Drugs cocktail ‘cut HIV deaths by 27%’
More than 10,000 lives a year could be saved with a simple change to HIV medication, doctors say.
HIV is often diagnosed late, when it has already ravaged the immune system, leaving people vulnerable.
To counter this, researchers tried prescribing a cocktail of drugs at the start of HIV therapy to treat “opportunistic” infections.
The results, published in the New England Journal of Medicine, showed deaths fell by 27%.
HIV itself does not kill. Instead, it leaves the body exposed to dangerous bacterial infections such as tuberculosis or pneumonia as well as fungi that can cause cryptococcal meningitis.
But starting antiretroviral therapy poses risks too. The drugs restore the immune system, but if it suddenly realises there is an infection, then it can launch such a strong attack – in the brain, for example – that this can occasionally be deadly too.
So, the trial gave patients with a CD count – used to measure the health of the immune system – below 100 a mix of drugs, including antibiotics, alongside standard antiretroviral medication for HIV.
Patients with a CD count below 50 are six times more likely to die within 24 weeks than those with a count above 100.
The trial was conducted in Uganda, Zimbabwe, Malawi, and Kenya and involved 1,805 patients over the age of five.
Normally, more than one in 10 would have died within weeks of diagnosis.
But the results showed the preventative therapy led to:
- deaths falling by 27%
- tuberculosis falling by 28%
- cryptococcal disease falling by 62%
- candidiasis falling by 58%
- hospitalisation falling by 17%
Overall, three lives were saved for every 100 treated.
One of the study authors, Prof Diana Gibb, from the UK’s MRC Clinical Trials Unit, told the BBC News website: “You might save over 10,000 deaths [globally], but also prevent tuberculosis disease, cryptococcal meningitis and hospital admissions, which are costly.
“So, I think it could have quite a big impact and could be a relatively simple additional intervention.”
The medicine is $5 (£3.80) more expensive per patient than standard treatment.
‘Back to the future’
And because every patient is prescribed all the drugs, no expensive tests for each infection are needed.
Speaking to the BBC at the IAS Conference on HIV Science in Paris, Prof Gibb said the approach was “very cost-effective throughout Africa” and “we think this should become part of guidelines”.
Dr Carl Dieffenbach, the director of the division of Aids within the US National Institutes of Health, said the idea reminded him of the early era of HIV/Aids, when there was more emphasis on treating opportunistic infections.
He told the BBC News website: “It’s logical, and it’s ‘back to the future’ in a good way.
“I think it’s the best possible medicine you could be doing, the challenge for health departments around the world is they’ve largely felt they could get out of dealing with the opportunistic infections.
“They can’t neglect this population of patients, it’s not enough to just put them on antiretroviral therapy.”
Many patients on the trial had appeared healthy when they were diagnosed with HIV.
Despite their average CD4 count being just 36, half of them had showed no symptoms.
Drs Nathan Ford and Meg Doherty, from the World Health Organization, said: “[There needs to be a] renewed focus to respond to the needs of patients with advanced HIV infection who are at high risk for illness and death.”
Tobacco firms ‘hamper anti-smoking push’
The tobacco industry is hampering efforts to introduce life-saving interventions in low and middle-income countries, according to a report by the World Health Organization.
Countries covering two-thirds of the world’s population now have measures in place to encourage people to stop smoking.
But tobacco still kills more than 7 million people every year.
Tobacco companies say they are not opposed to “reasonable” regulation.
The proportion of smokers and those using other tobacco products around the world is falling – but it is happening slowly.
One in five people over the age of 15 now use tobacco, compared to one in four in 2007, according to the WHO report on the “global tobacco epidemic”.
Dozens of countries have introduced measures to discourage people from smoking over the the past decade, such as introducing higher taxes for products, advertising bans and smoke free zones.
Fighting tobacco use:
Nepal: Introduced the world’s largest health warnings on tobacco packaging in 2015, covering 90% of packets.
India: Launched a nationwide tobacco cessation programme and toll-free quit line in 2016.
The Philippines: Introduced a “Sin Tax Reform Law” which increased tax on tobacco significantly over time, earning an extra $5,2bn for other public services, including healthcare.
“There has been progress, but there’s more to do,” said Dr Vinayak Prasad, head of WHO’s tobacco control unit in Geneva.
“Most of tobacco usage is now happening in the Middle East, in Asian economies and (tobacco use ) in Africa is also adding up”
He said that tobacco companies are now increasingly setting their sights on “easier, less regulated markets”, and putting pressure on their governments.
“Many of these countries have not recognised the full value of tobacco taxation to make tobacco more expensive.
“Industry has given arguments on the economic value of tobacco or illicit trade.
“But the health cost burden and economic burden (in total $1.4 trillion) are far in excess than the contribution from the tobacco industry.”
He said the tobacco industry’s key aim is to make profits, and said they shouldn’t be at the table when it comes to national health policies.
“We need to recognise that the tobacco industry is not a friend of the government, they are only there to make profits.”
Some of the world’s biggest tobacco manufacturing companies have told the BBC that whilst they do not oppose reasonable tobacco regulation, they do need to be part of the debate on policy.
Jonathan Duce from Japan Tobacco International, responsible for brands such as Benson and Hedges and Camel cigarettes, said: “We believe that public officials and policing organizations should have access to all facts when it comes to policy-making, including from businesses.
“Topics such as combating organized crime in tobacco should not be addressed in isolation of the available knowledge from various experts which contributes to informing and driving policies that are effective.”
Coffee drinkers live longer – perhaps
Drinking three cups of coffee a day may help you live longer, according to a study of almost half a million people from 10 European countries.
The research, published in the journal the Annals of Internal Medicine, suggests an extra cup of coffee could lengthen a person’s lifespan – even if it is decaffeinated.
But sceptical experts point out it is impossible to say for sure that it is the coffee that is having a protective effect, rather than say, a more healthy lifestyle in coffee drinkers.
They say there is no need to reach for that extra cup of coffee just yet.
What does the new study claim?
Researchers from the International Agency for Research on Cancer and Imperial College London say they have found that drinking more coffee is linked to a lower risk of death – particularly for heart diseases and diseases of the gut.
They came to their conclusions after analysing data of healthy people over the age of 35 from 10 EU countries.
They asked them once at the beginning of the study how much coffee they tended to drink and then looked at deaths over an average of 16 years.
If true – by just how much could a cup of coffee lengthen lifespan?
Prof Sir David Spiegelhalter, from the University of Cambridge, analyses the public understanding of risk and says that if the estimated reductions in death really were down to coffee, then an extra cup of coffee every day would extend the life of a man by around three months and a woman by around a month on average.
But despite the sheer scale of the study, it is by no means perfect and cannot prove that coffee beans are the magic ingredient.
Why you do not need to rush out and buy more coffee just yet
Frustratingly for coffee fiends, the findings really are not as clear-cut as they might first seem.
That’s because the study could not take every factor into account – clouding how certain one can be about coffee’s effects.
For example, it did not look at how much coffee drinkers earned in comparison with non-coffee drinkers. It might be that people who can afford three cups of coffee a day are richer and that extra money, in some way, helps protect their health.
It might be that people who drank three cups of coffee a day spent more time socialising and that in turn may have boosted their wellbeing.
And even if they were to be certain it was the coffee that was responsible, not every risk improved.
The researchers found higher coffee-drinking was linked to a higher rate of ovarian cancer in women, for example.
And although the paper looked at a lot of people, the researchers excluded anyone who had diabetes, heart attacks or strokes at the beginning of the study.
So it doesn’t tell us much about the risks or benefits of drinking coffee if people are unwell.
It is also possible some of those people became unwell while having their regular brews.
Is coffee good for you?
Previous studies have shown conflicting and often contradictory results.
For many people, experience suggests that drinks containing caffeine can temporarily make us feel more alert.
But caffeine affects some people more than others, and the effects can vary from person to person.
NHS experts have not set limits for coffee in the general population but they do say that pregnant women should avoid drinking more than 200mg of caffeine a day.
They say this is because coffee might increase the chance of the baby being born too small. Too much caffeine may also increase the risk of miscarriage.
And, of course, caffeine is not just found in coffee.
The 200mg caffeine limit could be reached by having two mugs of tea and a can of cola, for example, or two cups of instant coffee.
There was also recently the case of a US teen who, it’s thought, may have died from drinking too many caffeinated drinks too quickly.
How could we ever be sure whether coffee makes you live longer?
The most rigorous scientific way to be certain that coffee could make you live longer would be to force thousands of people all over the world to drink it regularly while preventing many thousands of otherwise similar people from ever drinking coffee.
Scientists would then have to monitor every other aspect of their life – what else they ate and drank, how much they earned, how much exercise they did, for example.
That’s a study that is never likely to take place.
So for now, some experts say, instead of putting all your bets on coffee being good for you, you could instead do something that has been proven to extend life – take a brisk, 20-minute walk to the nearest coffee shop – whether you order a cup or not.
Contaminated blood scandal inquiry announced
A UK-wide inquiry will be held into the contaminated blood scandal that left at least 2,400 people dead, the prime minister has confirmed.
A spokesman for Theresa May said it would establish the causes of the “appalling injustice” that took place in the 1970s and 1980s.
Thousands of NHS patients were given blood products from abroad that were infected with hepatitis C and HIV.
It’s been called the worst treatment disaster in the history of the NHS.
Many of those affected and their families believe they were not told of the risks involved and there was a cover-up.
Speaking to the BBC, Mrs May said: “They deserve answers, and the inquiry that I have announced today will give them those answers, so they will know why this happened, how it happened.
“This was an appalling tragedy and it should never have happened.”
What is the contaminated blood scandal?
A recent parliamentary report found around 7,500 patients were infected by imported blood products.
Many were patients with an inherited bleeding disorder called haemophilia.
They needed regular treatment with a clotting agent Factor VIII, which is made from donated blood.
The UK imported supplies and some turned out to be infected. Much of the plasma used to make Factor VIII came from donors like prison inmates in the US, who sold their blood.
Jason Evans was just four years old when his father Jonathan, a haemophiliac, died after being infected with HIV through contaminated Factor VIII treatment.
Jason recently discovered that in late 1984 his father had raised concerns with his doctors about Factor VIII but he says he was told “there was nothing to worry about, this is sensationalism and not to pay attention to it. And he trusted his doctor”.
What will the inquiry do?
Families of those who died will be consulted about what form the inquiry should take.
It could be a public Hillsborough-style inquiry or a judge-led statutory inquiry, the prime minister confirmed.
Labour leader Jeremy Corbyn said the inquiry should have the potential to trigger prosecutions.
A Scottish government spokesperson said: “We were very surprised that as the new inquiry is expected to extend to Scotland, the UK government did not seek to discuss this with us in advance of their announcement. We will be seeking clarity as a matter of some urgency.
“People in England and Wales should get the same opportunity to get answers as we have already given through the Penrose Inquiry in Scotland.”
Sir Peter Bottomley, co-chairman of the cross-party parliamentary group on haemophilia and contaminated blood, said the success of the inquiry would depend on it being able to get hold of sensitive information.
“It must have powers to get documents from pharmaceutical companies and government,” he said.
Why has it taken so long?
The government has been strongly criticised for dragging its heels.
Greater Manchester mayor and former health secretary Andy Burnham has repeatedly called for a Hillsborough-style probe into what happened.
Mr Burnham claimed in the Commons that a “criminal cover-up on an industrial scale” had taken place.
The Downing Street announcement came hours before the government faced possible defeat in a vote on an emergency motion about the need for an inquiry.
Will victims be financially compensated?
Payments have been made to some of the people who were infected. A fund was established to help support survivors.
If the new inquiry finds culpability it opens the door to victims seeking large compensation payouts through the courts.
Liz Carroll, chief executive of the Haemophilia Society, said: “The government has for decades denied negligence and refused to provide compensation to those affected, this inquiry will finally be able to properly consider evidence of wrongdoing.”
Are blood products safe now?
Improvements in donor vetting meant that by 1986 UK patients were receiving safer treatments.
By the late 1990s, synthetic treatments for haemophilia became available, removing the infection risk.
Anyone who received a blood transfusion before 1991 is potentially at risk of Hepatitis C infection since blood donations were not screened before this date.
Blood donations are now routinely tested for infections, including hepatitis and HIV
Spreading cancer caught on film
The way in which every single cancer cell spreads around the body has been captured in videos by a team in Japan.
The normal body tissues show up as green, while the cancer comes out as intense red spots.
The team, at the University of Tokyo and the RIKEN Quantitative Biology Center, says the technology will help explain the deadly process.
The research is on mice so far, but it is hoped the method could one day help with treatment too.
The spread of cancer around the body is a crucial moment called metastasis.
Before a cancer spreads it is easier to contain and cure, afterwards it is incredibly difficult.
The tumour itself has to evolve so bits of it are able to break free, survive travelling in the blood stream and invade new tissues.
A deeper understanding of how this happens could lead to new ideas for treatment.
The mice were injected with cancerous tissue engineered to fluoresce.
The researchers then let the disease progress before using chemicals that made the mouse’s body and internal organs highly transparent.
It meant the body could be rapidly imaged and the location of any cancerous tissue detected.
The study, published in the journal Cell Reports, details cancers growing in the lungs, intestines, and liver before spreading around the body.
Dr Hiroki Ueda, one of the researchers, said: “The images reveal cancerous colonies in enough detail to calculate their shapes, volumes, and distributions – characteristics critical to distinguishing between patterns of metastasis.
He told the BBC News website: “We are now applying this technology to the human clinical samples.
“I hope this tissue-clearing and 3D imaging of human samples will make diagnosis easier, more objective and accurate in near future.”
Further experiments showed how cancer can get better at spreading.
Dr Kohei Miyazono said: “Most of the cancer cells appear to die during circulation in the bloodstream and fail to metastasise.”
But cancers then start producing chemical signals to help them grow.
The researchers tested the effect of one of them, called TGF-beta, and showed it dramatically improved the chances of cancers colonising the lung tissue.
“[They] are far more likely to survive the journey and form malignant outposts,” Dr Miyazono added.
It is thought the technology could be adapted to other disciplines, including how the body’s cells behave in people with autoimmune diseases.
EU nurse applicants drop by 96% since Brexit vote
There has been a sharp drop in nurses registering to work in the UK since the EU referendum, figures suggest.
Last July, 1,304 nurses from the EU joined the Nursing and Midwifery Council register, compared to 46 in April this year, a fall of 96%.
The Health Foundation said the findings could not be more stark and said they should act as a “wake-up call”.
But the NMC said the introduction of English language testing for EU nurses is also likely to have played a role.
It comes as the NHS is already struggling with nurse vacancies and, without this supply line, shortages could get worse.
In May, research by the Royal College of Nursing found one in nine posts in England was vacant.
The union said it meant the NHS was 40,000 nurses short of what was needed.
Vital supply line
The figures – obtained by the Health Foundation under the Freedom of Information Act – cover the numbers applying to go on the register so they do not necessarily mean they are employed by the NHS.
But they give an indication of the supply line from the EU which provides a significant proportion of the workforce.
Anita Charlesworth, director of research and economics at the Health Foundation, said the drop since the Brexit vote could not be more “stark”.
“Without EU nurses, it will be even harder for the NHS and other employers to find the staff they need to provide safe patient care.
“The findings should be a wake-up call to politicians and health service leaders.”
The NMC has also drawn attention to the introduction of English language tests, which were brought in for EU nurses for the first time in January 2016 – they were already in use for non-EU nurses.
It normally takes a few months from being tested to making it on to the register so officials believe this could have also played a role in the drop in numbers.
A Department of Health spokeswoman said EU nurses played a “valued” role in the NHS and they would be a priority in Brexit negotiations.
‘On the brink’
But shadow health secretary Jonathan Ashworth said the government was making a mess of things.
“Theresa May’s weak and unstable government has pushed NHS services to the brink, and it is patients who will pay the price.
“Our health service has always relied on the contribution of overseas workers, yet these staff are being forced out by this government’s neglect and disregard.
“The Tories are overseeing an unforgivable drain of talent out of our country, because of their chaotic attitude to the Brexit negotiations.”
And Lib Dem health spokesman Norman Lamb added: “These figures are profoundly worrying and the possible implications for the NHS and patients cannot be underestimated.”
Overall there are 650,000 nurses on the register. Just over 36,000 of these have been trained in the EU, 5.5% of the total. Another 67,000 come from outside the EU with the rest from the UK.
Drug that creates a ‘real sun-tan’ could prevent cancer
Scientists have developed a drug that mimics sunlight to make the skin tan, with no damaging UV radiation involved.
The drug tricks the skin into producing the brown form of the pigment melanin in tests on skin samples and mice.
Evidence suggests it will work even on redheads, who normally just burn in the sun.
The team at Massachusetts General Hospital hope their discovery could prevent skin cancer and even slow the appearance of ageing.
UV light makes the skin tan by causing damage.
This kicks off a chain of chemical reactions in the skin that ultimately leads to dark melanin – the body’s natural sunblock – being made.
The drug is rubbed into the skin to skip the damage and kick-start the process of making melanin.
Dr David Fisher, one of the researchers, told the BBC News website: “It has a potent darkening effect.
“Under the microscope it’s the real melanin, it really is activating the production of pigment in a UV-independent fashion.”
It is a markedly different approach to fake tan, which “paints” the skin without the protection from melanin, sun beds, which expose the skin to UV light or pills that claim to boost melanin production but still need UV light.
