become aware of their habits and make changes for the better.

Food diaries are well known to those of us who suffer from inflammatory bowel disease, because there's no other way to keep track of which foods cause reactions and which don't. They may be tedious, but they're extremely helpful.

However, clearly something else is at work with these weight-loss diaries. Perhaps some people gain weight because they eat unthinkingly and keeping a diary helps them to spot that, or people can begin to see the emotions or situations that cause them to overeat (being stressed, tired, angry, visiting the in-laws, when certain friends drop by etc) and can then take measures accordingly. Perhaps it makes them realise quite how much they turn to food, and how often.

Anyway, whatever the reason, it's welcome research - after all, a diary costs nothing to keep so it is a simple thing to add to your repertoire of diet aids. 

Having fat friends can raise your risk of obesity, according to the latest findings.

Well, that's a doh moment, isn't it? Of course it does, because we live in a culture that revolves around eating and drinking. It's like having friends who take drugs or friends who drink - birds of a feather flock together.

People who live a fat, unhealthy lifestyle aren't all that likely to spend their time together doing sports, I'd hazard a guess. Trampolining, swimming, playing tennis, jogging? Not really fattie pursuits. Stuffing your face at McDonald's, though, that's another matter. Big blowouts down the local Chinese. And if everyone around you is eating a huge amount, it makes your huge amount look normal, right?

Another survey just a few weeks ago found that, worryingly, few people in the UK are now able to correctly gauge how overweight they are. This is an alarming trend, as it means that many more people are inching towards the danger zone of clinical obesity while believing themselve only 'a few pounds over'. But when everyone around you is that same few pounds over, overweight begins to looks normal. It skews your perceptions.

The zeitgeist in the UK has changed dramatically over the last 10 years, and it is leading to a population that is becoming dangerously overweight. People work longer hours and eat more convenience food, packed with empty calories. They don't cook at home, and they have no idea what constitutes a balanced meal. They eat out far more an in restaurants, where portion sizes, as my friend K noted, have increased. And you're served a large portion, it takes discipline to not eat it all, especially if you grew up with the kind of 'finish what's on your plate', or 'eat the meat' mentality that was drummed into me back in the 60s. Food is love, and you'd better not refuse anything mommy makes for you. I've had some very sniffy waiters take away my plates over the years, apparently personally wounded at how little I've eaten. 

But if you do finish what's on your plate, you could be looking at a fantastic amount of over-consumption - which is the reason that most people who regularly dine out have more body fat than those who eat at home. Restaurant meals are designed to be tasty and mouthful, not nutritious and balanced. Even expert dieticians routinely underestimate calories in restaurant meals by about 37 per cent, which doesn't leave the rest of us with much chance. So is it a surprise to learn that many restaurant meals top a staggering 1000 calories? That a latte and a cake from Starbucks is about 930? That if you eat that once a week, by the end of the year you'll have gained 14 pounds?

The worst thing is that, confronted with days' worth of food on a plate, some people still don't like to leave anything because after all, they've paid for it. It's a joke here among the ex-pats that you can always tell the visiting Brits because all they ever mention about restaurants is the portion size - as long as the plate's full, they don't seem to care what the actual food's like. 

Oh well, we all know it's a hard habit to break. I recently reduced my consumption of protein to 50g per serving and it's a shock, because it's an unbelievably small amount of food - less than one crottin of goat's cheese, only three slices of duck breast, a quarter of a fillet of chicken. I think I'm doing pretty well (and I feel a lot healthier for it) but I still have a way to go to reach the amount recommended by the US Food and Drug Administration, which is 56g per day. I can't imagine how most people would fare when confronted with this as a 'meal' - it barely looks enough to feed a hamster but actually it's extremely healthy. You just focus on vegetables and use proteins as a garnish. 

Nevertheless, the best way to not have this amount of protein look completely stranded on the plate is to have the plate smaller, so I've used that old dieter's trick and switched from a main-course plate to a sideplate at lunch, and from a sideplate to a saucer in the evening. I now eat like a little pixie. Watch this space, before I fade away....

I was reading an article in the Guardian today by Rose Shapiro. In it, she condemns alternative medicine, pointing out that its quackery enabled a man like Karadic to hide his identity very effectively, and another quack to possibly kill her patient Dawn Page (see yesterday's story on detox diets).

