Woman's Hour - Weekend Woman's Hour: Breast implant rare cancer risk, Ellen Burstyn, Paralympian medallists

Episode Date: September 7, 2024

We hear about the thousands of women suing the breast implant manufacturer Allergan over alleged links with a rare cancer. We have an exclusive interview with a woman who has received a payout from the company after falling sick. Susan Axelby told our reporter Melanie Abbott that she ended up being diagnosed with cancer after having an operation which was supposed to prevent it. Plus, Nuala McGovern was joined by lawyer Sarah Moore to go over details of the case and reveal whether more women in the UK are likely to take action. And Professor Suzanne Turner from Cambridge University discusses her research into this cancer and gives advice to women who have implants, including the fact that the numbers diagnosed are small and it is treatable.Ellen Burstyn has been a star of American stage and screen for 70 years. This week she received the Liberatum Pioneer Award at the Venice Film Festival for her contribution to cinema and the industry, particularly in paving the way for women. She talks to Krupa Padhy about her stories from a lifetime on camera.Head teacher Ruth Perry took her own life in January last year whilst waiting for the publication of an Ofsted report she knew would grade her school as "inadequate". Ruth’s sister, Professor Julia Waters, has been campaigning for change in the way Ofsted rates schools ever since. A review was published today into Ofsted's response to Ruth Perry’s death, and this week the Government announced changes to the way the school's inspector for England rates schools. Nuala was joined by Professor Waters to give her response.From spongy flesh to wandering wombs, there have been many theories about the inner workings of women across the centuries. In her new book, Immaculate Forms, Professor Helen King talks to Anita Rani about how scientific theories and religious beliefs have shaped our understanding of women’s bodies, from Ancient Greece to the present day.This week we speak to not just one Paralympic medallist but two - Team GB triathletes Lauren Steadman and Claire Cashmore, who won bronze and silver in the Para-triathlon category in PTS5. They join Nuala from Paris.Presenter: Krupa Padhy Producer: Annette Wells Editor: Rebecca Myatt

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2. And of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme. Peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, this is Krupapati and you're listening to the Woman's Hour podcast. Welcome to Weekend Woman's Hour with me, Krupapati. In the next hour, the first broadcast interview with Susan Axelby, who developed a rare type of cancer allegedly linked to her breast implants and who warns that others with similar implants could be walking around like time bombs. Ellen Burstyn, the Oscar, Emmy and Tony Award winning actor

on being an icon and being awarded the Liberatum Pioneer Award at the Venice Film Festival. And the Paralympian rivals and friends Lauren Stedman and Claire Cashmore on their bronze and silver wins for Team GB in Paris this week and how their rivalry spurs them on. Lauren and I have known each other since, well, she was a very little girl and we went to school together.

So I was always the older one, probably bossing her around, telling her what to do. Nothing has changed. No, exactly. But yeah, so we raced each other as swimmers and then to go into the triathlon world. And so, yeah, it's great to be able to push the boundaries together. Also, a new book that looks at how women's bodies have been shaped and understood by science and religion throughout history and often by men.

There's lots to get through. So grab a cup or whatever takes your fancy and settle in for the hour. A special investigation by this programme has discovered more and more women are suing the breast implant manufacturer Allergan, claiming their implants have given them a rare form of cancer. The textured implants sold under the brand BioCell were recalled in 2019. This followed more than 100 reports of what is called Breast Implant Associated Anaplastic large cell lymphoma or BIA-ALCL. It's a cancer of the immune system and develops in scar tissue around the implants. It happened to Susan Axelby from Sheffield and she has now received a £57,000 out-of-court settlement from Allergan.

We will hear her first broadcast interview shortly and we'll also hear from Sarah Moore from Lee Day Solicitors, who acted for Susan, and to Professor Suzanne Turner from the University of Cambridge, who's been studying this rare form of lymphoma. Nuala spoke first to Woman's Hour reporter Melanie Abbott, who's been following the fallout from breast implants since 2010, and began by asking her what we know about BIA-ALCL.

Well, the first report made by Allegan about it was in 2007. It documented cases then. And we know this because of documents that Allegan provided to the French health regulator eight years ago, back in 2016. And that showed that by then there had been 104 complaints of this breast implant associated lymphoma. Yet the recall of these products didn't happen until three years later, three years after those documents had been handed over. And has Allergan explained about that? I did ask Allergan, but they haven't responded. But when Susan got her implants, there had already been cases. handed over. And has Allergan explained about that? I did ask Allergan but they haven't responded. But when Susan got her implants there had already been cases? That's right yes she got her implants back in 2011. By then according to Allergan in those documents I mentioned there'd been

19 complaints of this type of cancer but those figures weren't revealed until five years after Susan got those implants. Now we can't say when Allergan might have begun collating those figures weren't revealed until five years after Susan got those implants. Now, we can't say when Allegan might have begun collating those figures, but we certainly know that someone was logging the data as early as 2007, and there had been some reports before then too. Now, Susan has received this out-of-court settlement, £57,000 from Allegan without them admitting liability. Susan's story begins when she had a preventative mastectomy 25 years ago. £57,000 from Allergan without them admitting liability.

Susan's story begins when she had a preventative mastectomy 25 years ago. Her family has a history of breast cancer. She was given the implants then, but she told me that she was never happy with that outcome. They weren't formed properly. One was higher than the other one. All the skin was puckered. The nipples weren't in the right place.