But the team is not motivated by making a new cosmetic.
Dr Fisher said the lack of progress in skin cancer – the most common type of cancer – was a “very significant frustration”.
He added: “Our real goal is a novel strategy for protecting skin from UV radiation and cancer.
“Dark pigment is associated with a lower risk of all forms of skin cancer – that would be really huge.”
Tests, detailed in the journal Cell Reports, have shown the melanin produced by the drug was able to block harmful UV rays.
Eventually the scientists want to combine their drug with sun-cream to give maximum protection from solar radiation.
Dr Fisher said everyone should “absolutely” use sun-cream but its weakness was it “keeps you pale”.
The way the drug works could also allow a ginger tan, as the genetic mutation that causes red hair and fair skin disrupts the normal process where UV light leads to dark melanin.
It is not yet clear if the drug might have the unintended consequence of affecting the glorious hair colour, but it is thought the hair follicle is too deep in the skin for the drug to reach.
But whether you are ginger, blonde or brunette, the drug is not yet ready for commercial use.
The researchers want to do more safety testing, although so far there has been “no hint of problems”.
They will probably want to give it a better name than an SIK-inhibitor too.
Matthew Gass, from the British Association of Dermatologists, said the study was a “novel approach” to preventing skin cancer.
He added: “A lot more research has to be done before we see this sort of technology being used on humans, however, it’s certainly an interesting proposition.
“Skin cancer rates in the UK are going through the roof… any research into ways that we can prevent people from developing skin cancer in the first place is to be welcomed.”
Stopping UV damage could have an extra boon beyond cancer – slowing the appearance of ageing.
Dr Fisher’s final piece of promise for the research is: “Many people would say the obvious and most dramatic sign of ageing is what skin looks like and even casual UV damage over the years causes damage.
“Medically it is very difficult to focus on, but if it is tremendously safe then it could keep skin healthier for longer.”
‘Fat but fit is a big fat myth’
The idea that people can be fat but medically fit is a myth, say experts speaking in Portugal.
Their early work, as yet unpublished, involved looking at the GP records of 3.5 million people in the UK.
They say people who were obese but who had no initial signs of heart disease, diabetes or high cholesterol were not protected from ill health in later life, contradicting previous research.
A summary of their study was discussed at the European Congress on Obesity.
The term “fat but fit” refers to the alluring theory that if people are obese but all their other metabolic factors such as blood pressure and blood sugar are within recommended limits then the extra weight will not be harmful.
In this study, researchers at the University of Birmingham analysed data of millions of British patients between 1995 and 2015 to see if this claim held true.
They tracked people who were obese at the start of the study (defined as people with a body mass index of 30 or more) who had no evidence of heart disease, high blood pressure, high cholesterol or diabetes at this point.
They found these people who were obese but “metabolically healthy” were at higher risk of developing heart disease, strokes and heart failure than people of normal weight.
Is the ‘fat but fit’ theory well and truly busted?
Dr Mike Knapton, from the British Heart Foundation, said: “It’s not often that research on this scale and magnitude is able to clarify an age-old myth.
“These findings should be taken extremely seriously and I’d urge healthcare professionals to take heed.”
He added: “Previously we used to think that being overweight led to an increase in heart attacks and stroke because it raised your blood pressure or cholesterol.
“What was new from this study for me is that it showed that people who were overweight or obese were at increased risk of heart disease even though they may have been healthy in every other respect.
“Just being overweight puts you at increased risk of heart attack and stroke.”
But the study has not appeared in a scientific journal and, as such, it will not have gone through a number of checks by other academics to judge whether it is scientifically sound.
It is difficult for example to know how well other influential factors – such as diet, lifestyle or smoking – were taken into account.
This makes it hard for scientists to see how clear-cut the conclusions are or gauge how big any increased risks of ill-health might be.
What should people do?
According to the British Heart Foundation, the normal heart health advice applies – not smoking, eating a balanced diet, exercising regularly and limiting alcohol intake – can all help keep people healthy.
Dr Knapton added: “This is not about laying the blame at individuals though.
“This is a wake-up call for planners, local councillors, food manufacturers and the government to make sure we can make healthy choices more easily.”
Dr Rishi Caleyachetty from the University of Birmingham, added: “The priority of health professionals should be to promote and facilitate weight loss among obese persons, regardless of the presence or absence of metabolic abnormalities.”
He added: “At the population level, so-called metabolically healthy obesity is not a harmless condition.”
Does everyone agree?
Other studies suggest it might just be possible to be fat and have the right genes, for example, to remain fit.
For example research published in 2012 appears to suggests it is possible for people to buck the trend and be fat and healthy if they have no metabolic diseases.
Published in the European Heart Journal, researchers suggest people who are obese yet physically healthy are at no greater risk of heart disease or cancer than people of normal weight.
Fitness and fatness: tricky things to measure?
But other experts point out that the way scientists measure fatness and fitness makes this a tricky area to study and could make some of the more tantalising results invalid.
Tom Sanders, emeritus professor of nutrition and dietetics, King’s College London, says a major weakness of the Birmingham study is that it uses definite cut-offs to decide when someone has high blood pressure or high cholesterol for example.
Instead, he argues that it is too simple and not accurate to use such definite values to decide whether someone is healthy.
And other studies have suggested that it is not always the amount of fat that matters but where the excess fat is carried on the body that can affect fitness and health.
For example, weight around the middle may be more damaging than weight distributed evenly around the body.
Overall, experts say it is important to not just focus on what you see in the mirror or on the scales – exercise and healthy eating can help boost wellness, no matter how much a person weighs.
Road accidents biggest global killer of teenagers
Road traffic injuries are the biggest killer of teenagers globally, international data released by the World Health Organization reveals.
In 2015, more than 1.2 million adolescents died. Road injuries were to blame for about one in 10 of these deaths.
Most of the road fatalities involved males between the ages of 10 and 19.
Chest infections and self-harm were the biggest global killers of girls and young women, however.
The top five killers of teens (aged 10-19):
1. Road injury
2. Lower respiratory infections
3. Self-harm (intentional and accidental suicide)
4. Diarrhoeal diseases
According to the worldwide report, more than 3,000 adolescents die every day.
Over two-thirds of these deaths happen in low- and middle-income countries in Africa and South East Asia.
And most are preventable.
Most young people killed by the top cause – road crashes – are “vulnerable” road users: pedestrians, cyclists and motorcyclists.
Males aged 15-19 make up the biggest share of these 115,302 fatalities, mostly in poorer countries in Europe, the Americas and the Eastern Mediterranean region.
Although far fewer in number, road injuries are still the leading cause of adolescent death in high-income countries, shortly followed by deaths from self-harm.
In 2015 in Britain, road accidents killed 145 people aged 10-19, and left 3,166 more seriously injured.
According to UK experts, the transition between primary and secondary school, when children often begin to walk to school unassisted, can be a particularly risky time.
In some countries, such as the UK, road safety education and legislation encouraging drivers to slow down appears to be having the desired effect, reducing road accident rates, says the WHO report author, Dr Anthony Costello.
But other countries are lagging, he says.
The other big killers
Globally, adolescent deaths as a whole have been reducing.
But some fatalities are becoming more commonplace.
Deaths from self-harm are increasing in many regions, says Dr Costello.
“Self harm is a massive and increasing issue in many countries. We are seeing suicide rates go up.
“Adolescence is quite a stressful time of life. Young people need support, but adolescent health across the world has been largely neglected.”
He says improving the way health systems serve adolescents is just one part of improving their health.
“Parents, families and communities are extremely important, as they have the greatest potential to positively influence adolescent behaviour and health.”
The Global Accelerated Action for the Health of Adolescents report was produced by the WHO in collaboration with UNaids, Unesco, UNFPA, Unicef, UN Women, World Bank, the Every Woman, Every Child initiative and The Partnership for Maternal, Newborn, Child & Adolescent Health.
Yemen war: Emergency in Sanaa as cholera kills scores
A state of emergency has been declared in the Yemeni capital, Sanaa, after an outbreak of cholera killed scores of people.
Hospitals in the city, which is controlled by Houthi rebels, are crowded with cholera patients.
The Red Cross says the number of suspected cases in the country has tripled in a week to more than 8,500.
Yemen has been ravaged by hunger and civil war, allowing disease to spread rapidly.
Two-thirds of the population do not have access to safe drinking water, according to the UN.
Dominik Stillhart, director of operations at the International Committee of the Red Cross, told a news conference in Sanaa on Sunday that there had been 115 deaths from cholera nationwide from 27 April – 13 May.
“We now are facing a serious outbreak,” he said.
Sanaa has been worst hit, followed by the surrounding province of Amanat al-Semah, the World Health Organisation (WHO) says.
Cholera is a water-borne disease that is transmitted through contaminated water and food.
Symptoms include acute diarrhoea and vomiting. People with cholera can become very sick and, if left untreated, death can occur within hours.
Some 32,000 people have now been affected since October by the cholera outbreak, which subsided over the winter.
The WHO said last week that fewer than 45% of health facilities in Yemen were fully functioning.
Almost 300 hospitals or clinics have been damaged or destroyed in fighting between forces loyal to President Abdrabbuh Mansour Hadi – who is backed by a Saudi-led multinational coalition – and those allied to the Houthi rebel movement.
Since fighting escalated in March 2015, more than 8,010 people – mostly civilians – have been killed and about 44,500 others injured, the UN says.
The civil war has also left 18.8 million people in need of humanitarian assistance.
Research reported by the American Heart Association finds that walking is just as good as running when it comes to lowering your risk for heart disease.
Researchers analyzed the health of some 48,000 runners and walkers mainly in 40s and 50s. They found that, mile for mile, brisk walking lowers the risk for diabetes, high cholesterol and high blood pressure as much as running does.
The difference? You’ll have to spend more time walking than you do running to get the same health benefits simply because it takes longer to walk than to run the same distance. For instance, a 15-minute jog burns about the same number of calories as a half-hour brisk walk.
Keep in mind that the chance of being injured is greater in runners because running puts more stress on the body — on the joints in particular.
And keep in mind that you don’t have to stick to either walking or running. You can stay motivated by mixing it up. What’s more, adding short sprints to your walking routine will give you a bigger calorie-burning boost for your efforts.
Air pollution: ‘Heart disease link found’
Extremely small particles of pollution have the potential to evade the lungs’ protective filter system and end up deep in the body, scientists suggest.
Researchers speculate the particles could then build up in blood vessels and raise the risk of heart disease.
They say their early study – based on extremely small particles of gold – brings them a step closer to cracking the “mystery” of how air pollution and heart disease and stroke are linked.
The work appears in ACS Nano.
Air pollution is estimated to help shorten of the lives of about 40,000 people a year in the UK.
Several studies suggest it does this in the most part by worsening or triggering heart or lung problems.
But despite many theories, exactly how air pollution affects the heart is not fully understood.
Some scientists suspect that it may be partly down to extremely tiny pollution particles (known as nanoparticles) that could potentially be too small to be removed by the body’s filter system in the nose and lungs.
To investigate researchers, from the University of Edinburgh and universities in the Netherlands studied extremely small particles of inert gold – at a similar size to those found in diesel exhaust fumes.
Scientists asked 14 healthy volunteers to breathe in air containing pieces of gold, which scientists consider inert, while exercising for two hours.
A day later, researchers found that gold nanoparticles had made their way into the bloodstream of most participants.
And for some people, the particles remained in the body for months – they were detected in people’s urine three months later.
So I Can Breathe
A week of coverage by BBC News looking at ways to cut air pollution.
Scientists suggest this shows that nanoparticles of pollution have the potential to make a similar journey into the body.
Dr Nicholas Mills, co-author of the work, said: “We have always suspected that nanoparticles in the air that we breathe in could escape from the lungs and enter the body, but until now there was no proof.
“These findings are of wide importance for human health, and we must now focus our attention on reducing emissions and exposure to airborne nanoparticles.”
In another similar experiment, researchers asked three patients with clogged-up blood vessels to breathe in air containing tiny gold nanoparticles.
A day later, when the patients had part of their damaged blood vessels surgically removed, there was evidence of this gold building up in the diseased parts of vessels.
Researchers speculate that by accumulating in vulnerable areas of the body air pollution particles could worsen heart disease and stroke.
Dr Zongbo Shi, at the University of Birmingham, said: “This is a well designed and high quality study, and the results unequivocally showed that nanoparticles can travel from lungs to blood vessels and different organs.
“This research provides a missing link or mechanism between airborne nanoparticles exposure and their adverse health effects. “
But Prof Peter Dobson, at the University of Oxford, argues the study has a number of pitfalls, including the fact that gold does not match the chemistry of particles present in pollution.
And Mike Hawes of the Society of Motor Manufacturers and Traders said the industry had invested billions into reducing emissions and had drastically reduced or banished pollutants such as particulates.
Meanwhile Prof Jeremy Pearson, at the British Heart Foundation, which part-funded the study, said there was no doubt that air pollution was a killer that needed to be taken seriously.
But he cautioned more research was still needed to pin down the mechanism involved and firm up the evidence.
Postpartum haemorrhage: Cheap lifesaver ‘cuts deaths by a third’
A cheap drug has been shown to stop women bleeding to death, in a discovery that should change practice around the world, say researchers.
Every year, 100,000 women die from massive bleeding in the moments after giving birth.
But an international study, in the Lancet, suggests “tranexamic acid” could cut that by a third.
Postpartum haemorrhage is the biggest cause of death during pregnancy and early motherhood.
“They gave me 41 bottles of blood,” said Nosheen, from Rawalpindi, in Pakistan who nearly died after the birth of her daughter.
Nosheen’s life was saved only by an emergency hysterectomy.
She told the BBC World Service’s Health Check programme: “Doctors told me that they will have to remove my uterus to save my life.
“My health is completely destroyed, and I am very upset about it.”
Tranexamic acid might have helped Nosheen.
It stops blood clots breaking down to make it easier for the body to stem bleeding.
It was invented by husband and wife Shosuke and Utako Okamoto in Japan in the 1960s.
But they could not convince local doctors to perform a clinical trial for postpartum haemorrhage.
So instead it was picked up by a pharmaceutical company and used as a treatment for heavy periods.
And there the story nearly ended.
Eventually, a study was coordinated by the London School of Hygiene and Tropical Medicine in a collaboration of 193 hospitals mostly in Africa and Asia.
Prof Utako Okamoto died, aged 98, just after the 20,000th and final patient was enrolled on to the trial that would finally prove she had been right.
It found tranexamic acid cut deaths by a fifth overall and by 31% in those given the drug within three hours of birth.
Prof Ian Roberts, one of the researchers, told the BBC: “We’ve got an important result.
“We found an inexpensive drug, given in a single shot, that reduces the risk of bleeding to death, and it should play a role in reducing maternal mortality around the world.”
The World Health Organization said is would update its recommendations for treating postpartum haemorrhage treatment.
The findings would not have been a surprise to Utako.
The UK team went to visit the “physically small, but so switched-on firecracker” near the start of the trial.
Her husband had already died.
In a film they made, she told them: “It’s going to be good, it’s going to be effective.
“Without doing the research, I know it will be effective.”
In the poverty of post-War Japan, she and her husband decided to start researching blood because they could donate their own samples to study.
“We wanted to work on something international, we wanted to discover new drugs to show our gratitude to humanity,” she said.
“We thought that would be wonderful.”
Prof Roberts says he was blown away and inspired by her and this is not the end of the journey.
The drug might be cheap, but getting it into hospitals around the world will still be a challenge.
Prof Roberts added: “It is an awful thing for a mother to die in childbirth.
“When we started the trial, the staff would cry hearing about babies left without their mothers.
“Making sure the treatment is available everywhere it can save a life is hugely important.
“We shouldn’t have children growing up without a mother for lack of a drug that costs a dollar.”
Dr Rizwana Chaudri, from Rawalpindi Medical College, said: “Women dying of postpartum haemorrhage, women brought dead to the hospital, there’s so many of them.
“You can’t even think of that in a developed world, but over here this is a daily thing that goes on and on and on.”
Exercise ‘keeps the mind sharp’ in over-50s, study finds
Doing moderate exercise several times a week is the best way to keep the mind sharp if you’re over 50, research suggests.
Thinking and memory skills were most improved when people exercised the heart and muscles on a regular basis, a review of 39 studies found.
This remained true in those who already showed signs of cognitive decline.
Taking up exercise at any age was worthwhile for the mind and body, the Australian researchers said.
Exercises such as T’ai Chi were recommended for people over the age of 50 who couldn’t manage other more challenging forms of exercise, the study in the British Journal of Sports Medicine said.
Physical activity has long been known to reduce the risk of a number of diseases, including type-2 diabetes and some cancers, and it is thought to play a role in warding off the brain’s natural decline as we enter middle age.
The theory is that through exercise the brain receives a greater supply of blood, oxygen and nutrients that boost its health as well as a growth hormone that helps the formation of new neurons and connections.
In this analysis of previous studies, researchers from the University of Canberra looked at the effects of at least four weeks of structured physical exercise on the brain function of adults.
In a variety of brain tests, they found evidence of aerobic exercise improving cognitive abilities, such as thinking, reading, learning and reasoning, while muscle training – for example, using weights – had a significant effect on memory and the brain’s ability to plan and organise, the so-called executive functions.