Shapiro is a sceptic, and of course she is also trying to publicise a book she's written against alternative medicine. But one thing she doesn't mention is that people so often turn to alternative medicine because regular medicine lets them down.

Why do so many doctors have so little in the way of interpersonal skills? Why do so many treat their patients like they were a collection of symptoms rather than a human being? No wonder there is a vast yawning gap, just waiting to be filled by every crystal-swinger in town. What doctors need is more training in how to deal with their patients. 

My friend C, a nursing matron, last year had the worst kind of medical experience, as her mother suffered and died of oesophageal cancer over a period of 15 months. From start to finish, the indifferent attitude of the consultants, which bordered on the callous, was an added level of distress. Without preparation, without a 'sorry', they bluntly informed her mother of her incurable medical condition and the severity of the operation she would have to undergo, then left her to weep. C was outraged, despite 25 years of working in medicine. The only positive thing that came out of it was that her mother died in a hospice, in a calm and quiet atmosphere, and where doctors, incidentally, are notable by their absence.

In my experience, not many of us have come across a caring, sharing consultant. At the peak of their profession, they are often pulled early out of the student body and are never taught how to interact with patients. 

My experience of family doctors, back in the 1970s, was also parlous. As a child, I was terrifed of Dr S, who was the old-school type of doctor who stood for no bloody nonsense from children, and pulled me about like a puppet. I never went to see him unless I was desperate. The cure for my bad periods, he told me, was pregnancy. Aside from the fact that I didn't want children either then or later, I was 15 years old. He put me on a high-dose contraceptive, which did help my bad periods, but also led ultimately to the uterine fibroids that plagued me for years.

The cure for the fibroids, incidentally? Acupuncture - a treatment which Shapiro lumps in with others in suggesting there is no evidence for its efficacy. A single session of acupuncture and my fibroid pain was gone - and this was something that for two years had laid me out flat, despite every effort of the allopathic medical establishment. 

The problem with doctors is that too many of them are close-minded, regurgitating only what they have been taught. And it begins even before their training. It is no surprise to anyone who went to university to hear that medical studients are often complete wankers. The worst kind of privileged class, they are almost universally the comfy middle-class sons and daughters of other doctors, or lawyers. Many, in the UK, have been to single-sex public schools, with all the class differences that this inculcates. Their understanding of the lives of the majority of the working-class populace (who will become their patients) is almost non-existent.

Nor, when I was at college, did many of them appear to have gone into medicine to help people. There were, of course, exceptions, but most admitted quite readily that they were doing it for the money and the status. Frankly, it's not a good start. 

Working on such poor subjects, the training then doesn't help matters. I'm not saying that it shouldn't be - of necessity - medically based, but doctors, particularly general practitioners, deal very often with social problems - obesity and diabetes caused by poor diet, health problems caused by smoking, health problems caused by poor housing, depression caused by living in difficult circumstances.

I spoke last year with a GP who practised in the low-income Elephant and Castle area of London, a place known for high crime, drug use, poor housing, pollution and all the rest of the joys the inner city has to offer.

"So," I said. "Let me guess. You see what? Drug addiction, borderline malnutrition, diabetes, smoking-related diseases, TB, bronchitis caused by damp housing?"

"Bang on," she replied grimly.

The bronchitis and emphysema were particularly noteworthy, she said, due to the area's 'project' housing of the 1970s, and of course drugs were always a problem - though a substantial proportion were prescription drugs - ie: drugs that had been prescribed by doctors.

Nothing in this woman's training (and she was a dedicated, intelligent doctor) had equipped her to deal with her patients' real problems and many of them were beyond her power to solve. She had patients with a low IQ, or poor literacy, patients who couldn't read the instructions on the medication, patients who didn't know how to feel themselves adequately. Dealing with them was something she had to learn as she went along and she often felt beleagured. Above all, she felt that what she had learned as a doctor was not what she had been taught as a doctor. She had had to learn to take account of the whole patient and their circumstances, not simply the symptoms.

Perhaps if doctors were taught better how to deal with their patients, it wouldn't drive so many of those who can afford to choose into the arms of the alternative community, where at least they feel that their voice can be heard. And if the quacks can learn to treat their patients like people, why can't the general medical profession?