Scars. Well, I didn't even think I would have any scars. And then I got necrosis and they said it was because there wasn't any oxygen getting to the nerve ends. The smell was horrendous. It was like dead meat, but worse. Because necrosis is when your skin is dying isn't it yes that's right so i had to go for all these like injections and put this powder put on to see if they could make it grow and and it did but it was all starred and it did never look right what did you do did you just try to live with it well i did try to live with it? Well, I did try to live with it, but it was always on my mind. And to be quite honest, I had a bit of a mental breakdown. I was housebound for two years. I turned to alcohol. I was drinking every day, early in the morning till, you know, I collapsed at night. Gosh, did you eventually try to get something done about them then?

I've got a daughter and we tried to get her the genetic testing. So she went to see a breast cancer nurse and I went with her and Alicia mentioned how bad my breasts were. And she said, do you mind if I have a look? And she actually took a step back and went, you know, sharp intake of breath. And then I was referred to a surgeon and she put new implants in and tried to like even my breasts up which she did and didn't look too bad although I didn't look like a page three model but hey ho so that's when you got the Allergan implants that is when they got the Allergan yeah then a few years after that i got some swelling in in my left breast and it felt hot to the touch so i went back to the hospital and they

drained 500 milliliters of fluid out of it then i went back home and it swelled up again. So I went back again and they drained the same amount off again within a month that was. And then it started to swell up again and they found out I've got this very rare cancer. What was your reaction when you were told that? Well, I didn't believe it. I was in denial. I'd had my breast stopped getting cancer and now I've got cancer. I thought, how can that be? And it wouldn't go in. And I even said to the nurse, I said, I've got cancer. And she wouldn't tell me then. My husband came.

And I said, don't be happy. And sorry, my husband came. And he really... Sorry to bring it all back. I'm not going to face. You see, not only have they hurt me, they hurt my husband, they hurt children. Are you okay? Yeah.

It has ramifications for everyone around you, of course. Yes, I'm sorry about that. No, don't worry. So then, of course, it's like, you know,'t worry so then of course he said you know we're gonna have to take it out and take the breasts off again and they said I could never ever have another implant the only way around it is to like take stuff from another part of my body and like rebuild it and I just said can't go through that again. I just cannot go through that again.

So I just said, can you possibly just take the other one off then? So there's no nipples. There's actually nothing. There's just, like, a straight line all the way across the top of my body. And are you getting used to how you look? Yeah. Yeah, I suppose so. I'm still, well well not embarrassed really but i don't like anyone to

see me without any clothes on and that does quite include my husband although he's not bothered at all obviously you've been through a lot but what made you decide that you would sue allegan implant manufacturers because i'm thinking not so much me i mean I'm nearly 70 but there's young girls you know because they wanted breast augmentation they're walking around like time bombs they have no idea what's in their body now you know it's happened to me and a few other people you know they can be walking around like that and they knew this Melanie they've known this for years that there's a chance that this could happen, but they did nothing about it.

They need to be brought to justice. They really, really do. You told me you coped very badly when you first had the mastectomy. So how are you coping now? I still get problems with my anxiety and my depression, you know, so it's never going away. It's never going to go away.

Susan Axelby, and I would like to thank her for sharing her story, depression, you know, so it's never going away. It's never going to go away. Susan Axelby, and I would like to thank her for sharing her story, upsetting as it obviously was to talk about it. And she has made a full recovery from the lymphoma. Now, if you've been affected by this, there is information on our website about where to get support. And there's also a link to the health regulator for medicine and healthcare products, the MHRA, for advice about this kind of cancer. Yes, indeed. Thanks very much to Susan for sharing her story. Has the surgeon who operated on Susan commented? The surgeon who gave her the Allergan implants. I have been in touch with her and she does say that unfortunately, we routinely used Allergan implants at the time and indeed for many years afterwards, because as she says

we didn't understand the association I'm quoting her there and she says they were widely regarded as high quality implants. We know there are class action suits underway to sue Allergan in the United States. What about Europe? Yeah in the Netherlands 60,000 women are taking part in a case against Allergan. And I should stress they don't all have this BIA-ALCL cancer. For some, they fear developing this lymphoma, and so they want to be compensated for that worry and for possibly having the implants removed. The lawsuit's being brought by a women's rights organisation called Bureau Clara Wickman.

Now, I did, of course, course ask Allegan to comment. They sent a pretty brief statement saying in 2019 Allegan issued a voluntary global recall of biocell textured breast implants and tissue expanders and no longer manufactures these type of implants. Thank you very much

Melanie Abbott. Well I want to stay with this story and particularly the lymphoma we're talking about. I want to speak to Sarah Moore from Lee Day Solicitors, who acted for Susan Axelby, who we heard earlier in the programme, and to Professor Suzanne Turner from the University of Cambridge, who's been studying this rare form of lymphoma. Sarah, let me begin with you and welcome to Woman's Hour. I know you've had other women in contact with you. Do you expect to see many more cases?

Yes, I think we do. I mean, how many is a really good question, and I can't answer it. Sure, of course not. But what we know is that this product was suspended from the market in 2018 and then removed from the market in 2019. We also know that this particular type of cancer from which Susan suffered has a latency period of about eight to nine years. Oh, a long time then.

Yeah, it's quite a long time before it can present. So on that basis, we might be expecting to see cases of ALCL being reported up to 2028, 2030 potentially, even though the product's now suspended. And what about that case that we were hearing about, a class action suit, the laws had changed in the Netherlands. Is that possible in the UK? No it's not and that's a really significant issue for women in this country who have exactly the same problem as being reported in the Netherlands but because we don't have access to the kind of class representative system that they have in the Netherlands we can't do that here their group is

very large. Well I was really interested in that part of many of the women do not have the cancer, have not presented with the cancer, but for the worry that they feel they have experienced and also potentially having those implants removed. Yes, which, you know, you can see, I mean, Susan used the expression time bomb. You know, if you've got these implants and you have this potential risk, albeit small, it's there, it's in your body, you know, and potential cancer is waiting to develop. Or even if it is not, you're worrying that it might. Absolutely right.