Joe Northey, study author and researcher from the Research Institute for Sport and Exercise at Canberra, said the findings were convincing enough to enable both types of exercise to be prescribed to improve brain health in the over-50s.
“Even if you are doing moderate exercise only once or twice a week there are still improvements in cognitive function, but the improvements were better the more exercise was done,” he said.
He said people should be able to hold a conversation while doing moderate exercise.
NHS guidelines recommend that adults do at least 150 minutes of moderate aerobic activity every week and exercise the major muscles on two or more days a week.
Heavy shopping bags
Dr Justin Varney, lead for adult health and wellbeing at Public Health England, said any physical activity was good for brain and body.
“Whilst every 10 minutes of exercise provides some benefit, doing 150 minutes a week cuts the chances of depression and dementia by a third, and boosts mental health at any age.
“Doing both aerobic and strengthening exercises leads to a greater variety of health benefits.”
He said cycling or walking to work could count as aerobic activity and carrying heavy shopping bags was one example of a good strength exercise.
Dr Dean Burnett, lecturer in neuroscience and psychiatry at Cardiff University, said the study gave a clearer picture of how exercise affected the brain – but there were still issues.
“It could lead to increased pressure for the 50-plus age group to exercise more in order to stay mentally healthy, which is good advice but also overlooks the fact that as we age it’s increasingly difficult to engage in physical activity, as our bodies are simply less capable of it,” he said.
“Physical exercise is one element of improved brain functioning, but not the whole story.”
As well as staying physically active, Dr David Reynolds, from Alzheimer’s Research UK, said it was equally important to look after our brains by staying mentally active, eating a balanced diet, drinking only in moderation and not smoking.
Malaria: Kenya, Ghana and Malawi get first vaccine
The world’s first vaccine against malaria will be introduced in three countries – Ghana, Kenya and Malawi – starting in 2018.
The RTS,S vaccine trains the immune system to attack the malaria parasite, which is spread by mosquito bites.
The World Health Organization (WHO) said the jab had the potential to save tens of thousands of lives.
But it is not yet clear if it will be feasible to use in the poorest parts of the world.
The vaccine needs to be given four times – once a month for three months and then a fourth dose 18 months later.
This has been achieved in tightly controlled and well-funded clinical trials, but it is not yet clear if it can be done in the “real-world” where access to health care is limited.
It is why the WHO is running pilots in three countries to see if a full malaria vaccine programme could be started. It will also continue to assess the safety and effectiveness of the vaccination.
Dr Matshidiso Moeti, the WHO regional director for Africa, said: “The prospect of a malaria vaccine is great news.
“Information gathered in the pilot programme will help us make decisions on the wider use of this vaccine.
“Combined with existing malaria interventions, such a vaccine would have the potential to save tens of thousands of lives in Africa.”
The pilot will involve more than 750,000 children aged between five and 17 months. Around half will get the vaccine in order to compare the jab’s real-world effectiveness.
In this age group, the four doses have been shown to prevent nearly four in ten cases of malaria.
This is much lower than approved vaccines for other conditions.
It also cuts the most severe cases by a third and reduces the number of children needing hospital treatment or blood transfusions.
But the benefits fall off significantly without the crucial fourth dose.
Ghana, Kenya and Malawi were chosen because they already run large programmes to tackle malaria, including the use of bed nets, yet still have high numbers of cases.
Each country will decide how to run the vaccination pilots, but high-risk areas are likely to be prioritised.
Despite huge progress, there are still 212 million new cases of malaria each year and 429,000 deaths.
Africa is the hardest hit and most of the deaths are in children.
The pilots are being funded by: Gavi, the Vaccine Alliance, the Global Fund to Fight Aids, Tuberculosis and Malaria, Unitaid, the WHO and GSK.
Dr Seth Berkley, the chief executive of Gavi, said: “The world’s first malaria vaccine is a real achievement that has been 30 years in the making.
“Today’s announcement marks an important step towards potentially making it available on a global scale.
“Malaria places a terrible burden on many of the world’s poorest countries, claiming thousands of lives and holding back economies.
“These pilots are crucial to determining the impact this vaccine could have on reducing this toll.”
Is Komodo dragon blood the key to new antibiotics?
Komodo dragon blood contains an important compound which scientists think could offer a new treatment for infected wounds.
The reptile’s saliva harbours many different types of bacteria, which somehow do not affect the dragon.
Scientists at George Mason University in the US created a synthetic compound based on a molecule in dragon blood that had antimicrobial activity.
They found it promoted the healing of infected wounds in mice.
The study – published in npj Biofilms and Microbiomes – suggests that the protein could potentially be developed into an antibiotic in the future.
The scientists believe this could be a step forward in the quest to find new antibiotics that are needed to fight multidrug-resistant pathogens.
Enter the dragon
The dragons that are found on five islands in Indonesia have more than 80 bacterial strains in their mouths, including some that cause blood poisoning or sepsis.
The reptiles are not harmed by the bacteria – suggesting they are immune.
Led by Monique van Hoek, the team in Virginia found DRGN-1 worked well on infected wounds in mice against two bacterial strains, the “superbugs” Pseudomonas aeruginosa and Staphlyococcus aureus, also known as MRSA.
These two bacteria are particularly stubborn and hard to treat as they have bacteria that stick together to form colonies (or biofilms) that are much more resistant to antibiotics than a single bacterium.
They suggest that DRGN-1 assists wound-healing both through antimicrobial activity and also by promoting the migration of skin cells to close the wound.
Although it has only been tested on mice and on only two bacteria strains, they believe DRGN-1 is a good candidate for additional studies and possible development as a topical therapeutic agent for infected wounds.
‘Wide awake drunk’ on energy drinks and alcohol mix
Mixing energy drinks with alcohol could be a risky combination, leading to a greater risk of accidents and injuries, research from Canada suggests.
The caffeine contained in energy drinks can make people feel wide awake and encourage them to drink more than normal.
Medics say this could also cause problems sleeping and a raised heart rate, although more research is needed.
Charity Drinkaware does not recommend mixing alcohol and energy drinks.
Mixing spirits and liqueurs with energy drinks, such as Red Bull and Monster, has become increasingly popular – in pubs and clubs, and at home.
But recent research suggests that drinking alcohol mixed with high-caffeine energy drinks could be more risky than drinking alcohol on its own, or with a more traditional mixer.
This is because it can make people “wide awake drunk” – a result of the stimulating effects of caffeine and the brain-slowing effects of alcohol.
What are the risks?
In a review of 13 studies published between 1981 and 2016, researchers at the University of Victoria, Canada, found a link in 10 studies between intake of alcohol mixed with energy drinks and an increased risk of falls, fight and accidents.
But they said they were unable to pin down the size of the injury risk because of the varied nature of the studies and the difficulty of comparing results.
When it comes to the question of whether mixing alcohol and energy drinks is harmful to health, larger studies are still needed to work this out.
At present, the Food Standards Agency and the Committee of Toxicity says the evidence is not clear.
What is in energy drinks?
Energy drinks contain high levels of caffeine, usually about 80mg in a 250ml can – equivalent to a mug of instant coffee.
In comparison, a 330ml can of classic Coca-Cola contains 32mg and a can of Diet Coke 42mg.
Energy drinks also contain lots of sugar as well as other ingredients, such as glucuronolactone and taurine, and sometimes vitamins and minerals or herbal substances.
Some smaller “energy shot” products can contain as much as 160mg of caffeine in a 60ml bottle.
|Drink||Amount of caffeine|
|Red Bull (250ml can)||80mg|
|Monster (500ml can)||160mg|
|Coca-Cola (330ml can)||32mg|
|Mug of instant coffee||100mg|
|Cup of tea||40mg|
How much caffeine is too much?
High levels of caffeine can lead to anxiety, panic attacks and increased blood pressure.
Pregnant and breast-feeding women are advised not to have more than 200mg of caffeine over the course of a day.
There is more information on NHS choices.
European advice says that most other adults are safe to drink up to 400mg a day.
Children should have caffeine in moderation – a daily intake of less than 3mg of caffeine per kilogram of body weight in children and adolescents is safe, the European Food Safety Authority says.
Under current UK rules, drinks that contain more than 150mg per litre of caffeine (apart from teas and coffees) must carry a warning saying: “High caffeine content. Not recommended for children or pregnant or breast-feeding women”.
But there are currently no legal restrictions on the amount of caffeine that may be present in a food or drink product in the UK.
What are the recommended limits on alcohol?
Men and women should not drink more than 14 units of alcohol a week.
That’s equivalent to six pints of average strength beer or seven glasses of wine.
The advice, from the Department of Health, also says that it’s best not to save up units and drink them all in one go and to make sure you have alcohol-free days every week.
What’s the advice on mixing both?
Audra Roemer, study author and doctoral student in clinical psychology at the University of Victoria, says: “Usually when you’re drinking alcohol, you eventually get tired and you go home.
“Energy drinks mask that, so people may underestimate how intoxicated they are, end up staying out later, consume more alcohol, and engage in risky behaviour and more hazardous drinking practices.”
The charity Drinkaware said anything that encouraged people to drink more alcohol was “a very risky thing to do, and a worrying trend”.
But Gavin Partington, director general at the British Soft Drinks Association, said there was no indication that energy drinks had any specific effect related to alcohol consumption.
“The European Food Safety Authority has concluded that it is unlikely that caffeine interacts adversely with energy drinks or with alcohol,” he said.
“However, anybody drinking alcohol should do so in moderation, whether or not it’s mixed with an energy drink.”
Any top tips?
If you’re going to mix alcohol and energy drinks, then try to reduce any risks by:
- keeping a close eye on how much you and your friends are drinking
- eating food such as pasta or potatoes before a night out
- tracking the caffeine and sugar content of energy drinks
- avoiding drinking them before going to bed
B vitamins may have ‘protective effect’ against air pollution
B vitamins may offer some protection against the impacts of air pollution, a small scale human trial suggests.
Researchers in the US found that high doses of these supplements may “completely offset” the damage caused by very fine particulate matter.
The scientists involved say the effect is real but stress the limitations of their work.
Follow up studies are urgently needed, they say, in heavily polluted cities like Beijing or Mexico.
While the impacts of air pollution on health have become a cause of growing concern to people all around the world, the actual mechanics of exactly how dirty air makes people sick are not clearly understood.
According to the World Health Organization (WHO), over 90% of the world’s population live in areas where air pollution exceeds safety guidelines.
One of the pollutants that is considered the most dangerous is very fine particulate matter, referred to as PM2.5, where particles have a diameter of less than 2.5 micrometres.
These complex particulates come from diesel cars, wood burning stoves and as a by-product of chemical reactions between other polluting gases.
At around 1/30 the width of a human hair, PM2.5 fragments can lodge deep in the human lung and contribute to lung and heart health issues in the young and old.
Scientists have long suspected that PM2.5 causes what are termed epigenetic changes in our cells that can damage our health.
The genes in our DNA contain the instructions for life, but epigenetics controls how those instructions are used – it’s like the relationship between an mp3 track and the volume control, you can only hear the musical notes (genes) when you dial up the volume (epigenetic changes).
The study shows the very presence of environmental factors like air pollution seems to alter genes in the immune system at the epigenetic level – switching them on or off, and inhibiting our defences.
Researchers had already seen that nutrients could somehow stop this process in animal studies with the chemical Bisphenol A.
Now in this new human trial, an international team of scientists wanted to see if exposure to concentrations of PM2.5 could be mitigated by a daily B vitamin supplement containing 2.5mg of folic acid, 50mg of vitamin B6, and 1mg of vitamin B12.
Ten volunteers were tested initially exposed to clean air while given a placebo to measure their basic responses. The same volunteers were later tested with large doses of B vitamins while exposed to air containing high levels of PM2.5.
The researchers found that a four week B vitamin supplementation limited the PM2.5 effect by between 28-76% at ten gene locations. They found a similar reduction in impact on the mitochondrial DNA, the parts of cells that generate energy.
“Where we quantify the effect, it is almost close to a complete offset on the epigenome of the air pollution,” said Jia Zhong from Harvard School of Public Health, who led the study.
“On the mitochondrial DNA side, it also offset a big proportion of it.”
However, the authors caution that their study, while observing a real effect, has many limitations. As well as the small number of participants, there was little information on the size of the B vitamin dose that elicited the response.
“We didn’t have different doses and the doses we used were quite high, higher than a normal pregnancy suggested intake. So it is quite high but at the same we did observe this protective effect,” said Jia Zhong.
Other scientists in the field, while welcoming the study, agree that caution is needed.
“The fact that they find a coherent story in only 10 subjects is promising, but clearly warrants further follow-up in larger populations especially considering the ethnic variability in this study,” said Prof Carrie Breton from the University of Southern California, who wasn’t involved in the report.
“While I think it is great that doing something as easy as taking a vitamin would help protect against air pollution harm, the public health goal still needs to be one of reducing air pollution to a level that is not harmful,” she said in a statement.
The authors acknowledge that this was a pilot study to test a hypothesis and they are not in a position to make any deductions about whether B vitamins could be used in clinical practice as a means of protecting against air pollution.
More and bigger studies are needed – and they need to be done in environments where people have a major exposure to PM2.5.
“I think that B vitamins are a likely hope that we can potentially utilise as an individualised treatment to complement the policy regulations to minimise the impacts of air pollution,” said Jia Zhong.
“A more sophisticated study is urgently needed in Beijing or India or Mexico just to see whether those who are chronically exposed, if the protective effect can still be effective.”
The study has been published in the journal Proceedings of the National Academy of Sciences (PNAS).
Trump healthcare plan ‘will strip insurance from 14 million’
An estimated 14 million people would lose insurance coverage in 2018 under the new Republican healthcare plan, according to a budget analysis.
The long-awaited Republican plan was assessed by the Congressional Budget Office (CBO), a nonpartisan group of budget analysts and economists.
The CBO said the added number uninsured would rise to 24 million by 2026.
President Donald Trump, who backs the new plan, had pledged while campaigning that no-one would lose their insurance.
The CBO reports also found that the bill would reduce the federal deficits by $337bn (£275bn) over the 10-year period.
Those savings could help House Republicans sell the new legislation – known as the American Health Care Act (AHCA) – to some conservatives who remain sceptical about costs.
President Donald Trump has backed the plan, which would replace former President Barack Obama’s signature healthcare bill, the Affordable Care Act, known as Obamacare.
Other key findings in the report
The CBO, along with the Joint Committee on Taxation, also found that five million fewer people would be covered under Medicaid, which covers low-income people, by 2018.
An estimated 14 million fewer people would enroll in the Medicaid programme by 2026, it said.
And the report found that by 2026, an estimated 52 million people would be uninsured, compared with the 28 million who would not be covered that year under Obamacare.
Analysis: Anthony Zurcher, North America reporter
Now we see why the Trump administration spent the past week attempting to play down the importance of the CBO’s scoring of the American Healthcare Act. The numbers are in, and the top-line increase in uninsured Americans in 2018 – more than 14 million next year – is staggering.
Conservatives will herald the long-term budget savings derived from the legislation as well as the reduced taxes. But the pain from the cuts to coverage and subsidies will be more immediate and focused on the poor and the elderly.
Moderates, particularly those up for re-election in 2018 in states that had expanded Medicaid coverage, may very well cite the CBO number as reason to run for the exits.
The House bill was already under fire from the right for enshrining what they saw as a new “welfare entitlement”, so any attempts to lesson the blow of the changes will be difficult. The odds in favour of eventual passage are growing longer by the day.
The Republicans know they have to do something to fulfil their “repeal and replace” campaign promises, but finding a solution will take all the political skill the congressional leadership, and the Trump administration, can muster.
How have Republicans reacted to the CBO report?
House Speaker Paul Ryan highlighted the CBO’s conclusions on deficit reduction and decreased premiums. “I recognise and appreciate concerns about making sure people have access to coverage,” Mr Ryan said.
“[O]ur plan is not about forcing people to buy expensive, one-size-fits-all coverage. It is about giving people more choices and better access to a plan they want and can afford.”
Health and Human Services Secretary Tom Price said the administration “strenuously disagreed” with the report’s findings on the number of people who would lose coverage.
“Right now, current law, we’ve got individuals who have health coverage but no healthcare,” he said after the assessment was released.
Mr Price contended the new plan would cover more individuals at a lower cost.
How have Democrats reacted?
Democrats jumped on the figures in the CBO assessment. California Representative Adam Schiff called the numbers “appalling”.
“Now we know why Speaker Ryan rushed to pass his repeal bill; CBO says it kicks 24 million off their healthcare in next 10 years. Appalling,” Mr Schiff tweeted.
Virginia Representative Don Beyer called it a “disaster”.
Why is Trump proposing a new bill?
During his campaign, Mr Trump promised to scrap most elements of Obamacare.
The legislation is hugely unpopular among Republicans, who claim it imposes too many costs on business and is an unwarranted government intrusion into the affairs of businesses and individuals.
They say the AHCA will lower costs and argue that statistics showing it will lower coverage are misleading.
Democrats have accused Republicans of attacking the legislation simply in order to attack the credibility of Mr Obama and the Democratic party.
Paralysis inspires MS discovery
“I had a dead leg one Sunday morning and it progressed to full paralysis within two hours,” says Dr Denise Fitzgerald, from Queen’s University Belfast.
She was only 21 at the time, but the event helped to inspire the fledgling scientist to crack how the brain is repaired.
The discovery reported today could potentially help millions of people with multiple sclerosis who have the opposite problem, a rogue immune system attacking part of the brain.
Dr Fitzgerald’s paralysis was caused by a similar condition to multiple sclerosis called transverse myelitis.
Her spinal cord had been stripped of a fatty substance called myelin – a protective coating that allows electrical signals to travel down nerves.
It serves the same function as insulation on an electrical cable. Without myelin, her brain could no longer control her body.
The key difference between the two conditions is transverse myelitis is a one-off event, while multiple sclerosis is a life-long assault on myelin.
Dr Fitzgerald’s myelin slowly regenerated and was growing at about the same pace as the hair on your head.
“I asked the doctor ‘can you speed this up?’ and they said ‘not until some bright spark like you comes up with something’.”
She was, eventually, able to make a “95% recovery” and even taught herself to walk again.
She told the BBC: “It shows how much regenerative capacity we have and on my mind was the repair process.
“It was efficient and effective and that led me on to research on MS.”
Disease and recovery
In multiple sclerosis, the immune system mistakes myelin for a hostile invader and launches an assault.
It can either just get worse, known as primary progressive MS, or come in waves of disease and recovery, known as relapsing remitting MS.
“The reason people have relapsing-remitting is because that natural repair process kicks in,” Dr Fitzgerald told the BBC.
She is one part of a large research group made up of neuroscientists, immunologists and stem cell scientists that has cracked how the myelin is regenerated.
They hope harnessing this process could lead to new therapies.
Their series of mouse experiments, published in Nature Neuroscience, has unpicked how the body restores myelin (it is the same sequence of events that ultimately restored Dr Fitzgerald’s movement).
It starts with a type of white blood cell (called a T-regulatory cell) that is attracted to the damaged myelin in the brain.
Once there it begins to co-ordinate the recovery like a foreman at a construction site.
But rather than bark verbal instructions, the white blood cells do it chemically by using a protein with the technical name of CCN3.
The protein then jolts nearby stem cells into activity.
Stem cells have the rare ability to morph into other cell types and CCN3 tells them to become myelin-manufacturing cells.
Dr Fitzgerald said: “From my perspective it is a fundamental step forward in the biology of repair.
“Our goal is to eventually use this knowledge to develop drugs to drive the repair of myelin and potentially this could lead to patients regaining function.
“I love my career, but I’d happily be unemployed if we cure multiple sclerosis.”
It is still early days and the next stage of the research will be to perform experiments using human rather than mouse tissues.
“If only I had saved my T-cells from back then, when I was on the hospital bed I should have been saying ‘save some of that blood for me’,” she said while musing on a missed opportunity for an experiment.
But even with treatments still on the horizon, the findings ask interesting questions about multiple sclerosis itself.
Why does the repair process get worse with time? Does the disease become more severe and the repair process cannot keep up? Or does age make the repair less efficient?
These will also be considered in the next stage of the research.
Fellow researcher Dr Yvonne Dombrowski added: “This knowledge is essential to designing future treatments that tackle neurological diseases, such as MS, in a new way – repairing damage rather than only reducing attacks.
“In the future, combining these approaches will deliver better outcomes for patients.”
Dr Sorrel Bickley, the head of biomedical research at the MS Society, said: “This exciting study gives us an important understanding of how myelin repair can be promoted, which could open up new areas for treatment development.”
Raw milk cheese linked to two listeria deaths in US
Two people have died and four more have fallen ill following an outbreak of listeria linked to recalled cheese in several eastern US states.
Officials say it was probably caused by a soft raw milk cheese called Ouleout from Vulto Creamery in New York state.
The cheese was stocked by a Whole Foods shop in Fairfield, Connecticut, and may also have been available in specialised cheese shops.
The creamery recalled several soft cheeses on Tuesday.
Six cases of listeria have been recorded in Connecticut and Vermont, where the deaths occurred, as well as in New York and Florida.
The people infected range in age from less than a year to 89, and five of them are female, the US Centers for Disease Control and Prevention (CDC) says. All six were taken to hospital and the identity of those who died has not been released.
Listeria bacteria can occur in raw milk and foods made with it, and can survive refrigeration. The bacteria are killed by cooking and pasteurisation.
Vulto Creamery said it was working on recalling the affected cheese.
The company says it makes small batches of handmade cheese using raw milk from local dairy farmers. Its founder started out by making cheese in his apartment in Brooklyn.
Vulto describes the Ouleout cheese as a “semi-soft washed rind cheese” made from unpasteurised milk that tastes “pungent and meaty”.
How dangerous is raw milk?
Raw milk is milk from cows, goats, sheep or other animals that has not been pasteurised – the process of heating the milk to a specific temperature for a specific period of time to kill bacteria.
Some consumers say raw milk has more flavour and makes better cheese. Others choose unpasteurised milk as part of a broader shift away from processed foods, which are increasingly seen as unhealthy.
However the CDC says raw milk presents one of the biggest risks to consumers, who may face “many days of diarrhoea, stomach cramping and vomiting” and in rare cases kidney failure, paralysis, chronic disorders and even death.
The bacteria in raw milk can be especially dangerous to those with weak immune systems, older people, pregnant women and children, the CDC says.
Raw milk products are illegal in 20 US states, can be obtained from farms in 25 states and are available in shops in 13 states. EU countries make their own laws but products made with raw milk must be labelled. About a fifth of French cheese is made using raw milk.
In the UK, the sale of raw cow’s milk is banned in Scotland but products made from it can be bought. Raw cow’s milk can be bought from producers in the rest of the country.
Can sweat patches revolutionise diabetes?
Scientists have developed a sensor that can monitor blood sugar levels by analysing sweaty skin.
But rather than a gym-soaked t-shirt, it needs just one millionth of a litre of sweat to do the testing.
The team – in South Korea – showed the sensor was accurate and think it could eventually help patients with diabetes.
And in extra tests on mice, the sensor was hooked up to a patch of tiny needles to automatically inject diabetes medication.
The team at the Seoul National University were trying to overcome the need for “painful blood collection” needed in diabetes patients.
- Type 1 diabetes is caused by the immune system attacking the part of the body that controls blood sugar levels
- Type 2 diabetes is often caused by lifestyle damaging the body’s ability to control blood sugar levels
- Patients with both conditions need to medically control their blood sugar levels to prevent damage to the body and even death
This is how patients with diabetes would normally keep track of blood sugar levels:
And this could be the future:
The sensor is flexible so it can move with the skin it is stuck onto.
However, the scientists needed to overcome a series of challenges to make it work.
There is less sugar in sweat than blood so it is harder to find, and other chemicals in sweat such as lactic acid can disrupt the results.
So the patch has three sensors keeping track of sugar levels, four that test the acidity of the sweat and a humidity sensor to analyse the amount of sweat.
It is all encased in a porous layer that allows the sweat to soak through and bathe the electronics.
All this information is passed onto a portable computer which does the analysis to work out the sugar levels.
Tests before and after people sat down for a meal, published in the journal Science Advances, showed the results from the sweat patch “agree well” with those from traditional kit.
However, for the next stage the researchers turned to mice with diabetes.
They used the blood sugar monitor to control an array of microneedles to give the mice doses of the diabetes drug metformin.
The researchers conclude: “The current system provides important new advances toward the painless and stress-free” care for diabetes.
However, there is a leap between proving something can sense sugar levels in a lab and turning that into something that is so reliable people can put their lives in its hands.
So the researchers next want to test how the patches work in the long-term.
Why young people are now less likely to smoke
All age groups in the UK are smoking less – but the largest decrease is among 18- to 24-year-olds, according to the Office of National Statistics. Why is that?
Fewer start smoking
The latest figures, for 2015, suggest one in every five (20.7%) 18- to 24-year-olds is a smoker.
In 2010, this figure was one in every four (25.8%).
Today, about 70% of 16- to 24-year-olds have never started smoking cigarettes in the first place, the data suggests – up from 46% in 1974, when records began.
And even among the age group most likely to smoke, 24- to 35-year-olds, about 60% – up from 35% in 1974 – have never picked up the habit.
Action on Smoking and Health (Ash) says: “We know that young people who try smoking are highly likely to grow up to become smokers, so the high numbers of young people reporting that they have never even tried smoking is good news.”
Model Kylie Jenner was called a bad role model after she was pictured smoking on Instagram, perhaps an indicator it is no longer seen as cool.
More are quitting
The new data suggests 23.3% of 16- to 24-year-olds quit smoking in 2015, compared with 21.4% in 2010 and 13.4% in 1974.
Ash says this has been “achieved through a combination of effective legislation, policy and support for adults to quit over many decades – much of which has had a big impact on youth uptake as well as quitting”.
Policy director Hazel Cheeseman says: “Creating an environment in which fewer young people try smoking and more smokers quit will protect the health of future generations and avoid hundreds and thousands of premature deaths.
“However, the achievements made to date are at risk.
“The government must urgently publish a new tobacco control plan for England and ensure this is properly funded.”
The rise of vaping
In 2015, three out of every 100 16- to 24-year-olds used electronic cigarettes, up from one in every 100 in 2014, the new data suggests.
And, in total, 2.3 million people in the UK are using them – half in order to stop smoking.
But some are concerned vaping could prove a gateway to smoking for teenagers.
And critics say the fruit flavours of some e-cigarettes could make them more appealing to children.
In December 2016, the US Surgeon General said the use of e-cigarettes by children was “a major public health concern”.
But Ash says the latest figures “confirm that most users are smokers or ex-smokers”.
“The figures also highlight that most users are seeking to improve their health, with the most common reason for use being as an aid to quit smoking,” it says.
“Where smokers make a complete switch, they can expect to significantly reduce their exposure to harmful chemicals which cause cancer and other smoking-related illnesses.”
Artificial ’embryos’ created in the lab
Scientists have created “artificial embryos” using stem cells from mice, in what they believe is a world first.
The University of Cambridge team used two types of stem cells and a 3D scaffold to create a structure closely resembling a natural mouse embryo.
Previous attempts have had limited success because early embryo development requires the different cells to coordinate with each other.
The researchers hope their work will help improve fertility treatments.
It could also provide useful insights into the way early embryos develop.
However, experimentation on human embryos is strictly regulated, and banned after 14 days.
Once a mammalian egg has been fertilised, it divides to generate embryonic stem cells – the body’s “master cells”.
These embryonic stem cells cluster together inside the embryo towards one end, forming the rudimentary embryonic structure known as a blastocyst.
The Cambridge team, whose work is published in the journal Science, created their artificial embryo using embryonic stem cells and a second type of stem cell – extra-embryonic trophoblast stem cells – which form the placenta.
Lead researcher Prof Magdalena Zenricka Goetz said: “We knew that interactions between the different types of stem cell are important for development, but the striking thing that our new work illustrates is that this is a real partnership – these cells truly guide each other.”
However, the researchers say their artificial embryo is unlikely to develop into a healthy foetus as it would probably need the third form of stem cell, which develops into the yolk sac that provides nutrition.
The same team recently developed a technique that allows blastocysts to develop in the lab up to the legal limit of 14 days in the UK.
They have already grown these artificial mice embryos to the equivalent stage, and they are now working on using the same technique to develop artificial human embryos.
If they are successful, it could open the door to experimenting on embryos beyond the current 14-day limit.
Prof Jonathan Montgomery, an expert in health care law, at University College London, said: “It wouldn’t, obviously, be within the current regulatory framework, although we would need to think carefully about how we should oversee it.
“It is early days, but if they do manage to not only create the partnership that’s needed to get started but also the nutrition that’s needed to sustain it, you could see that we are contemplating the opportunity of developing human embryos for quite a substantial period in vivo.”
Prof Robin Lovell-Badge, of The Francis Crick Institute, said some structures seen in early embryos had failed to develop.
This, and other problems, would need to be solved before the technology could be developed further.
He also said it was unlikely that human equivalents could be developed because the necessary cells from human embryos were not available.
Fruit and veg: For a longer life eat 10-a-day
Eating loads of fruit and vegetables – 10 portions a day – may give us longer lives, say researchers.
The study, by Imperial College London, calculated such eating habits could prevent 7.8 million premature deaths each year.
The team also identified specific fruit and veg that reduced the risk of cancer and heart disease.
The analysis showed even small amounts had a health boon, but more is even better.
A portion counts as 80g (3oz) of fruit or veg – the equivalent of a small banana, a pear or three heaped tablespoons of spinach or peas.
The conclusions were made by pooling data on 95 separate studies, involving two million people’s eating habits.
Lower risks of cancer were linked to eating:
- green veg (eg spinach)
- yellow veg (eg peppers)
- cruciferous vegetables (eg cauliflower).
Lower risks of heart disease and strokes were linked to eating:
- citrus fruits
- green leafy vegetables (eg lettuce)
- cruciferous veg
Harriet Micallef, from Chippenham, says she often manages eight to 10 portions a day and has multiple portions of spinach every day.
She told the BBC: “I have a lot, I don’t ever have a meal without veg or salad so eight to 10 portions is a regular thing.”
She starts her day with a veg-packed omelette containing spinach and sometimes avocado or tomatoes.
Harriet’s salad-based lunch is also packed with a mix of veg and her evening meals tend to be stir fries or stews.
Snacks during the day include blended fruit smoothies or peppers dipped in hummus.
She added: “It’s definitely healthy, if you’ve got loads of colours on your plate then you’re pretty much okay.”
The results, published in the International Journal of Epidemiology, also assessed the risk of dying before your time.
Compared with eating no fruit or veg a day, it showed:
- 200g cut the risk of cardiovascular disease by 13% while 800g cut the risk by 28%
- 200g cut the risk of cancer by 4%, while 800g cut the risk by 13%
- 200g cut the risk of a premature death by 15%, while 800g cut the risk by 31%
The researchers do not know if eating even more fruit and veg would have even greater health benefits as there is little evidence out there to review.
Dr Dagfinn Aune, one of the researchers, said: “Fruit and vegetables have been shown to reduce cholesterol levels, blood pressure, and to boost the health of our blood vessels and immune system.
“This may be due to the complex network of nutrients they hold.
“For instance, they contain many antioxidants, which may reduce DNA damage and lead to a reduction in cancer risk.”
However, many people struggle to even eat the five a day (400g) recommended by the World Health Organization.
In the UK, only about one in three people eats enough.
Heather Saunders, 24 and from Oxford, routinely manages nine or 10 portions a day since becoming vegan.
She has two pieces of fruit with breakfast, a “massive pot” of roasted vegetables at lunch and then at least four vegetables in curries or chillies in the evening.
She told the BBC: “It is about making a conscious decision, I feel fuelling myself with plant-based foods is a more healthy way to sustain myself.”
Her tips for anyone trying to eat more is to do it gently: “Maybe decide to have one or two meat-free days a week and phase more veg in, I quite like a sweet potato curry with spinach and chickpeas.”
Dr Aune said the findings did not mean the five-a-day message needed to change.
He told the BBC: “There are many different considerations if changing policy, it’s not just the health effects – is it feasible?
“But our findings are quite clear in that they do support five a day, but there are even some further benefits for higher intakes.”
Dr Alison Tedstone, chief nutritionist at Public Health England, said: “The five-a-day target is the foundation of a healthy balanced diet and is an achievable way to help prevent a number of diseases.
“Whilst consuming more than five portions of fruit and vegetables a day may be desirable… adding pressure to consume more fruit and vegetables creates an unrealistic expectation.”
Your questions answered
Jonathan Shorney asked: “I eat a lot of apples, but that amounts to a lot of sugar. Could that amount of sugar be harmful?”
Sugar seems to have become public enemy number one in the past few years. But it is important to remember the “war on sugar” is actually a “war on free sugar”.
This includes sugars added to food as well as honey or those liberated in making fruit juices.
However, this does not include any naturally occurring sugars in fresh fruit and vegetables and the World Health Organization says “there is no reported evidence of adverse effects of consuming these sugars”.
Mike asked: “Do pulses contribute to the 10?
Yes they do. All kinds of beans from kidney to cannellini as well as lentils count as a single portion according to Public Health England.
Gary Kruger asked: “Should fruit and vegetables be heavily subsidised by the government to encourage further consumption?
This is not being seriously considered, but something kind of similar is happening.
Rather than making the healthy stuff cheaper, a sugar tax will make sugar-sweetened beverages more expensive with the aim of shifting buying habits.
There is no VAT on fruit and veg, but the British Medical Association has called for the government to go further and use the proceeds of a sugar tax to discount fruit and veg.
However, it is not clear how big a health impact there could be without knowing who it would be for (everyone or just the poor), how big the discount would be and then how that would change shopping habits.
Harriet, who started cooking family meals at the age of 12, thinks more should be done to get children eating more.
“I think it comes from schooling and the traditional British meat and two veg.
“I think if you teach children to always have something green on their plate in addition then they’ll naturally start having more.
“There’s just so many different veg that people don’t have like bean sprouts and chard.”
Not all of the 95 studies that were analysed fully accounted for other aspects of lifestyle, such as exercise levels, that could also play a role in prolonging lives.
However, Dr Aune said the conclusions were “quite robust”.
Brain scans ‘may spot teen drug problems’
An international team of scientists say the way teenagers’ brains are wired may help predict whether they will develop drug problems in the future.
The team looked at adolescents who were generally more impulsive than their peers – a trait sometimes linked to the misuse of drugs.
They found teenagers who had a particular pattern of activity on brain scans were more likely to misuse drugs.