So in the Netherlands, you can act on the basis that, or you can bring a case on the basis that this cancer may present later. In the UK, you cannot. Until you have that cancer, you do not have a viable claim. Interesting. Let me turn to Professor Turner. Welcome also to Women's Hour. You were one of the first to begin researching this type of lymphoma. It is rare. I do want to stress that.

The MHRA, the regulatory body that Melanie had mentioned, reports there have been 104 cases in the UK. I'd be curious for your thoughts on how rare it is and also what causes it, if we know. So of course it is quite a rare cancer, fortunately, in that women that have these types of breast implants, the risk of developing this type of disease ranges from about 1 in 300 women up to 1 in 14,000 women that have these implants in place. So it depends on which study you look at. So it is rare. And we're not completely sure what's going on, why it's occurring. And there have been a number of theories floated around without much evidence to back them up. But in our lab in particular, we've been looking at the role of chemicals on the surface of these particular types of breast implants, and how these may be acting to promote cancer development in

certain women. And I was very glad to hear that Susan has made a full recovery from the lymphoma, although obviously has been through so much. She did talk about a swelling. Is that what women should look out for? Because we don't want to cause unnecessary worry this morning, but some might be wondering, how would you know? Yeah? Yeah absolutely so the most common symptom is a sudden swelling in one breast so it can occur in both breasts in very very rare cases but it's that sudden swelling in one breast and that can be anything from one to two years after having your implants put in all the way through as was mentioned previously 10-11 years after having your implants put in all the way through, as was mentioned previously, 10, 11 years after having the implants placed. So it's quite a long incubation period, if you like, for this

cancer. It's normal to have a swelling immediately after surgery. That's just your body trying to repair itself from the surgical process. So these are what we call delayed seromas or later swellings. At the same time, there have been some women who have presented with lumps and bumps, like you get in any breast cancer. So the advice is really to just be very aware of changes to your breast, as you would if checking for breast cancer in general. So always go to your doctor if you do have any concerns. The official guidance from the regulator, the MHRA, is that women do not need to have them automatically removed if they have these Allergan implants. I'd be curious for your

thoughts on that. Yeah, so of course, it is rare. So the idea that lots of women with these implants in place would suddenly come to the National Health Service wanting them to be removed, of course, in the current status of things, is not really going to be something that we can do in the NHS. And of course, this is also a highly treatable cancer. And so being aware of the symptoms, looking out for those symptoms, and then going to your GP, should you be worried about any of the symptoms you're experiencing is really the advice at the moment. Tricky though I can imagine for women just as you say that and also I don't know I suppose it brings up that divide between NHS and private perhaps as well for those that can afford it. Absolutely yes and you know there's lots of controversies around plastic surgery and what's taken a place abroad and all these other wider issues at the moment.

And where does the NHS pick up on those sorts of issues? And of course, having a national health service, we are limited in the finances we have and what can be done, which again argues towards the company perhaps needing to take responsibility to pay for these removals and replacements. And listening is Sarah Moore who represented Susan Axelby. You know Professor Turner is touching on how the ramifications of this particular case might be. What do you think about that action against other implant manufacturers or do you think it'll stay with Allergan? So we know that with ALCL, this particular type of cancer, that 85% of this cancer presenting worldwide is in relation to Allergan. It seems to be an Allergan problem largely. There are other textured implants that have the ALCL associations, but they are few and far between.

So we think it's largely an Allagan problem in the UK, at least. If I can just say as well, in terms of the importance of getting help, what we've seen with Susan's case is that it took a long time for her to get to the point of diagnosis. And other women that have come forward as well have had the same problem. So they've gone back to see their initial plastic surgeon. They haven't necessarily been very quick to diagnose or help in any way. And then they've been referred back into the NHS

and eventually have come to the point of diagnosis. But that's been sometimes six months or even 12 months after the symptoms are first presented. We know with any cancer, obviously it's important to get treatment as swiftly as possible. But that creates another issue from a legal perspective as well, if I may, which is that when you bring a claim against a manufacturer in the UK, you have 10 years from the date at which the product is produced to bring legal action. So you can see here where we have instances of a cancer presenting at sort of 8 is viable, even when you've been diagnosed within that 10-year period.

Because some of these implants sit on the shelf before they're implanted. That was going to be my next question, exactly how long are implants from the time they're created to the time that they're actually put into a body? It could be a year. So if you are presenting with this cancer at nine years and the implant was on the shelf a year before it was put in, then you're already right up against that time limitation period in terms of being able to

bring legal action which is another problem that we face here in the UK. So again if people are interested in bringing legal action we need to have that confirmed diagnosis and obviously clinical treatment must be your first priority but if you do want to look at legal action then really the clock is ticking and you know time is of the essence. That was Sarah Moore, Professor Suzanne Turner and Melanie Abbott talking to Nuala. We also heard from Susan Axelby. And there is a link on our website on Wednesday's episode page. Just scroll to the bottom to the MHRA advice about this lymphoma for anyone concerned about it. Also, if you have had breast implants and want to find out if the manufacturer is Allergan, do ask the surgeon who fitted them and they should have a

record. Next, Ellen Burstyn has been a star of the American stage and screen for over six decades. She has one of those rare accomplishments, the triple crown of acting, which means that she's won an Oscar, an Emmy and a Tony. What made her an icon is her incredible run of films in the 1970s, including The Last Picture Show, The Exorcist, and of course, Alice Doesn't Live Here Anymore, the comedy directed by Martin Scorsese that won Ellen her Best Actor Academy Award. This week, Ellen, who is now 91, is at the Venice Film Festival, where she received the Liberatum Pioneer Award. I've been speaking to her, and we started by talking about her mother.