The early work appears in the journal Nature Communications.
Scientists asked 144 adolescents who had not previously used recreational drugs to fill in questionnaires and take part in behavioural tests to assess how impulsive they were and how attracted they were to trying new things.
Researchers then conducted a range of brain scans, while asking the adolescents to carry out tasks that could win them cash prizes at the same time.
The tests were designed to look at how particular parts of the brain responded to the prospect of getting a reward.
They found those teenagers who had less nerve activity in these brain areas during these tasks, were more likely to have drug problems two years later.
One theory behind this, the scientists say, is that teenagers who are more likely to take drugs have less motivation for traditional rewards like money, and more for less conventional rewards.
Prof Brian Knutson, at Stanford University, says he hopes with more work, these types of tests could help identify vulnerable teenagers who could be offered help before problems arise.
Meanwhile Prof Derek Hill, of University College London, said the study was “interesting” with carefully collected and analysed data.
But he cautioned that the methods used in the study were still experimental.
He added: “It is therefore important that results like this are replicated in separate studies before the results in this paper should be used to change the way these young people are diagnosed and treated.”
Life expectancy to break 90 barrier by 2030
South Korean women will be the first in the world to have an average life expectancy above 90, a study suggests.
Imperial College London and the World Health Organization analysed lifespans in 35 industrialised countries.
It predicted all would see people living longer in 2030 and the gap between men and women would start to close in most countries.
The researchers said the findings posed big challenges for pensions and care for elderly people.
“South Korea has gotten a lot of things right,” Prof Majid Ezzati told the BBC News website.
“They seem to have been a more equal place and things that have benefited people – education, nutrition – have benefited most people.
“And so far, they are better at dealing with hypertension and have some of the lowest obesity rates in the world.”
The data also forecasts that Japan, once the picture of longevity, will tumble down the global rankings.
It currently has the highest life expectancy for women, but will be overtaken by both South Korea and France, the study suggests. Meanwhile, male life expectancy will go from the fourth highest to eleventh out of the countries studied.
US falling behind
The US also performs poorly and is on course to have the lowest life expectancy of rich countries by 2030.
The study predicts an average age of 80 for men and 83 for women – roughly the same state Mexico and Croatia will have achieved.
“They are almost opposite of South Korea,” added Prof Ezzati.
“[Society in the US is] very unequal to an extent the whole national performance is affected – it is the only country without universal health insurance.
“And it is the first country that has stopped growing taller, which shows something about early life nutrition.”
The US will be overtaken by Chile, where women born in 2030 will expect to live for 87 years and men for 81.
Between 2015 and 2030, life expectancy in the UK is expected to go from 79 to 82 for women and from 83 to 85 for men.
Men catching up
The study, published in the Lancet, also shows the gap in life expectancy between women and men is closing.
Prof Ezzati said: “Men traditionally had unhealthier lifestyles, and so shorter life expectancies.
“They smoked and drank more, and had more road traffic accidents and homicides, however, as lifestyles become more similar between men and women, so does their longevity.”
Much of the increases are due to improvements for the over-65s rather than reductions in deaths during childhood.
The study made the projections in a similar way to the methods used by meteorologists to forecast the weather.
It combined 21 separate mathematical models that analysed past trends to make projections into the future.
This approach indirectly takes account of all the different factors – smoking rates, medical advances, obesity patterns – that are changing life expectancy.
It assumes countries continue to progress as they are, so exceptional, unpredictable events equivalent to the fall of the Soviet Union, or huge breakthroughs like a vaccine for all cancer, would massively alter the forecasts.
In summary, Prof Ezzati said: “Places that perform well do so by investing in their health system and making sure it reaches everyone.”
Risky treatment can stop multiple sclerosis for years
A multiple sclerosis treatment being tested in patients can stop the disease for at least five years, say doctors.
The risky therapy involves wiping out the person’s immune system with strong cancer drugs and then rebooting it with a stem cell transplant.
Doctors say only some patients will be suitable to try it, particularly because it is so high risk.
Out of 281 people who had the treatment, nearly half benefited, but eight died shortly afterwards.
The work in JAMA Neurology is one of the largest and longest investigations of this aggressive MS treatment.
Mark Rye, 41 and from Surrey, had his transplant just before Christmas 2016. Two months on he is doing well.
“It was a hard decision, knowing what could go wrong. My wife and I discussed it for many, many hours. We’ve got small children and I didn’t want my MS to get worse and end up in a wheelchair.
“I did this to halt the condition and so that I can be there for my children, who are still so young. I want to be able to play rugby and football with them as they grow up.”
What is not clear is for how long the therapy might ultimately work.
MS is not fatal, but it is incurable.
The disease causes the immune system to attack the protective coating of nerves in the brain and spinal cord, which can create problems with a person’s vision, walking and balance.
Treatments aim to slow or stop the attack.
Researchers from Imperial College London gathered data from 25 centres in 13 countries that have been trialling the radical therapy known as autologous haematopoietic stem cell transplantation or AHSCT.
The idea behind the one-off treatment is to reset the immune system to stop it from attacking the body. But it requires toxic drugs to kill off existing cells in the patient’s bone marrow, which is unpleasant and hazardous.
The medical trial data gives doctors and patients a better idea about who might benefit from the treatment.
The findings suggest that patients who are younger, who are not responding to other MS drugs and who have relapsing MS, might benefit from AHSCT.
Lead investigator Dr Paolo Muraro said the risks must be weighed up against the benefits.
“We previously knew this treatment reboots or resets the immune system – and that it carried risks – but we didn’t know how long the benefits lasted.
“In this study, which is the largest long-term follow-up study of this procedure, we’ve shown we can ‘freeze’ a patient’s disease – and stop it from becoming worse, for up to five years.
“However, we must take into account that the treatment carries a small risk of death and this is a disease that is not immediately life-threatening.”
Advanced clinical trials are already under way to test how well AHSCT works compared to existing treatments for MS.
Last year, the BBC’s Panorama programme was given exclusive access to several patients who have undergone the stem cell transplant.
Steven Storey was diagnosed with MS in 2013 and, within a year, went from being an able-bodied athlete to needing a wheelchair and losing sensation in much of his body.
He said: “I went from running marathons to needing 24-hour acute care. At one point I couldn’t even hold a spoon and feed myself.”
Within a few days of the transplant he was able to move his toes, and after four months he could stand unaided.
AHSCT is not routinely available on the NHS. If anyone with MS is considering it they should speak to their neurologist, advises the UK MS Society, which has been funding this and other research.
Vitamin D pills ‘could stop colds or flu’
Vitamin D supplements could spare more than three million people from colds or flu in the UK each year, researchers claim.
The sunshine vitamin is vital for healthy bones, but also has a role in the immune system.
The analysis, published in the British Medical Journal, argues food should be fortified with the vitamin.
But Public Health England (PHE) says the infections data is not conclusive, although it does recommend supplements.
These, it says, should be taken for improved bone and muscle health.
The immune system uses vitamin D to make antimicrobial weapons that puncture holes in bacteria and viruses.
But as vitamin D is made in the skin while out in the sun, many people have low levels during winter.
Trials on using supplements to prevent infections have given mixed results, so the researchers pooled data on 11,321 people from 25 separate trials to try to get a definitive answer.
The team at Queen Mary University of London (QMUL) looked at respiratory tract infections – which covers a wide range of illnesses from a sniffle to flu to pneumonia.
Overall, the study said one person would be spared infection for every 33 taking vitamin D supplements.
That is more effective than flu vaccination, which needs to treat 40 to prevent one case, although flu is far more serious than the common cold.
There were greater benefits for those taking pills daily or weekly – rather than in monthly super-doses – and in people who were deficient in the first place.
Why is vitamin D important?
Its main function is to regulate the amount of calcium and phosphate in the body, which are vital for the growth and maintenance of healthy bones, teeth and muscles.
In extreme cases, low levels can lead to rickets in children – where the bones become soft and weak and misshapen as they continue to grow.
In adults, vitamin D deficiency can lead to osteomalacia – causing severe bone pain and muscle aches.
But there is a balance – too much vitamin D can lead to high levels of calcium in the blood which can cause heart and kidney problems.
Anyone with a chronic condition or taking medication should seek advice from their doctor.
One of the researchers, Prof Adrian Martineau, said: “Assuming a UK population of 65 million, and that 70% have at least one acute respiratory infection each year, then daily or weekly vitamin D supplements will mean 3.25 million fewer people would get at least one acute respiratory infection a year.”
PHE already advises everyone to take vitamin D supplements in autumn and winter for the sake of healthy bones and muscles.
They are recommended all year round for some people who get little sunlight on their skin, including people in care homes or those who cover up.
However, there is considerable debate about the importance of the latest study.
Prof Louis Levy, the head of nutrition science at PHE, said: “The evidence on vitamin D and infection is inconsistent and this study does not provide sufficient evidence to support recommending vitamin D for reducing the risk of respiratory tract infections.”
But Prof Martin Hewison, from the University of Birmingham and the Society for Endocrinology, said the findings were “striking”.
“I agree with the authors that this study supports a new indication for vitamin D beyond its established benefits for bone health,” he added.
And the research wing of the NHS, the National Institute for Health Research which funded the study, said the findings were “worthy of serious further debate”.
Ultimately, the researcher team at QMUL want vitamin D to be added to food like in the US where milk is fortified.
Prof Martineau said: “Vitamin D fortification of foods provides a steady, low-level intake of vitamin D that has virtually eliminated profound vitamin D deficiency in several countries.
“By demonstrating this new benefit of vitamin D, our study strengthens the case for introducing food fortification to improve vitamin D levels in countries such as the UK where profound vitamin D deficiency is common.”
Cancer drugs may be delayed after Brexit, say experts
Patients in the UK could face delays getting new drugs if Britain withdraws from the EU’s medicines regulator, ministers have been warned.
Former UK regulator Sir Alasdair Breckenridge said new cancer drugs could be among those affected.
Health Secretary Jeremy Hunt said he did not expect the UK to remain within the European Medicines Agency (EMA).
The Department for Health said Brexit offered new opportunities to bring timely access to new drugs.
Sir Alasdair told BBC Radio 4’s Today programme: “The UK market compared to the European market of course is small and they may decide not to come to the United Kingdom.
“So therefore there will be delay in getting new drugs – important new drugs, anti-cancer drugs, anti-infective drugs – for patients in the UK.”
The EMA authorises drugs for use across the EU and is currently based in the UK, although it is expected to leave after Brexit.
Sir Alasdair – who was the chairman of the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) for almost a decade – said companies could be slower to seek permission for Britain alone, as they may need to pay for a separate assessment of their product for use in the country.
His concerns echo those expressed by the current MHRA chairman Professor Sir Michael Rawlins, who said the UK could be at the back of the queue behind Japan, the US and the EU when drugs are introduced.
In previously unreported comments in January, he told peers: “One of the biggest worries I have about Brexit and standing alone as a regulator is that we are only 3% of the world market for new drugs and if we are not careful we are going to be at the back of the queue.”
The UK needed to carry out regulation more efficiently to cope, he added.
In January Jeremy Hunt said he did not expect the UK to remain within the EMA but was “hopeful” of being able to continue working closely with the regulator.
“Separate regulatory arrangements” would be put in place, he added.
David Jeffreys, the vice-president of Eisai – a Japanese drugs firm that employs 450 people in the UK – said British patients could face delays of up to two years.
He said: “The early innovative medicines will be applied for in the USA, in Japan and through the European system and the UK will be in the second or indeed the third wave so UK patients may be getting medicines, 12, 18, 24 months later than they would if we remained in the European system.”
Mr Jeffreys, who also speaks for the trade body the Association of the British Pharmaceutical Industry (ABPI), said they wanted the UK to agree a co-operation deal with the EMA, even if it did not remain part of the EU system.
The former chief executive of the MHRA, Sir Kent Woods, said he believed an agreement could be reached between the UK and the EU for drug regulation in the future, but was concerned about the issue getting absorbed in a wider debate about trade terms.
Moving the EMA from London could put its work overseeing the safety of medicines imported from outside the EU at risk, he added.
The Department of Health said ensuring patients have timely access to safe and effective medicines remains a priority for the government.
A spokeswoman added: “In fact, Brexit brings opportunities in this area, and we will be focused on whether we can secure even faster access to the latest innovations for British patients.
“So we are already taking action to ensure the UK continues to be a world leader and our cross-agency Brexit taskforce is considering the future regulatory roles the MHRA could adopt.”
The EMA is subject to rulings by the European Court of Justice, and Prime Minister Theresa May has said the UK must be outside the court’s jurisdiction.
Should I worry about arsenic in my rice?
Does rice really contain harmful quantities of arsenic? Dr Michael Mosley of Trust Me, I’m A Doctor investigates.
Many of us are regular consumers of rice – UK consumption is on the rise, and in 2015 we ate 150m kg of the stuff. But there have been reports about rice containing inorganic arsenic – a known poison – so should we be worried?
Arsenic occurs naturally in soil, and inorganic arsenic is classified as a category one carcinogen by the EU, meaning that it’s known to cause cancer in humans.
Trust Me, I’m A Doctor is on BBC Two on Wednesdays at 20:00 GMT –
The consequences of arsenic poisoning have been seen most dramatically in Bangladesh, where populations have been exposed to contaminated drinking water.
The result has been described as a “slow burning epidemic” of cancers, heart disease and developmental problems.
Because arsenic exists in soil, small amounts can get into food, though in general these levels are so low that they’re not a cause for concern.
Rice however, is different from other crops, because it’s grown under flooded conditions. This makes the arsenic locked in the soil more readily available, meaning that more can be absorbed into the rice grains.
This is why rice contains about 10-20 times more arsenic than other cereal crops. But are these levels high enough to do us any real harm?
“The only thing I can really equate it to is smoking,” says Prof Andy Meharg of Queen’s University Belfast, who has been studying arsenic for decades. “If you take one or two cigarettes per day, your risks are going to be a lot less than if you’re smoking 30 or 40 cigarettes a day. It’s dose-dependent – the more you eat, the higher your risk is.”
He believes that the current legislation isn’t strict enough, and that more needs to be done to protect those who eat a lot of rice.
Eating a couple of portions of rice a week isn’t putting an adult like me at high risk, but Prof Meharg is concerned about children and babies.
“We know that low levels of arsenic impact immune development, they impact growth development, they impact IQ development,” he says.
Because of this, the legislation is stricter around products specifically marketed at children – but many other rice products that they may also eat, such as puffed rice cereals, can contain adult levels of arsenic.
It sounds quite scary, even if you don’t eat lots of rice, but there’s an easy solution – a way to cook rice that dramatically reduces the arsenic content.
Now, some ways of cooking rice reduce arsenic levels more than others. We carried out some tests with Prof Meharg and found the best technique is to soak the rice overnight before cooking it in a 5:1 water-to-rice ratio.
That cuts arsenic levels by 80%, compared to the common approach of using two parts water to one part rice and letting all the water soak in. Using lots of water – the 5:1 ratio – without pre-soaking also reduced arsenic levels, but not by as much as the pre-soaking levels.
So, while I would now think twice about feeding young children too much rice or rice products, I’m not going to stop eating rice myself. I will, however, be cooking it in more water and, when I remember, leave it to soak overnight.
Almost two-thirds of children worry ‘all the time’
At nine, Tom was so worried about not being able to do his class work that he kept running out of the school gates.
More than once he tried to escape out of a first-floor window, convinced his teacher was criticising him.
He is not alone – research among 700 children aged 10 and 11 for the mental-health charity Place2Be suggests almost two-thirds worry “all the time”.
Concerns about family and friends and fear of failing at school are the top causes of anxiety, says the charity.
The school referred Tom and his mother for counselling sessions, run by the charity at the school.
Tom felt he could not learn and his mother could not get a job as she was so worried about what would happen if he ran home from school and found her gone.
Tom was taught breathing exercises to control his anger and reduce his anxiety – techniques he used for the rest of his school career.
“It helped me get through,” he said.
Eight years on he applied for a place on a performing arts course and says he owes his progress to the counselling sessions.
Place2Be surveyed children in the top primary year at 20 schools across England, Scotland and Wales at the end of 2016.
The entire year group in each school took part.
Their top concerns were:
- Family well-being – 54%
- Well-being of friends – 48%
- School work – 41%
- 40% felt their worries got in the way of school work
- Almost 30% said that once they started worrying they could not stop
- 21% said they did not know what to do when worried
There was a gender divide, with 36% of girls worrying about being bullied, compared with 22% of boys.
More girls (28%) worried about their looks than boys (18%).
But boys (24%) were more likely to worry about being angry than girls (16%).
The most common coping strategies were talking to family members (72%) or to friends (65%), while 65% of boys calmed themselves by playing computer games compared with 39% of girls.
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More than 80% of the children surveyed said the best way for adults to help was to listen sympathetically and pupils said it was important to be kind to anxious classmates. .
“I give them a hug and tell them not to worry and everything is OK,” said one 10-year-old.
The charity’s chief executive, Catherine Roche, said primary school was often characterised as innocent and happy.
“But in reality we know that young children can worry about a lot of things, whether it’s something going on at home, with their friends, or even about bad things happening in the world.
“It’s perfectly normal to worry from time to time, but if these worries become more serious or persistent, it’s important that children know where they can turn for help.
“Schools and families play a crucial role in ensuring that children learn to look out for each other and know how to get help if they need it.”
Some names have been changed.