Previously, Ellen had spoken openly about her difficult relationship with her mother, calling it abusive. But now, she told me, she's trying to reflect on the situation differently. Now I say that she was a very conscientious mother in that she always gave me piano lessons, ballet lessons. She dressed me very nicely. She made all of my clothes. She was trying to be a good mother. It's just that she had a ferocious temper. And she grew up in a house where her father administered punishment physically a lot. So she thought that was the way to administer justice or whatever, where she was trying to convince us up. So there was a lot of physical, what's now called abuse.

At that time, she called it spankings. But it was more than that because it was running around the house and her chasing me with a yardstick. But, you know, I came across an American-Iranian poet who said, art is what survives of what we survive. So I feel that's true, that somehow the troubles we deal with early on fertilize our innate talent, whatever that is. You left home swiftly as soon as you could with a mere $3 in your pocket. Tell us about that journey. Yeah, I left home on my 18th birthday with a foot that had just been operated on

and I was supposed to stay in bed. But my mother spoke to me in a belittling way and I thought, I'm 18, I don't know what to put up with belittling way, and I thought, I'm 18 now. And I got up and started packing. And she came up and said, what are you doing out of bed? And I said, well, I'm 18 today. And you always said I was under your jurisdiction until I was 18, so I'm living home. And I left with two suitcases and began my life.

Was acting always the plan? You know, it was always something I could do. Even as a child, it felt natural to me. It's the way of expressing my soul, it is. It's the way of expressing who I am. I create other people in me or out of me. And that makes me think that there's an acting gene that I carry. I don't know what it would look like.

I don't know what it would be composed of. But if it exists, and I suspect it does, I was blessed with one. You arrived then in New York City. You found your way to the actor's studio of which you are now co-president, the Home of Method Acting, for those who don't know. It's run by Lee Strasberg and Marlon Brando was one of his first members. What was that experience like? Was that you finding a home away from home, that place of belonging?

Just one day, it was a moment of clear thinking. I realized there were actors who knew something I didn't know. And I wanted to find out what that was. And I knew they were all students of Lee Strasberg, so I went to him. And I found a real teacher. I could feel guidance come into my life, you know, that I'd never had. And I read a lot about people talking about method acting as though it's making it real. Like if you have to play Medea, do you have to kill your children? No. It's not making it real. It's making it real to your senses so that your senses respond. 1971, that was the year when you got your big

break with The Last Picture Show. You were 39 years old. It was the first of your many famous roles playing unconventional mothers. Were you ever worried about being typecast? No, not at all. I don't know why I wasn't. I wasn't. I just felt like, you know, I observed that women's roles were either the mother or the good wife, you know, who stayed home and waited for the husband to come back from saving the world so she could make him a nice cup of tea, or she was the prostitute with a heart of gold. There were types, and the young mother was what I was suited to. I felt it was a pattern set before I got there, and I did my best to get into it.

Let's turn to The Exorcist. You were playing the mother of a young girl possessed by a demon, but obviously it was an incredible hit and did so well. But it was a demanding shoot, wasn't it? It was a very demanding shoot. But, you know, it was a very creative atmosphere. And that's my favorite atmosphere. So in a way I was thriving.

And at the end of each day, I had a ritual. The costume designer would come into my dressing room and we opened a little split of champagne and we each had a glass of champagne, laughed about the events of the day and kind of unwound. And I went on about my life. Let's also talk about your Oscar for Alice Doesn't Live Here Anymore. Interestingly, I've been told that you were asked to direct the film initially. It was offered to me. When I read it, I felt it was very amusing and wonderfully written. But again, it was kind of that stereotype of what a woman was.

And I wanted at that point to make a film about a woman as I knew women to be, because we were right at the beginning of the women's movement then. And John Calley, who was the head of Warner Brothers at the time, he asked me if I wanted to direct it. And I said, no, I'm not ready to direct and act at the same time. I wouldn't know how to do that. And he said, who do you want?

And I said, somebody new and exciting. And I knew Francis Coppola by then. I can't remember how we met, but we did. And I called him and I said, who's new and exciting? And he said, look at a film called Mean Streets. And I looked at Mean Streets and I was so impressed with the. And I said to him, I want this film told from a woman's point of view, which as far as I know had never been done before. And I said, what do you know about women?

And he said, nothing, but I'd like to learn. And I thought that was the best possible answer a man could ever come up with to me. So we went into business together and I must say I had no idea what a brilliant choice that was going to turn out to be because he certainly has become the master of cinema now. And it was wonderful working with him. About a decade ago, you said that you could no longer make a living from acting.

That is what you shared. And that was seen by some as an assessment almost on the state of the acting industry and how it doesn't give older women enough opportunities. Do you still feel that way? How do you feel about the situation now?

Well, I mean, certainly there aren't the number of parts that there once were, certainly. And certainly women's careers do fall off. No question about that. I just mean that I, without realizing what I was doing, was promoting myself to the grandmother level instead of the mother level. And that was another, you know, territory of roles available.

But is there as much work for women in films after 45? No, not really. But, you know, there is grandma. What role would you like to play? Because we know this is not the end for you. Beyond grandma, beyond the mother. You know, I'd like to play women that are full human beings, that are not just a role in life of daughter, wife, mother, grandmother,

great-grandmother, you know. Full human beings. I like to play full human beings who are full besides their role in the family. Ellen Burstyn there. Still to come on the programme, Paralympian rivals and friends Lauren Stedman and Claire Cashmore talk about how their rivalry spurs them on. And remember, you can enjoy

Woman's Hour any hour of the day. If you can't join us live at 10am during the week, just subscribe to the daily podcast for free via BBC Sounds. A major independent review has found that Ofsted's response to headteacher Ruth Perry's suicide following a school inspection was defensive and complacent. Ruth had been head of Cavisham Primary School in Berkshire for 13 years when she took her own life in January last year, ahead of an inspection report being made public. The report had downgraded the school from outstanding to inadequate based on safeguarding concerns. Ruth had no previous history of mental ill health. And a report from the coroner stated that Ofsted contributed to Ruth Perry's death. Her school was regraded last year to good. In her diary shortly before she took her own life,

Ruth wrote, inadequate keeps flashing behind my eyes. The current chief inspector of Ofsted, Sir Martin Oliver, spoke on the Today programme this week and said that he accepted the findings of the independent review and wanted to concentrate on providing a good service in the future. Let's remember, we do thousands, tens of thousands of inspections and the vast vast majority of them go exceptionally well and we get great feedback and indeed in some of the survey responses and in Dame Christine Gilbert's review there are plenty

of mentions about how things have improved not just since I took over but they've been improving since my predecessor made some changes so we know that we can make a difference and we will continue to make a difference for children. We reported on the programme on Tuesday that many parents and teachers welcome the news from the government that Ofsted will scrap the one and two word judgments, outstanding, good, requires improvement or inadequate, as a means of evaluating a school's performance in England. It follows the work of

a high-profile campaign by Ruth Perry's sister, Professor Julia Waters, who joined Nuala in the studio. Nuala asked for her response to what she'd just heard. Well, I would like to say that I'm surprised and shocked to learn of the extent of dysfunction within Ofsted, to learn of its defensive and complacent institutional culture. But having been on the receiving end of that culture, in terms of Ofsted's public response after my sister's death, I'm not surprised. But there is clearly an awful lot of work that Sir Martin Oliver is going to need to do to put that culture right if he really does want, as he said, to look to the future and to rebuild trust and to build on the, yes, positive changes that have come in already there still seem to be some profound problems within Ofsted its structures its systems its culture that need to be urgently addressed

if the positive messages that are coming out now about reform are actually to be realised. When you were with us last December, you told us that you had screamed long and loud at the radio when you heard the former Ofsted chief inspector, Amanda Spielman, talking about your sister's death. And as a reminder, the Spielman had told us on Woman's Hour last November that Ruth Perry's death had been used by the media and others to discredit Ofsted. And you talk about not being surprised today, but what would you say is your feeling,

kind of putting all that in context, perhaps from that time? Well, as I made the comment at the time, that it was just outrageous and extraordinarily insensitive to suggest that in calling for change, talking about what had happened to my sister, that it was being used to discredit Ofsted. I think what Christine Gilbert's report shows very clearly was that there were absolutely profound and dangerous gaps in systems, a defensive culture that would never accept that they could possibly do anything wrong. You know, it says in this report that most Ofsted staff and the board of Ofsted that are meant to hold Ofsted to account found out about Ruth's death via the media. That Ofsted staff, the board,

and actually the Department for Education were shocked by the inquest conclusions because they'd been told that Ofsted had done nothing wrong. And so here we see, if you like, behind the scenes, what was going on that made Amanda Spielman feel she could go out publicly and make these statements that were hurtful and turned out to be wrong. Let me read a statement. We did contact Ofsted and the Chief Inspector Sir Martin Oliver said the tragic death of Ruth Perry was a catalyst for this change, but the case for change has been building for years.

We recognise the growing challenges facing education and social care, particularly since the pandemic. We don't want to add to this pressure. Many of the changes we are introducing are aimed at reducing the pressure on those we inspect. We always strive for higher standards for children, particularly the most vulnerable children. And I should say we also contacted Amanda Spielman,

who was chief inspector, as we were saying, when Mrs. Perry died. She did decline to comment. I want to get into a couple of specifics with the review. It said that Ofsted did not attempt to contact the school

or Mrs. Perry's family in the months following her death and could have shown empathy by seeking to speak with them straight away. Do you think, that's a difficult question maybe, that some of the pain of the aftermath of your sister's death could have been mitigated in some way if you had been contacted by the organisation earlier? That's possible. I think what's more important actually than Ofsted showing empathy is Ofsted learning lessons. Martin Oliver,

like his predecessor, has spoken often about Ruth's tragic death. The tragedy of Ruth's death was it was preventable. Ofsted and the Department for Education have been issued with prevention of future death reports by the coroner. You can only prevent a death if you're prepared to learn lessons from that death. And turning to looking towards the future without looking at the failings and the mistakes of the past is wrong footed, in my opinion. You know, yesterday and today, I suppose some of the specifics coming out saying that inspectors will now be trained in mental health and an inspection will be paused

if a headteacher is in severe mental distress. I'm wondering how you see that. Do you have faith in that, in those words for that process? Well, one of the recommendations that's made in Christine Gilbert's response that comes from Sinead McBreaty of the fantastic Education Support Partnership says that what is needed is not just broad mental health training, it's specific training that acknowledges

the power imbalance between the inspector and the inspected. As you said at the beginning, Ruth had no history of mental illness before that inspection. And it was the rude and intimidating behaviour of the inspector, the shock of that inspection and the consequences of an inadequate judgment that really preyed on her mind. And what is being recommended is that that sort of general mental health training be much more targeted for the specifics of that power dynamic between inspector and inspected. I think the other point about giving schools like Ruth the chance to put right what were actually quite minor issues around safeguarding record keeping before the final inspection report comes out is eminently sensible and I welcome that and I've been arguing that that should be the case right from the start. Ruth was more than capable

of putting right the few slips that were identified by the inspector. And it so preyed on her mind that she wasn't given that opportunity to improve the school she loved herself, you know, and she feared losing her job. Yesterday, we talked about this, that they are scrapping the one or two word judgments, as I was putting them out, whether it's, you know, requires improvement or inadequate, of course, which was the terrible words that haunted your sister. How do you feel about them being scrapped?