Gene therapy: Deaf to hearing a whisper
Deaf mice have been able to hear a tiny whisper after being given a “landmark” gene therapy by US scientists.
They say restoring near-normal hearing in the animals paves the way for similar treatments for people “in the near future”.
Studies, published in Nature Biotechnology, corrected errors that led to the sound-sensing hairs in the ear becoming defective.
The researchers used a synthetic virus to nip in and correct the defect.
“It’s unprecedented, this is the first time we’ve seen this level of hearing restoration,” said researcher Dr Jeffrey Holt, from Boston Children’s Hospital.
About half of all forms of deafness are due to an error in the instructions for life – DNA.
In the experiments at Boston Children’s Hospital and Harvard Medical School, the mice had a genetic disorder called Usher syndrome.
It means there are inaccurate instructions for building microscopic hairs inside the ear.
In healthy ears, sets of outer hair cells magnify sound waves and inner hair cells then convert sounds to electrical signals that go to the brain.
The hairs normally form these neat V-shaped rows.
But in Usher syndrome they become disorganised – severely affecting hearing.
The researchers developed a synthetic virus that was able to “infect” the ear with the correct instructions for building hair cells.
Experiments showed that once profoundly deaf mice could hear sounds down to 25 decibels – about the volume of a whisper.
Dr Gwenaelle Geleoc told the BBC: “We were extremely surprised to see such a level of rescue, and we’re really pleased with what we have achieved.”
There are about 100 different types of genetic defect that can cause hearing loss. A different therapy would be needed for each one.
Dr Holt told the BBC News website: “We’ve really gotten a good understanding of the basic science, of the biology of the inner ear, and now we’re at the point of being able to translate that knowledge and apply it to human patients in the very near future.”
One of the big questions will be whether the synthetic virus is safe.
It was based on adeno-associated virus, which has already been used in other forms of gene therapy.
The researchers also want to prove the effect is long-lasting – they know it works for at least six months.
There are also questions about the “window of opportunity”. While the therapy worked in mice treated at birth, it failed when given just 10 days later.
Dr Ralph Holme, the director of research at Action on Hearing Loss, said: “This research is very encouraging.
“However, there is a concern that delivering this gene therapy at birth to babies with Usher may be too late [as the ears are more developed in people than mice by birth].
“The technology may be better suited to treating more progressive forms of hearing loss.”
Hospital operation ‘long waiters’ rise by 163%
The number of people facing “long waits” for hospital treatment in England has more than doubled in the past four years, figures show.
Patients needing routine care such as knee and hip replacements are meant to be treated in 18 weeks under NHS rules.
But the numbers waiting longer than that now top 350,000 – a 163% rise since 2012. There are 3.7 million people in total on the waiting list.
The government promised the NHS would do “better in the future”.
Scotland, Wales and Northern Ireland have also seen pressures grow – meaning no part of the UK is now meeting its target to see patients.
Royal College of Surgeons president Clare Marx said the picture was “very disappointing” as these operations and treatments could make a huge difference to people’s lives.
“Someone waiting for a gall-stone removal will be in a lot of pain and discomfort.
“The longer you wait for a hip or knee replacement the less likely you are to have good outcomes. These waits really matter.
“The standards of care are being eroded and we don’t want it to get worse.”
But Richard Murray, from the King’s Fund think tank, predicts the numbers on the waiting list will keep rising.
The total of 3.7m is a 44% increase since 2012, but he expects to see the trend continue and break through the four million barrier by the spring.
“If you go back 15 years waiting lists were longer, but it is now heading in the wrong direction.”
One of those affected has been Nikki Alldis, who lives in the South East.
She has been waiting 15 months for a bowel operation. It has twice been cancelled.
She said the wait had been very difficult and she was “gutted” the last time it was put off in January. “It’s hanging over me.”
How ‘long waiters’ have risen since 2012
England: Up 163%
Northern Ireland: Up 95%
Scotland: Up 82%
Wales: Up 74%
The figures are the percentage rise in the number of waits over the target time for treatment in each nation
The latest figures cover the month of November and mean the target for the NHS – that at least 92% of patients on waiting lists will not have been waiting over 18 weeks – has been missed since February last year.
A Department of Health spokesman said the NHS was having to treat more patients – 5,000 extra a day compared with 2010 – so the levels of performance were actually a “tribute” to the work of NHS staff.
He said the investment being made in the NHS this Parliament would help “transform services” and mean the NHS will do “better in the future”.
The targets for routine treatments are measured differently in Wales, Scotland and Northern Ireland, but all show a similar picture.
In Wales, 95% of patients are supposed to start treatment within 26 weeks. This target has not been met since August 2010 and the number of long waiters has risen by 74% to 60,643 in November 2016.
Scotland’s target is for 90% of patients to start treatment within 18 weeks. This has been missed since June 2014. The number waiting longer than 18 weeks was up 82% over that period at 16,635.
Northern Ireland has a target of 55% per cent of patients waiting no more than 13 weeks for an operation. The number waiting longer than that was up 95% in the four years to September 2016.
Misophonia: Scientists crack why eating sounds can make people angry
Why some people become enraged by sounds such as eating or breathing has been explained by brain scan studies.
The condition, misophonia, is far more than simply disliking noises such as nails being scraped down a blackboard.
“I feel there’s a threat and get the urge to lash out – it’s the fight or flight response,” says patient Olana Tansley-Hancock, 29, from Kent.
UK scientists have shown some people’s brains become hardwired to produce an “excessive” emotional response.
Olana developed the condition when she was eight years old. Her trigger sounds include breathing, eating and rustling noises.
She told BBC News: “Anyone eating crisps is always going to set me off, the rustle of the packet is enough to start a reaction.
“It’s not a general annoyance, it’s an immediate ‘Oh my God, what is that sound?’ I need to get away from it or stop it’.
“I spent a long time avoiding places like the cinema. I’d have to move carriages seven or eight times on 30-minute train journeys, and I left a job after three months as I spent more time crying and having panic attacks than working.”
Scientists at multiple centres in the UK scanned the brains of 20 misophonic people, including Olana, and 22 people without the condition.
They were played a range of noises while they were in the MRI machine, including:
- neutral sounds such as rain
- generally unpleasant sounds such as screaming
- people’s trigger sounds
The results, published in the journal Current Biology, revealed the part of the brain that joins our senses with our emotions – the anterior insular cortex – was overly active in misophonia.
And it was wired up and connected to other parts of the brain differently in those with misophonia.
Dr Sukhbinder Kumar, from Newcastle University, told BBC News: “They are going into overdrive when they hear these sounds, but the activity was specific to the trigger sounds not the other two sounds.
“The reaction is anger mostly, it’s not disgust, the dominating emotion is the anger – it looks like a normal response, but then it is going into overdrive.”
There are no treatments, but Olana has developed coping mechanisms such as using ear plugs.
She also knows caffeine and alcohol make the condition worse, “which is rubbish”.
“But I have a relatively mild case and am still able to have a job, I know a lot of people who aren’t able to have that, I feel quite fortunately really,” she said.
It is still not clear how common the disorder is, as there is no clear way of diagnosing it and it was only recently discovered.
Ultimately, the researchers hope, understanding the difference in the misophonic brain will lead to new treatments.
One idea is that low levels of targeted electricity passed through the skull, which is known to adjust brain function, could help.
Tim Griffiths, a professor of cognitive neurology at Newcastle University and University College London, said: “I hope this will reassure sufferers.
“I was part of the sceptical community myself until we saw patients in the clinic and understood how strikingly similar the features are.
“We now have evidence to establish the basis for the disorder through the differences in brain control mechanism in misophonia.”
Completely ‘locked-in’ patients can communicate
Patients with absolutely no control over their body have finally been able to communicate, say scientists.
A brain-computer interface was used to read the thoughts of patients to answer basic yes-or-no questions.
One man was able to repeatedly refuse permission for his daughter to get married.
The study on four patients in Switzerland – published in PLOS Biology – also showed they were happy despite the effects of being “locked-in”.
The patients all had advanced forms of amyotrophic lateral sclerosis, in which the brain loses the ability to control muscles.
It eventually traps people in their own body – they are able to think, but incapable of moving or talking.
When they become “locked in”, it can still be possible to develop ways of communication using eye movements.
But all the patients in the study, at the Wyss Center in Switzerland, were “completely locked in” and could not even move their eyes.
The activity of brain cells can change oxygen levels in the blood, which in turn changes the colour of the blood.
And scientists were able to peer inside the brain using light to detect the blood’s colour, through a technique called near-infrared spectroscopy.
They then asked the patients yes-or-no questions such as: “Your husband’s name is Joachim?” to train a computer to interpret the brain signals.
The system achieved an accuracy of about 75%.
It means questions need to be asked repeatedly in order to be certain of a patient’s answer.
Prof Ujwal Chaudhary, one of the researchers, told BBC News: “It makes a great difference to their quality of life.
“Imagine if you had no means of communicating and then you could say yes or no – it makes a huge impact.”
In one case a daughter wanted the blessing of her completely locked-in father before marrying her boyfriend.
But eight times out of 10 the answer came back no.
“We don’t know why he said no,” said Prof Chaudhary.
“But they got married… nothing can come between love.”
The form of communication is being used for more practical day-to-day means such as finding out if patients are in pain or want a family visit.
Prof John Donoghue, the director of the Wyss Center, told the BBC: “If a person who is totally locked-in is able to communicate, you’re freeing the mind to interact with the world around them.
“That is remarkable.”
Girls lose faith in their own talents by the age of six
Girls start to see themselves as less innately talented than boys do when they are only six years old, a group of US researchers has said.
They said the “disheartening” results suggested the problem could snowball to affect future careers.
The study on 400 children, in the journal Science, initially found both five-year-old boys and girls thought their own gender was “brilliant”.
But then only one year later, gender differences had emerged.
The team from Princeton University, New York University and the University of Illinois said it appeared stereotypes were starting to show.
Suspected influences include exposure to media, teachers, parents and other children.
The study put sets of five, six and seven-year-olds through different experiments.
In one, the children were read a story about someone who is “really, really smart” but it is not clear who the story is about.
They then had to guess the protagonist from four pictures – two of men and two of women.
At age five, boys pick men and girls pick women around 75% of the time. But fast-forward a year to age six and boys are still picking men while girls are now slightly more likely to pick men too.
In another scenario, groups of children played a new board game.
But for some it was branded as “for children who are really, really smart” and for others it was described as “for children who try really, really hard”.
Six and seven-year old girls were as likely as boys to enjoy the game for those who try, but much less likely to say they enjoy the game for smart children.
Prof Andrei Cimpian, one of the researchers, told the BBC News website: “The message that comes out of these data is that young kids are exposed to the cultural notion that genius is more likely a male than a female quality.
“It’s disheartening to see these effects emerge so early. When you see them, you realise how much of an uphill battle it’s going to be.”
His research has previously looked at academic careers associated with needing innate brilliance in order to succeed.
It argued that the higher people rated the need for genius – such as in physics or philosophy – the lower the number of women involved.
Prof Cimpian added: “Early on, society’s stereotypes can create differences in trajectory.
“At five, six or seven you’re not thinking about a career, but soon you’re making decisions about what courses to take and what extracurriculars to take part in.
“Even if the difference starts small it can snowball into something a lot bigger.”
Fellow researcher Dr Lin Bian advised parents and teachers to emphasise the importance of hard work.
She told the BBC: “[Studies suggest] that everyone does better when hard work is believed as the key to success.
“In our studies, girls might be particularly impacted by the messages focusing on ‘hard work’ – they became equally interested in playing the game as boys.
“Thus conveying the importance of hard work to success could protect and even promote young girls’ interests.”
The UK’s Fawcett Society campaigns on the gender pay gap and argues early differences – blue and superheroes versus pink and princesses – is part of the problem.
Sam Smethers, the organisation’s chief executive, said: “This is a massive issue and it is holding us all, but particularly girls, back.
“Our research found that young women experienced gender stereotypes at school and from an early age.”
Robots could help solve social care crisis, say academics
Humanoid robots, with cultural awareness and a good bedside manner, could help solve the crisis over care for the elderly, academics say.
An international team is working on a £2m project to develop versatile robots to help look after older people in care homes or sheltered accommodation.
The robots will offer support with everyday tasks, like taking tablets, as well as offering companionship.
Academics say they could alleviate pressures on care homes and hospitals.
Researchers from Middlesex University and the University of Bedfordshire will assist in building personal social robots, known as Pepper Robots, which can be pre-programmed to suit the person they are helping.
It is hoped culturally sensitive robots will be developed within three years. The programme is being funded by the EU and the Japanese government.
Prof Irena Papadopoulos, expert in trans-cultural nursing, said: “As people live longer, health systems are put under increasing pressure.
“In the UK alone, 15,000 people are over 100 years of age and this figure will only increase.
“Assistive, intelligent robots for older people could relieve pressures in hospitals and care homes as well as improving care delivery at home and promoting independent living for the elderly.
“It is not a question of replacing human support but enhancing and complementing existing care.”
She added: “We are starting with care homes and with people who are semi-independent living in sheltered housing, but we do believe that in the future the robots would become acceptable for people to have in their own homes.”
Pepper Robots are manufactured by Softbank Robotics and already used in thousands of homes in Japan.
Amit Humar Pandey, the company’s chief scientist, said the firm wanted to create a world where robots co-exist with humans in harmony, for a smarter, healthier, safer and happier life.
It is hoped the new robots will help improve the well-being of their charges by providing entertainment and enabling them to connect better, through smart appliances, with family and the outside world.
They will communicate through speech and with gestures, be able to move independently and pick up signs the elderly person is unwell or in pain.
Similar robots are already being used in hospitals in Japan to perform tasks such as lifting patients and serving food
In the final year of the project, the robots will be tested at Advinia Healthcare care homes in the UK.
The company’s executive chairman Dr Sanjeev Kanoria said it was keen to revolutionise the care of the elderly by supporting hard-working care staff.
“Robots can support care workers by helping to reduce errors in medication and assisting them with advanced technology to help vulnerable residents, live safer independent lives in care homes and at home.”
Artificial intelligence ‘as good as cancer doctors’
Artificial intelligence can identify skin cancer in photographs with the same accuracy as trained doctors, say scientists.
The Stanford University team said the findings were “incredibly exciting” and would now be tested in clinics.
Eventually, they believe using AI could revolutionise healthcare by turning anyone’s smartphone into a cancer scanner.
Cancer Research UK said it could become a useful tool for doctors.
The AI was repurposed from software developed by Google that had learned to spot the difference between images of cats and dogs.
It was shown 129,450 photographs and told what type of skin condition it was looking at in each one.
It then learned to spot the hallmarks of the most common type of skin cancer: carcinoma, and the most deadly: melanoma.
Only one in 20 skin cancers are melanoma, yet the tumour accounts for three-quarters of skin cancer deaths.
The experiment, detailed in the journal Nature, then tested the AI against 21 trained skin cancer doctors.
One of the researchers, Dr Andre Esteva, told the BBC News website: “We find, in general, that we are on par with board-certified dermatologists.”
However, the computer software cannot make a full diagnosis, as this is normally confirmed with a tissue biopsy.
Dr Esteva said the system now needed to be tested alongside doctors in the clinic.
“The application of AI to healthcare is, we believe, an incredibly exciting area of research that can be leveraged to achieve a great deal of societal good,” he said.
“One particular route that we find exciting is the use of this algorithm on a mobile device, but to achieve this we would have to build an app and test its accuracy directly from a mobile device.”
Incredible advances in machine-learning have already led to AI beating one of humanity’s best Go players.
And a team of doctors in London have trained AI to predict when the heart will fail.
Dr Jana Witt, from the charity Cancer Research UK, said: “Using artificial intelligence to help diagnose skin cancer is very interesting, as it could support assessments by GPs and dermatologists.
“It’s unlikely that AI will replace all of the other information your clinician would consider when making a diagnosis, but AI could help guide GP referrals to specialists in the future.”
Personality linked to ‘differences in brain structure’
Our personality traits are linked to differences in the thickness and volume of various parts of our brains, an international study has suggested.
Those with thicker and less wrinkled outer layers of the brain tended to have more neurotic tendencies, the study of scans of 500 people found.
Open-minded people were more likely to have thinner outer brain layers, it said.
Experts said the study, while worthy, was difficult to interpret.
‘Extraversion and agreeableness’
Published in the journal Social Cognitive and Affective Neuroscience, the study by scientists from the UK, US and Italy looked in detail at the brain scans of 500 young, healthy volunteers.
The volunteers also filled in questionnaires designed to assess five personality traits – neuroticism (how moody a person is), extraversion (how enthusiastic a person is), openness (how open-minded a person is), agreeableness and conscientiousness.
They found the different traits were linked to differences in the thickness of the cortex (the outer layer of the brain), how folded the cortex was and the overall volume of the brain.
Researcher Dr Luca Passamonti from Cambridge University said the research could help them understand more about mental health over time.
He added: “Linking how brain structure is related to basic personality traits is a crucial step to improving our understanding of the link between the brain morphology and particular mood, cognitive or behavioural disorders.
“We also need to have a better understanding of the relation between brain structure and function in healthy people to figure out what is different in people with neuropsychiatric disorders.”
‘How nerves connect’
The scientists acknowledged more research was needed to firm up their conclusions.
Michael Anderson, an associate professor of psychology at Franklin and Marshall College, said the study was difficult to interpret, although it was “carefully done, using well-controlled methods.”