I did see this shadow education secretary, Damien Hines, said the headline inspection outcome was a vital indicator for parents and that it's an accessible means to understand how a school is performing. You know, they haven't replaced it with anything yet. We know it's going to be a report card coming from September 2025. I'm really pleased

that the new government has recognised how damaging those single word judgments are, but also how simplistic and reductive and unhelpful they are for parents. And actually, to counter what Damien Hines said yesterday, Ofsted's own research that they have published now coming out of the big listen, clearly says that 78% of parents do not like single word judgments. So he's quoting outdated and discredited data there to defend a point that has been proven to be flawed. We'll move, you know, I'm happy to move on now from the era of defending single word judgments. That is a very welcome and overdue change that I know from the hundreds of messages I've received is predominantly welcomed by the

teaching profession. So that is a great move. Professor Julia Waters talking to Nuala there. And if you've been affected by the issues in this story, help and support is available at BBC Action Line. Now, spongy flesh and sewers, wandering wombs and virtuous virgins. Women and their bodies have been described in many ways over the centuries, from the comical to the bizarre to the downright dangerous. We've been learning more from Helen King, Professor Emerita in Classical Studies at the Open University, whose new book Immaculate Forms looks at how women's bodies have been shaped and understood

by scientific theories and religious beliefs throughout history, and often by men. Helen's book covers a vast range of time, going right back to ancient Greece and coming up to the present day, and is split into four sections, breasts, clitoris, hymen and the womb. Anita began by asking Helen why she had chosen to divide the book in this way. Well, I started off thinking what makes a woman and what are women told to do with their bodies?

And I was thinking of all sorts of things like voice and hair and clothing. Well, I started off thinking, what makes a woman and what are women told to do with their bodies? And I was thinking of all sorts of things like voice and hair and clothing. But then the more I studied it, the more it got down to really there were these four parts, which historically have been used to talk about women and to tell them what they should be up to. So I go from the breasts inwards. So start with what you can see, although even there, of course, as we all know, you can enhance your breasts. You can uplift your breasts. It's not as if anything is really as fixed as all that. Once you get to the womb, you're talking about an organ which couldn't even be seen and which had to be imagined for many, many centuries with all sorts of beliefs associated with that.

So let's start with breasts. One of the points you make about them is that there's often been a tension between seeing them as something maternal for milk and sexual. How far back does that tension go? I think that goes back all the way. So even in the earliest forms of medicine that we know in Western Europe, there was the idea that breast milk was actually a therapeutic product. And you still find online today people saying you can use it for conjunctivitis. I wouldn't like to recommend anything here. This comes with a therapeutic product. And you still find online today people saying you can use it for

conjunctivitis. I wouldn't like to recommend anything here. This comes with a health warning. But in the past, it was used for a range of conditions. And there were even ideas like if you were suckling a boy, your breast milk was a higher quality than if you were suckling a girl, so it could cure more things. But then you had the idea of how do you take breast milk? Can you take it direct from the woman? So then you get the situation where you had the idea of how do you take breast milk? Can you take it direct from the woman? So then you get the situation where you have historical accounts of men actually suckling from their wives as a health thing. So your face is saying everything. I'm actually just thinking how much fun you must have had, the facial expressions you must have pulled whilst you were doing the research.

Absolutely true. I think breasts was the most surprising chapter for me in many ways because I hadn't really worked on breasts before. I'd done gynecological reproductive stuff. But to find out that breasts were quite so bizarre. And then also the fact that men can produce breast milk. You can have a thing called a prolactinoma, which means that your hormones are affected. And if you happen to be a man, it can mean that you produce milk.

Plus there are things called accessory breasts, which sounds a lot like a sort of Gucci handbag, are affected. And if you happen to be a man, it can mean that you produce milk. Plus, there are things called accessory breasts, which sounds a lot like a sort of Gucci handbag, where you can have accessory tissue, breast tissue, somewhere else in your body and can have a nipple attached. And you can be male or female and produce milk from this breast tissue on, for example, your leg. And there are historical accounts of that and there are ones within the last 10 years. Helen, you've blown our minds already within the first three minutes of us chatting.

Staying with breast milk, it's led to many scientific and religious debates over time. For a long time, there was a theory that menstrual blood and breast milk were actually the same thing. How did that work? Yeah, so the idea, this goes back to the ancient Greeks, the idea was that your blood is concocted, sort of cooked in your body into other fluids.

And if you're a woman, you're colder than men are. And that doesn't mean you actually feel cold to the touch. It means your innards are working in a colder way. You're not cooking so well. So women could cook their blood a little bit and it would become breast milk. So they believed in channels between the womb and the breasts. There's a wonderful image Leonardo da Vinci did of two people having sex,

standing up, dissected down the middle, you know, like you do. And you can see the channel going from the womb right into the nipple, transferring the milk from the womb to the breasts. But then men, because they're hotter, were believed capable of cooking their blood a bit more. So they make semen, which obviously is the most superb fluid of all it has to be, doesn't it? Obviously.

And they would use that to explain why some men could produce breast milk. It was that they weren't quite man enough to go the full way to make it into semen. So on to the clitoris. Why do you think it's become the source of jokes about discovering or finding it? It's very strange. When you look at the history of the clitoris, it's clearly there all the time. Ancient Greek texts talk about the little apple or about, particularly the poet Sappho talks about the apple that's left at the top of the tree and the men

can't quite reach it. But dot dot dot. And that idea of something that's out of reach and not really known to men has been there a long, long time. When did it was it figured out that was actually a vast network of nerves? How recent is that knowledge? It's scarily recent. The big discoveries are 1998 by Helena Connell. Interesting, it's a woman who gets there. Hang on, 1998? 1998, yes. That's when she published On the Full Extent of the Clitoris.

And that's where you get the image of the clitoris that you often find today, you know, in plush toys and badges as well, of a sort of wishbone-shaped organ. That's where it comes from. Now, there were attempts to say that before. But what was happening before 1998? I know, you just, it was coming and going.

In medical textbooks, it was sometimes labelled, it was sometimes not. What was happening before 1998? at this point. It's not mentioned because who wants to talk about women? But it's a woman, Helen O'Connell, who gets there. And she was drawing on 19th century work, but it had never really taken off before. On the other hand, we still don't really know much about the hymen. Why did you want to devote a chapter to it? I think because the hymen was something I was told about growing up. And I sort of imagined it was just a normal part of the body and the more you study it the more you realize that it's the least believable part of all of the four I look at. Why is that? Because women don't necessarily have one because if there's a membrane it could be very very fragile or and break easily it could be really really tough

there's a medical condition called imperforate hymen where it will not break and your menstrual period sort of backs up behind it and you have to have an operation to get that out. So it can be a really extreme thing, but it may not exist at all. So where did the connection to virginity come from? And When you look at the earliest texts, so biblical texts and ancient Greek texts about bleeding at first intercourse, they don't necessarily mention a membrane. It could be simply that the pressure is supposed to cause bleeding or the girl is very young and the man doesn't know what he's doing and therefore there's bleeding. But the idea there's an actual organ, an actual piece of membrane, that's all Hyman means, membrane. That is a really dodgy, dodgy idea to base anything on. So you're busting quite a few myths. Finally, we need to get to the womb. You say that its hiddenness being inside the body has made it a breeding ground for myths about its nature and function. What are some of those myths? Well, you've got some lovely ancient medical papyri, sorry, ancient magical papyri,

which talk about controlling the womb and talk about calling it like it's a dog. You know, don't bite like a dog. What, actually talking to it? Yeah, yeah, you can talk to the womb. Of course. Well, I mean, yeah, absolutely. Don't we all? So it's like a dog or it's like an octopus because octopuses' tentacles have sort of clingy bits on that they use to move with

and the womb is supposed to cling on to a baby and hold it inside. So it's like an octopus as well. It's like a sewer, which is letting out bad products from the body, but at the same time it's the most precious organ of all. It's special. It's got extra powers. It can hold. It can push out.

It knows when to do things. It's a really, really potent organ, but it's hidden. So they didn't have any way of knowing. That was Helen King talking to Anita. This week, Nuala spoke to not one, but two Paralympic champions. Team GB triathletes Lauren Stedman and Claire Cashmore are rivals, but they're also friends and went to the same school. Lauren won bronze and Claire silver in the para triathlon category PTS5. Both women have a missing forearm. Nuala asked Claire how fierce their rivalry is.

Oh yeah, it's super fierce. You know, we're sat in this room together on opposite sides. No, you know, Lauren and I have known together on opposite sides no you know Lauren and I have known each other since well she was a very little girl and we we went to school together um so I was always the older one probably bossing her around uh nothing has changed exactly um but yeah so we raced each other as swimmers um and then to go into the triathlon world and you know obviously she moved over first and then you helped me with a lot of advice when I first moved into the sport. So yeah, it's great to be able to push the boundaries together.

I think both of us are very passionate about getting more young girls involved in disability sport. And I think that's great that we can fly the flag for British triathlon and hopefully inspire the next generation of young little Laurence and Claire's. and does the rivalry spur you on absolutely yeah I think that that's why we do it you know you you don't want an easy race um and particularly you know Grace Norman that the three of us together have been battling it out for the the last few years and it's kind of who will get on the podium on that day I I should say, sorry, forgive me for interrupting you,

but I should say just for our listeners that Grace Norman is the US athlete. She won gold. But this podium of three can be various configurations when it comes to the three of you. Yeah, definitely. And yesterday was a British sandwich. But no, it's great.

I think we're rivals on the start line, but then we're friends at the end. And that's the way you kind of want it. It keeps you on your toes for sure. And day in, day out, that's kind of what keeps us going. And speaking about Grace Norman, the US athlete, Lauren, you were a bridesmaid at her wedding. Yeah, she, I think after what we went through in Tokyo, we got really close and, you know, we exchanged lots of messages post games and it was really special. Went out to train with her and she was like, actually, I'd really love it if you'd come to my wedding. And I remember the first time I ever saw Grace in 2014.

She'd come forth and I turned to my dad and I'd said, she's coming for me. And rightly so she did. But yeah, so I've known her for a really long time and I yeah I think I just super proud like we were sat on the pontoon all of the girls we race we talk about rivalry and friendship but we were all sat there and we're just like appreciative of we have the Eiffel Tower there we have the Pont Alexander Bridge behind us what a backdrop to go and showcase just how great our category is and how competitive it is. Why did you make the move over to triathlon from swimming? I was a very good swimmer, but I never seemed to get over that last hurdle.