He said: “Most regions of the brain are associated with multiple cognitive and behavioural functions, so it can be difficult to say with any confidence which functions are relevant to these particular associations.”
He added: “Brain function is less a matter of the number of nerve cells being used or the amount of brain tissue being used and more about how nerves connect to each other – which is not investigated in this study.”
World’s smallest MRI helps tiny babies
Doctors in Sheffield are pioneering the use of a compact MRI scanner for imaging the brains of premature babies.
The machine, at the Royal Hallamshire Hospital, is one of only two purpose-built neonatal MRI scanners in the world.
At present, ultrasound is normally used to scan the brains of newborns.
Prof Paul Griffiths, of the University of Sheffield, said MRI was better at showing the structures of the brain and abnormalities more clearly.
So far about 40 babies have been imaged in the MRI scanner, which was built by GE Healthcare with funding by the Wellcome Trust.
One of them, Alice-Rose, was born at 24 weeks and had two bleeds in the brain.
Her parents, Shaun and Rachael Westbrook, said the MRI scan was very helpful.
Shaun told me: “It’s a much crisper image and a lot easier to understand than the ultrasound.”
Rachael added: “It’s been a rollercoaster since Alice-Rose was born on 6 November: not everything was fully formed, and she still weighs only 2lb 13oz (1.28kg).
“The MRI was reassuring as it meant you got a better look at her brain.”
Ultrasound of the brain is possible in newborn babies only because the bones in their skull are not yet fused.
Ultrasound v MRI
The sound waves can travel through the two fontanelles – the soft spots between the bones.
Prof Griffiths said: “Ultrasound is cheap, portable and convenient, but the position of the fontanelles means there are some parts of the brain which cannot be viewed.
“MRI is able to show all of the brain and the surrounding anatomy, making the images easier to explain to parents.
“From a diagnostic point, the big advantage is that MRI is able to show a wider range of brain abnormalities, in particular those which result from a lack of oxygen or blood supply.”
MRI scans are rarely performed on severely premature babies because the risks involved in transferring and handling a sick infant can outweigh the benefits.
Prof Griffiths said: “MRI machines are huge, heavy objects which are sited in the basement or ground floor of hospitals, whereas maternity units are usually higher up, or in a completely different building, so it can mean a complicated journey to get a baby to and from the scanner.”
Evelina Children’s Hospital in London has a full-size MRI scanner within the neonatal intensive care unit.
The compact baby MRI machine at the Royal Hallamshire is not much bigger than a washing machine and just metres away from the neonatal intensive care unit, meaning that specialist staff are on hand in case of problems.
The concept for a dedicated neonatal scanner was originally developed more than a decade ago by Prof Griffiths and Prof Martin Paley, of the University of Sheffield.
Two prototype 3 Tesla neonatal MRIs were eventually built – the other is in Boston Children’s Hospital in Massachusetts – although it is no longer in use.
Neither machine has regulatory approval for clinical use, and both remain purely for research.
Prof Griffiths said the next step would be to do a trial in premature babies to show definitively that MRI produces a better diagnosis and whether it altered the clinical management of children.
It is not known how much a neonatal MRI machine would cost, should the system eventually get commercialised, but full-size scanners are typically priced at several hundred thousand pounds.
Cincinnati Children’s Hospital has a 1.5 Tesla neonatal MRI scanner that was adapted from adult orthopaedic use.
Light at night may disrupt sleep and health
These are among the darkest days of the year — or they would be, if we lived like our ancestors, with nothing but the stars and moon to light our way between sunset and sunrise.
Instead, most of us live in cities and towns illuminated by street lights and in homes lit by lamps, ceiling fixtures, cell phones, tablets, computers and TV sets. For the 15 million Americans who work night shifts, the lights stay on all night.
All that artificial brightness has benefits. We can read our e-books, post on Facebook or make a living at any hour. But there also are possible health risks when we get too much of the wrong kind of light at the wrong time.
And that’s exactly what many of us are doing, some research suggests.
“Light is a stimulus that can have impacts on health, well-being and performance,” for good and ill, says George Brainard, professor of neurology at Thomas Jefferson University.
Light has this power because it drives our central circadian clock. Ideally, that internal clock produces daytime alertness and nighttime sleepiness on a predictable 24-hour schedule. Receptors in our eyes play key roles, taking their cues from the intensity and wavelengths of light we are exposed to each day and night.
Bright natural daylight is rich in blue wavelengths that can alert us and suppress the release of melatonin, a hormone that helps us fall asleep. When we get bright light, especially bright blue light, at night, it can disrupt sleep and might even contribute to weight gain, cancer susceptibility and other health problems, some studies suggest.
“No one is saying we should turn off all the lights,” says Mario Motta, a cardiologist in Salem, Mass., who has worked with the American Medical Association (AMA) to bring attention to nighttime light exposure. But, he says, it is time to take some steps to reduce possible harms.
The World Health Organization also has also chimed in, saying that nighttime shift work is linked with higher breast cancer rates. Chronic nighttime light exposure and suppression of melatonin, which has anti-cancer effects, could be at least partly to blame, the group says.
Still, research remains “in early days,” Brainard cautions. He is leading a study of an LED (light-emitting diode) lighting system for the International Space Station that will create bright blue light early in the day, a mid-range white light for working hours and dimmer, warmer light before bedtime. If it works, astronauts will be more alert and productive during the day and able to sleep better at night — and the rest of us might learn a few things too.
“But there’s a real need to test this and make sure it works the way we think it will work,” he says.
For now, here’s what earthbound humans should know about:
The big picture.
The less bright light you get during the day, the more susceptible you are to light disruption at night. So a hermit-like office worker may be more affected by a night of Web surfing than an outdoor construction worker would be. An office worker who takes an outdoor daytime walk might get some protection.
In a 2016 report, the AMA suggested communities avoid the use of bright LED street lights with high blue light levels. It noted that warmer versions are available. The intense lights can cause dangerous glare, especially for older drivers, and might contribute to poor sleep and other health harms in heavily-lit neighborhoods, the group said.
Mark Rea, director of the industry-supported Lighting Research Center at Rensselaer Polytechnic Institute, is skeptical that street lights will turn out to be important circadian disrupters. “You are not looking directly at the light fixture and you are not out there long enough to be affected,” he says.
And, he says, there are ways to install and adjust LED street lights that should minimize glare.
Some research suggests nighttime use of blue-light emitting computer, tablet and phone screens might disrupt sleep. In one small experiment, readers were asked to use either tablets or paper books at night. Tablet users took longer to fall asleep and were less rested the next day.
But any such effects depend “on how far away it is from your eyes, how bright it is, how much blue light it emits,” and how much light you get during the day, says Charmane Eastman, a professor of behavior sciences at Rush University Medical Center.
It makes sense to turn off devices in the hour or two before bedtime, says Mariana Figueiro, a professor at the Rensselaer lighting center. “If you can’t turn it off, dim it down and turn down the color if you can,” she says. You can turn down the blue light on an iPhone or iPad by choosing the “night shift” setting.
While lab studies show almost any amount of light at night can suppress melatonin, “the evening light levels in homes are extremely low,” and unlikely to cause major problems, Rea says.
Still, all bulbs sold for home use — whether incandescent, fluorescent or LED — are rated for for brightness (lumens) and color (with kelvin scores, typically ranging a warm amber 2500 to a cool blue 6500). And some LED lighting systems allow users to adjust color and brightness. So homeowners who want warmer, dimmer light at night can get it.
Vaccines for three deadly viruses fast-tracked
Scientists have named three relatively little-known diseases they think could cause the next global health emergency.
A coalition of governments and charities has committed $460m to speed up vaccine development for Mers, Lassa fever and Nipah virus.
They are asking funders at the World Economic Forum Davos for another $500m.
The Coalition for Epidemic Preparedness Innovations (Cepi) aims to have two new experimental vaccines ready for each disease within five years.
New vaccines usually take about a decade to develop and cost hundreds of millions of dollars.
The Ebola outbreak in West Africa, closely followed by the Zika epidemic in Latin America, exposed just how “tragically unprepared” the world is for new outbreaks.
Jeremy Farrar, director of the Wellcome Trust, one of the founding members of Cepi, said: “Before the 2014 outbreak we only had very small Ebola epidemics that were in isolated communities that we were able to control.
“But in the modern world with urbanisation and travel, 21st Century epidemics could start in a big city and then take off the way Ebola did in West Africa.
“We have to be much better prepared.”
Ebola killed more than 11,000 people in Liberia, Sierra Leone and Guinea.
The arrival of the Zika virus in Brazil in 2015 has left thousands of children brain-damaged.
During both outbreaks, there were no treatments or vaccines to prevent people getting sick.
Scientists scrambled to resurrect research on these obscure diseases.
Effective vaccines were eventually developed during the Ebola outbreak, but only as it started to wane.
Nevertheless, governments, scientists and regulators all came together with unprecedented speed, and managed to expedite the notoriously complex development and regulatory processes.
Cepi wants to continue that momentum and develop vaccines for other viruses so that by the time an outbreak hits, experimental vaccines are ready to be sent to affected areas for large human trials that can establish how effective the vaccine is.
Lassa, Middle East Respiratory Syndrome (Mers) and Nipah virus are “top of the list” of 10 priority diseases that the World Health Organization (WHO) has identified as potentially causing the next major outbreak.
Dr Marie-Paule Kieny, assistant director-general of the WHO, said: “Besides the known threats – such as Ebola and others – there are also all those viruses that are known but are thought to be very benign.
“They could mutate and become more dangerous for humans.
“Then there are the things that are completely unknown to us at the moment,” said Dr Kieny.
The lottery of viruses that could hit us next makes it very difficult to plan for the future.
Pharmaceutical companies aren’t lining up to invest in these little-known viruses because there is no commercial market for them.
However, some have come on board with this new alliance, including GSK and Johnson and Johnson.
“We’ve got lucky so far,” said Jeremy Farrar, because recent outbreaks haven’t become airborne.
But he said a far more contagious version of an Ebola like virus could emerge.
“I could cough it over you today and you could cough it over someone tomorrow and it could spread very quickly.
“That puts the world in a very vulnerable place.”
Brain activity ‘key in stress link to heart disease’
The effect of constant stress on a deep-lying region of the brain explains the increased risk of heart attack, a study in The Lancet suggests.
In a study of 300 people, those with higher activity in the amygdala were more likely to develop cardiovascular disease – and sooner than others.
Stress could be as important a risk factor as smoking and high blood pressure, the US researchers said.
Heart experts said at-risk patients should be helped to manage stress.
Emotional stress has long been linked with an increased risk of cardiovascular disease (CVD), which affects the heart and blood vessels – but the way this happens has not been properly understood.
This study, led by a team from Harvard Medical School, points to heightened activity in the amygdala – an area of the brain that processes emotions such as fear and anger – as helping to explain the link.
The researchers suggest that the amygdala signals to the bone marrow to produce extra white blood cells, which in turn act on the arteries causing them to become inflamed. This can then cause heart attacks, angina and strokes.
As a result, when stressed, this part of the brain appears to be a good predictor of cardiovascular events.
But they also said more research was needed to confirm this chain of events.
The Lancet research looked at two different studies. The first scanned the brain, bone marrow, spleen and arteries of 293 patients, who were tracked for nearly four years to see if they developed CVD. In this time, 22 patients did, and they were the ones with higher activity in the amygdala.
The second very small study, of 13 patients, looked at the relationship between stress levels and inflammation in the body.
It found that those who reported the highest levels of stress had the highest levels of amygdala activity and more evidence of inflammation in their blood and arteries.
Dr Ahmed Tawakol, lead author and associate professor of medicine at Harvard Medical School, said: “Our results provide a unique insight into how stress may lead to cardiovascular disease.
“This raises the possibility that reducing stress could produce benefits that extend beyond an improved sense of psychological wellbeing.
What does the amygdala do?
It’s the part of the brain that prepares you for fight or flight, becoming activated by strong emotional reactions.
The amygdalae (because there are two of them – one on each side of the brain) are almond-shaped groups of cells located deep within the medial temporal lobes of the brain.
In humans and animals, the amygdala is linked to responses to both fear and pleasure.
The term amygdala – which means almond in Latin – was first used in 1819.
Dr Tawakol added: “Eventually, chronic stress could be treated as an important risk factor for cardiovascular disease, which is routinely screened for and effectively managed like other major cardiovascular disease risk factors.”
Commenting on the research, Dr Ilze Bot, from Leiden University in the Netherlands, said more and more people were experiencing stress on a daily basis.
“Heavy workloads, job insecurity or living in poverty are circumstances that can result in chronically increased stress, which in turn can lead to chronic psychological disorders such as depression.”
Emily Reeve, senior cardiac nurse at the British Heart Foundation, said reducing the risk of heart disease and stroke from stress normally focused on controlling lifestyle habits such as smoking, drinking too much alcohol and overeating – but this should change.
“Exploring the brain’s management of stress and discovering why it increases the risk of heart disease will allow us to develop new ways of managing chronic psychological stress.
“This could lead to ensuring that patients who are at risk are routinely screened and that their stress is managed effectively.”
Weekend exercise alone ‘has significant health benefits’
Cramming all your recommended weekly exercise into one or two weekend sessions is enough to produce important health benefits, a study suggests.
And being active without managing 150 minutes of moderate activity a week was still enough to reduce the risk of an early death by a third.
The findings are based on a survey of about 64,000 adults aged over 40 in England and Scotland.
Health experts said purposeful exercise was key to better health.
Researchers from Loughborough University and the University of Sydney analysed data on the time people spent doing exercise and their health over 18 years.
They found that no matter how often people exercised in a week or for how long, the health benefits were similar as long as they met the activity guidelines.
Fighting the flab
This was good news for people with a busy lifestyle who turned into “weekend warriors” in order to fit in all their recommended physical activity, they said.
Compared with those who didn’t exercise at all, people who did some kind of physical activity – whether regularly or irregularly – showed a lower risk of dying from cancer and from cardiovascular disease (CVD), which can lead to heart attacks and strokes.
“Weekend warriors”, who did all their exercise on one or two days of the week, were found to lower their risk of dying from CVD by 41% and cancer by 18%, compared with the inactive.
Those who exercised regularly on three or more days per week reduced their risks by 41% and 21%.
Even the “insufficiently active” lowered their risk by a significant amount – 37% and 14%, the researchers said, writing in an article published online in JAMA Internal Medicine.
How much physical activity should I do?
People aged 19-64 should try to do:
- at least 150 minutes of moderate aerobic activity, such as cycling or fast walking every week, and
- strength exercises (such as lifting weights) on two or more days a week that work all the major muscles
- 75 minutes of vigorous aerobic activity, such as running or a game of singles tennis every week, and
- strength exercises on two or more days a week that work all the major muscles
- a mix of moderate and vigorous aerobic activity every week, such as two 30-minute runs plus 30 minutes of fast walking, and
- strength exercises on two or more days a week that work all the major muscles
Source: NHS Choices and Public Health England
What do you think? Join the debate on the BBC Lifestyle & Health Facebook page.
Dr Gary O’Donovan, study author and expert in physical activity and health, from Loughborough University, said the key was doing exercise that was “purposeful, and done with the intention of improving health”.
“You are not going to fidget or stand your way to health,” he said.
He added that a commitment to an active lifestyle was usually accompanied by other healthy lifestyle options, which made a positive difference regardless of body mass index (BMI).
But Dr O’Donovan said no-one yet knew the best way of meeting the weekly recommended exercise total.
‘Every little counts’
The study cannot show a direct link between physical activity and a reduction in health risks in individuals.
But extensive research has shown that exercise and a healthy diet can reduce the risk of a range of diseases – such as cancer, heart disease and type-2 diabetes – as well as helping to control weight, blood pressure and reduce symptoms of depression.
Justin Varney, national lead for adult health and wellbeing at Public Health England (PHE), said: “The maximum health benefits are achieved from 150 minutes of moderate activity per week.
“However, every little counts and just 10 minutes of physical activity will provide health benefits.”
PHE’s How Are You quiz gives you a health score and links to free local information, apps and tools to improve that score.
Mental health reforms to focus on young people, says PM
Plans to “transform” attitudes to mental health, with a focus on children and young people, have been announced by Theresa May.
Additional training for teachers, an extra £15m for community care, and improved support in the workplace were among measures announced by the PM.
Mental health experts said more funding was needed to improve services.
Mrs May’s speech comes as she outlined her plans to use the state to create a “shared society”.
The government says one in four people has a mental disorder at some point in their life, with an annual cost of £105bn.
Figures show young people are affected disproportionately with over half of mental health problems starting by the age of 14 and 75% by 18.
The prime minister said mental health had been “dangerously disregarded” as secondary to physical health and changing that would go “right to the heart of our humanity”.
In the speech at the Charity Commission, Mrs May announced:
- Every secondary school to be offered mental health first aid training – which teaches people how to identify symptoms and help people who may be developing a mental health issue
- Trials on strengthening links between schools and NHS specialist staff, including a review of children and adolescent services across the country
- By 2021, no child will be sent away from their local area to receive treatment for mental health issues
- Appointing mental health campaigner Lord Stevenson and Paul Farmer, chief executive of the charity Mind, to carry out a review on improving support in the workplace
- Employers and organisations will be given additional training in supporting staff who need to take time off
- More focus on community care such as crisis cafes and local clinics, with an extra £15m towards this, and less emphasis on patients visiting GPs and A&E
- The reallocation of £67.7m, mostly from the existing NHS digitisation fund, for online services, such as allowing symptom checks before getting a face-to-face appointment
- A review of the “health debt form”, under which patients are charged up to £300 by a GP for documentation to prove to debt collectors they have mental health issues
Health Secretary Jeremy Hunt told the BBC care for children and young people was a “black spot” that needed urgent attention as the pressures of social media, cyber bullying and a big increase in self-harming was a “massive worry for parents”.