I finished fifth and I've always been proud of my fifth place at London. And it was London. It was incredible. But I think for me, switching over, I was a much better swim, bike and run athlete than it was incredible but I think for me switching over I was a much better swim bike and run athlete than I was just the swimmer um and I just to be honest triathlon is a sport where you can swim anywhere you can ride anywhere you can do it with family you can do it with friends like the amount of time my mum's got her e-bike out and we've just been riding around like it I absolutely love it it's a participation sport um and so for me that makes it super special and you Claire yeah probably very similar to Lauren actually

um that the variety of triathlon is incredible you know from following a black line and counting tiles every day two times a day to suddenly being able to see the world and speak to people which is definitely something I like to do um but no I I got a little bit stagnant in swimming um I kind of started to lose the love for sport but I knew triathlon was always something I wanted to do I'd run as a kid and I was like one day I'd love to do it and then the fact that it came in in Rio I was like right I'll let there be one cycle they can figure all the things out and then after that I'm moving into that sport uh so yeah after Rio I I joined the the world of triathlon and also my partner Dave Ellis is in it as well, after Rio, I joined the world of triathlon

and also my partner Dave Ellis is in it as well. So to be able to travel the world with him and to watch him win gold medal was just so, so special. We need to tip our hat to him as well. Congratulations. At the finish line, is there any athlete that is more exhausted than a triathlete? Yeah, well, we're going to be biased, aren't we? We're going to say absolutely triathlon is the hardest sport, Is there any athlete that is more exhausted than a triathlete?

Yeah, well, we're going to be biased, aren't we? We're going to say absolutely triathlon is the hardest sport. But no, to be fair, I used to find swimming, 100 breaststroke, pretty horrific. That, you know, you'd be sick regularly after the race. So I think all sports are hard. I think physically maybe, obviously the three sports and it's, you know, going for an hour to an hour and 15 sometimes so physically maybe the most exhausted but the mental I don't know alignment you have as an athlete across any sport actually the day before our race I sat there thinking how many people are sat here right now wanting their best performance in this whole village there's just thousands of people with

nervous energy um so I think every athlete would be mentally exhausted regardless of the sport we had rachel latham on the program last week but she very much talked about you know the day of the race mentally getting yourself in that space to win anything you do in particular claire um to be honest it was a bit weird this time because obviously we were expecting to race the day before um so we woke up the morning of what was meant to be our race with being told that actually it was being postponed. So you're kind of in that state of mind the day before you didn't sleep well at all. And then suddenly it was like, right, OK, change the next day. But yeah, very much. I quite like to be chilled. I like to be myself. I'm chatting away. Probably my only routine is eating rice and yeah it's really exciting isn't

it I feel like I should give a much better answer than this so and it was can I just note that go ahead Lauren there was a little rice trail all the way from the Paralympic village to the triathlon venue I think it was not doing well with that rice I think it was the nerves and the adrenaline there so Lauren not rice that's not your thing what is to get in the zone definitely not rice um no for me I I love my coffee in the mornings I had some porridge and then yeah just super super chill I think when you get to the experience that me and Claire have with the amount of games you um you kind of know yourself well enough to actually relax into the moments you're still you're still nervous but I think also you know how to handle that and the expectations and so yeah being a golden oldies uh but also I think it's it's so much about enjoying it I think I've definitely learned from my past of kind of just

letting the whole experience pass you by and Lauren probably was so the same for her first games and you kind of get to the stage where you're like do you know what that we don't know how many more times we're going to be able to compete at the Paralympic Games. It is so incredibly special. Let's actually enjoy this rather than, you know, stressing and beating yourself up about, you know, whatever performance it is. We are very much enjoying watching you. But Lauren, what about this? You know, you have said that this could be your last summer games.

Do you want to talk me a little bit through that or what you're thinking about what's next uh yeah it's it's just coming from inside me and i think it's very much my last games and actually i knew that i was going to get the bronze and there was a long way back till fourth so i slowed up and thought to myself i'm pretty sure this is the last time i'm going to run down here and decided to give back to some of the fans that were there and do the high fives and stuff. And that was super special for me. I've just, I've got other things that I would like to achieve now outside the world of sport. And that has been the way since I got my gold medal in Tokyo, just felt a sense of achievement. So I need to get back to my PhD now. I really want to

make a second career that's just as worthy as what this first career has been. What is the PhD in? Mental health and our Olympians and Paralympians. So after the three years I've had post games and being unsure of who I am, what I stand for and anything to do with life outside of sport. And just in general, we've spoken about the heightened environment that we have to get in in order to perform. Like, I've learnt now what I need to do. But when you're younger, that kind of programme or mentorship

isn't quite in place yet for our younger athletes. So, yeah, try and create some sort of research that will actually make a difference to the younger generations coming through. That was Nuala speaking to Team GB triathletes Lauren Stedman and Claire Cashmore. That's all for today. Nuala's back on Monday with Tracey-Ann Oberman, who will be reprising her role as EastEnders Chrissie Watts next week after almost two decades.

That's with Nuala McGovern at 10am here on Radio 4 or catch up with any of our episodes on BBC Sounds. But for now, do enjoy the rest of your weekend. I'm Sarah Trelevan, and for over a year, I've been working on one of the most complex stories I've ever covered. There was somebody out there who was faking pregnancies. I started, like, warning everybody. Every doula that I know.

It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story. Settle in. Available now.