Mental health charity Sane said the plans needed to “be matched by substantially increased funds to mental health trusts” while Mind said it was “important to see the prime minister talking about mental health” but the proof would be in the difference it made to patients’ day-to-day experiences.
Dr Sangeeta Mahajan, whose 20-year-old son Sargaar killed himself after being diagnosed with bipolar disorder, said better access to services was essential.
“They don’t discharge patients with adequate information,” she said. “The doors were closed to us.
“We were told you either go to A&E or your GP and that is the only way you can come back to us.
“We had no direct access back to the specialist services. That is wrong.”
Bed shortages have meant some patients have had to travel hundreds of miles for treatment.
Fiona Hollings, 19, was treated in a specialist eating disorder unit for her anorexia in Glasgow – nearly 400 miles away from her family home in High Wycombe, Buckinghamshire.
Raising the profile of mental health
By Hugh Pym, BBC health editor
Mental health campaigners certainly recognise the significance of the latest initiative headed by the prime minister.
Theresa May’s focus on mental illness in her first major speech on health will in itself raise the profile of the issue and reaffirm the drive to achieve true “parity of esteem” with physical health.
Promoting mental health first aid training in schools in England illustrates the prime minister’s desire to see this as more than an NHS-only issue.
But there is no new Treasury money for the plans. Funding for care is still challenging. NHS Providers, representing mental health and other trusts, predicts the share of local NHS budgets devoted to mental health will fall next year.
Ministers will argue money isn’t everything but it remains an unresolved part of the mental health agenda.
Professor Sir Simon Wessely, president of the Royal College of Psychiatrists, welcomed Mrs May’s “new and bold vision”, but added: “We have a long way to go before mental health services are on an equal footing with those for physical disorders.”
Businesses also welcomed the workplace initiatives.
Simon Walker, director general at the Institute of Directors, said employers had “a real role to play” in ensuring the mental health of their workforce.
But while education leaders backed the ideas that focused on young people, they also had concerns.
Malcolm Trobe of the Association of School and College Leaders, said the major problem schools faced was a lack of access to local specialist NHS care and said government plans had to be “backed up with the funding”.
Russell Hobby, of school leaders’ union NAHT, agreed: “Rising demand, growing complexity and tight budgets are getting in the way of helping the children who need it most.”
Liberal Democrat Norman Lamb, a former health minister, said Mrs May was announcing policies already agreed under the coalition government and called it “a puny response” to “cover up for this government’s failure” on delivering, while Barbara Keeley, Labour’s shadow minister for mental health, questioned why funding was not being ring fenced.
Mr Hunt said the government had endured a “slightly patchy start” with funding, but that with about £1bn more being spent on mental health than two years ago things were “going in the right direction”.
In her speech the prime minister also described her wish to create a “shared society”, with the state taking a greater role in ending “unfairness”.
The emphasis on a “shared society” marks a contrast with her predecessor David Cameron’s “Big Society” agenda, which relied on voluntary organisations rather than state intervention.
Kids devouring too much ‘breakfast sugar’ warning
Children are packing in so much sugar at breakfast that half their daily allowance has already been eaten before school, Public Health England says.
It warns that sugary cereals, juices and spreads are all damaging to health.
Rotting teeth, ballooning waistlines and long-term health problems like type 2 diabetes are caused by unhealthy diets.
Officials are encouraging parents to use an app that reveals the sugar content of food and drink.
Around a quarter of five-year-olds have tooth decay and nearly a fifth of children are already obese by the time they leave primary school.
Sugar is the prime culprit with the National Diet and Nutrition Survey showing four- to 10-year-olds consuming twice as much sugar as they should be.
A survey of 200 parents with children aged four to 10 revealed the problem starts at breakfast.
It found children were eating more than 11g of sugar or nearly three sugar cubes, on average, at breakfast alone.
That adds up to more than 1,000 cubes of sugar at breakfast over the course of a year.
How much sugar should children eat?
age 2 – less than 13 grams or 3 cubes per day
age 3 – less than 15 grams or 4 cubes per day
age 4 to 6 – less than 19 grams or 5 cubes per day
age 7 to 10 years – less than 24 grams or 6 cubes per day
A small bowl of sugary breakfast cereal contains around two cubes of sugar, spreading chocolate spread on toast racks up three sugar cubes and a glass of fruit juice has a whopping five cubes in it.
Dr Alison Tedstone, the chief nutritionist at Public Health England, said: “Children have far too much sugar, and a lot of it is before their first lesson of the day.
“It’s crucial for children to have a healthy breakfast, but we know the mornings in a busy household can be fraught.”
The survey also showed that 84% of parents thought they were giving their children a healthy start to the day.
So Dr Tedstone is encouraging people to use the Be Food Smart App, which has been updated since its launch last year and lets you scan barcodes to find out the sugar content of your meal.
Alex Whittenbury, who tried it in January last year, commented on the BBC News Facebook page: “Having just scanned my daughter’s cereal and juice choice for breakfast, it appears she has already consumed her daily allowance of sugar.
“It certainly gives us food for thought.”
Public Health England’s top breakfast tips:
- Add fruit – like sliced banana, raspberries or blueberries to plain cereals or porridge
- Drink lower-fat milk – like semi-skimmed, 1% or fully skimmed (but not for children under 5) with cereal
- Have wholegrain toast – instead of having white or a sugary cereal and use only a thin layer of toppings like jam
- Master porridge oats – by mixing them with fruit and low fat (and low-sugar) yoghurt and leave it to soften overnight in the fridge
- Bagels – go for lower-fat soft cheese
Unmotivated to exercise? Dopamine could be to blame
Perhaps you have told yourself many times that, as of next week, you will start exercising more. Perhaps next month. Maybe even next year. For many of us, however, sticking to a disciplined program of physical exercise is one of the hardest New Year’s resolutions. New research offers clues as to why finding the motivation to exercise can be so difficult.
New research links a deficit in dopamine to the lack of physical activity in mice.
The benefits of physical activity are well known. The Centers for Disease Control and Prevention (CDC) report that regular physical activity can reduce the risk of severe illnesses, such as type 2 diabetes, cancer, and cardiovascular disease.
Exercise can also improve one’s overall physical and mental health, as well as increase longevity.
If you are looking to control your weight, the advantages of exercise are numerous. Not only has physical activity been shown to reduce metabolic syndrome – which means that it is good for regulating one’s metabolism – but it also burns calories, and in combination with a healthful diet, exercise can help to maintain weight over a long period of time.
While many people are aware of the benefits of physical activity in theory, many of us find it particularly hard in practice to stay physically active. New research may help to explain why this is so.
Can dopamine explain lack of physical activity?
Lead researcher Alexxai V. Kravitz – of the Diabetes, Endocrinology, and Obesity Branch at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) – wondered why it is that obese animals have such a hard time doing physical activity.
The common perception is that animals, or people that are obese, are less physically active because they have to carry much more body weight. However, because Kravitz has a background in Parkinson’s disease, he noticed similarities between obese mice and Parkinsonian mice while he was studying.
This triggered his hypothesis that perhaps something else could contribute to physical inactivity.
“We know that physical activity is linked to overall good health, but not much is known about why people or animals with obesity are less active. There is a common belief that obese animals don’t move as much because carrying extra body weight is physically disabling. But our findings suggest that assumption does not explain the whole story.”
Alexxai V. Kravitz
Kravitz hypothesized that a dysfunction in rodents’ dopamine system might help to explain their lack of physical activity.
“Other studies have connected dopamine signaling defects to obesity, but most of them have looked at reward processing – how animals feel when they eat different foods. We looked at something simpler: dopamine is critical for movement, and obesity is associated with a lack of movement. Can problems with dopamine signaling alone explain the inactivity?”
Examining dopamine receptors in mice
Researchers set out to examine dopamine signaling in lean and obese mice, and the findings were published in the journal Cell Metabolism.
To do this, they fed a group of eight mice a normal diet, and they fed another group a high-fat diet for 18 weeks.
Starting from week 2, the mice on a high-fat diet started gaining significantly more weight than the lean ones. By week 4, obese mice spent less time moving, had fewer movements, and were slower when they did move, compared with lean mice.
Scientists examined whether changes in movement correlated with body weight gain, and they found that it did not. Interestingly, the mice on a high-fat diet moved less before they gained the majority of the weight, which suggests that the extra weight could not have been responsible for the reduced movement.
To identify the mechanisms behind physical inactivity, Kravitz and team quantified several aspects of dopamine signaling.
They found that the D-2 type receptor (D2R) binding, found in the striatum, was reduced in obese mice. This was consistent with previous research in rodents.
Then, scientists genetically removed D2Rs from the striatum of lean mice to determine if there was a causal link between D2Rs and inactivity. Researchers then placed the lean mice on a high-fat diet.
Surprisingly, they found that these mice did not gain more weight, despite their physical inactivity.
This suggests that although deficits in striatal D2R contribute to physical inactivity in obesity, such inactivity is more “a consequence than a cause of obesity,” as the authors put it.
‘Middle age health crisis’ warning
Middle-aged people in England face a health crisis because of unhealthy lifestyles, experts have warned.
Desk jobs, fast food and the daily grind are taking their toll, says Public Health England.
Eight in every 10 people aged 40 to 60 in England are overweight, drink too much or get too little exercise, the government body warns.
PHE wants people to turn over a new leaf in 2017 and make a pledge to get fit.
Health officials say the “sandwich generation” of people caring for children and ageing parents do not take enough time to look after themselves.
We are living longer, but are in poorer health because we store up problems as we age.
The campaign’s clinical adviser, Prof Muir Gray, said it was about trying to make people have a different attitude to an “environmental problem”.
“Modern life is dramatically different to even 30 years ago,” Prof Gray told Radio 4’s Today programme. “People now drive to work and sit at work.”
“By taking action in mid-life… you can reduce your risk not only of type 2 diabetes, which is a preventable condition, but you can also reduce your risk of dementia and disability and, being a burden to your family,” he added.
Many people no longer recognise what a healthy body weight looks like, say the officials – and obesity, which greatly increases the risk of type 2 diabetes, is increasingly considered normal.
The PHE website and app has a quiz that gives users a health score based on their lifestyle habits by asking questions such as, “Which snacks do you eat in a normal day?” and “How much exercise do you get every day?”
Wake up call
The questions are simple, but the results are revealing, says Prof Kevin Fenton, director of Health and Wellbeing at PHE.
“The How Are You Quiz will help anyone who wants to take a few minutes to take stock and find out quickly where they can take a little action to make a big difference to their health.”
Speaking to BBC Breakfast, Dr Ellie Cannon said PHE recognised that the “sandwich generation” was “incredibly busy”.
“This is about making small changes that can have this really big improvement for your long-term health,” she added.
“People want this, people want the help… it is not encouraging people to take on board anything expensive or anything complicated.”
More than a million people have taken the quiz so far.
One of them is Lee Parker, who is 41 and from Bolton. He did the quiz in March before starting a diet in August.
He says it was his son who provided a much-needed wake-up call. Lee’s son, who is now eight, told him he loved him “even though you are fat”.
This was the final nudge that Lee says he needed.
Weighing more than 22 stone, Lee started to diet and exercise and lost just over five stone in 16 weeks.
His partner has joined in and has lost two and a half stone.
In April 2017, Lee will be taking part in the Manchester marathon. He says: “You can become very complacent when you are in your forties. You kind of think you’ve done everything and so you can relax and eat pizzas and Chinese in the week.
“I’ve still got another stone to go to my target weight. It’s been very, very difficult.
“I’m missing all the cakes and the crisps and the biscuits…. I still have them, I still enjoy them, but I know when to say no and I know how much I’ve had.”
Another quiz participant, Penny Henderson, says her bad habits “slowly crept up” on her with how much she was drinking and that she was not really exercising.
“When I took the test, I actually was not that honest and I kind of lied… I think I just did not say exactly how much I was drinking and that was quite a wake up call.
“I realised if I was lying to myself then it must be bad,” Ms Henderson told Breakfast.
After cutting down on alcohol, Ms Henderson said she had more time for things, was less stressed, coped with work better and, that family life was more pleasant.
“The thing is to keep it always achievable and then you can keep it up,” she added.
The NHS has a number of apps and websites that can help you make healthy changes:
Doctors confirm 200-year-old diagnosis
Doctors have confirmed a diagnosis made more than 200 years ago by one of medicine’s most influential surgeons.
John Hunter had diagnosed a patient in 1786 with a “tumour as hard as bone”.
Royal Marsden Hospital doctors analysed patient samples and case notes, which were preserved at the museum named after him – the Hunterian in London.
As well as confirming the diagnosis, the cancer team believe Mr Hunter’s centuries-old samples may give clues as to how cancer is changing over time.
“It started out as a bit of fun exploration, but we were amazed by John Hunter’s insight,” Dr Christina Messiou told the BBC News website.
Mr Hunter became surgeon to King George III in 1776 and is one of the surgeons credited with moving the medical discipline from butchery to a science.
He’s also rumoured to have given himself gonorrhoea as an experiment while writing a book about venereal diseases.
His huge medical collection is now housed at the Hunterian Museum at the Royal College of Surgeons.
It includes his colourful notes describing a man who arrived at St George’s Hospital, in 1786, with a hard swelling on his lower thigh.
“It appeared to be a thickening of the bone, it was increasing very rapidly… On examining the diseased part, it was found to consist of a substance surrounding the lower part of the thigh bone, of the tumour kind, which seemed to originate from the bone itself.”
Mr Hunter amputated the man’s leg and he recovered briefly for four weeks.
“From this time he began to lose flesh and sink gradually, his breathing more and more difficult,” the notes continued.
The patient died seven weeks after the operation and an autopsy discovered bony tumours had spread to his lungs, the lining of the heart and on the ribs.
More than 200 years later, the samples fell under the gaze of Dr Christina Messiou.
She said: “Just looking at the specimens, the diagnosis of osteosarcoma came very quickly to me and John Hunter’s write up was amazingly astute and fits with what we know about the behaviour of the disease.
“The large volumes of new bone formation and the appearance of the primary tumour are really characteristic of osteosarcoma.”
She went to get a second opinion from her colleagues at the Royal Marsden in central London.
And in an out-of-hours session at the hospital they used modern day scanning technology to confirm the centuries old diagnosis.
Dr Messiou, whose speciality is sarcoma, told the BBC: “I think his diagnosis is really impressive and in fact his management of the patient followed similar principles to what we would have done in the modern day.”
But she says the exciting stage of the research is still to come.
They are now going to compare more of Hunter’s historical samples with contemporary tumours – both microscopically and genetically – to see if there are any differences.
Dr Messiou told the BBC: “It’s a study of cancer evolution over 200 years and if we’re honest we don’t really know what we’re going to find.
“But it would be interesting to see if we can link lifestyle risk factors with any differences that we see between historical and current cancers.
“So we’ve got big ambitions for the specimens.”
Writing in the British Medical Journal, the Royal Marsden team apologised for delay in analysing the samples from 1786 and the obvious breach of cancer waiting times, but point out their hospital was not built until 1851.
Multiple sclerosis drug ‘a landmark’
A drug that alters the immune system has been described as “big news” and a “landmark” in treating multiple sclerosis, doctors and charities say.
Trials, published in the New England Journal of Medicine, suggest the drug can slow damage to the brain in two forms of MS.
Ocrelizumab is the first drug shown to work in the primary progressive form of the disease.
The drug is being reviewed for use in the US and Europe.
MS is caused by a rogue immune system mistaking part of the brain for a hostile invader and attacking it.
It destroys the protective coating that wraps round nerves called the myelin sheath.
The sheath also acts like wire insulation to help electrical signals travel down the nerve.
Damage to the sheath prevents nerves from working correctly and means messages struggle to get from the brain to the body.
This leads to symptoms like having difficulty walking, fatigue and blurred vision.
The disease can either just get worse, known as primary progressive MS, or come in waves of disease and recovery, known as relapsing remitting MS.
Both are incurable, although there are treatments for the second state.
Ocrelizumab kills a part of the immune system – called B cells – which are involved in the assault on the myelin sheath.
In 732 patients with progressive MS, the percentage of patients that had deteriorated fell from 39% without treatment to 33% with ocrelizumab .
Patients taking the drug also scored better on the time needed to walk 25 feet and had less brain loss detected on scans.
In 1,656 patients with relapsing remitting, the relapse rate with ocrelizumab was half that of using another drug.
Prof Gavin Giovannoni, from Barts and The London School of Medicine and Dentistry, was involved in the trials and said: “The results shown by these studies have the potential to change how we approach treating both relapsing and primary progressive MS.”
He told the BBC: “It’s very significant because this is the first time a phase three trial has been positive in primary progressive MS.”
More than 100,000 people are diagnosed with MS in the UK, around one-in-five are progressive.
Dr Aisling McMahon, the head of clinical trials at the MS Society, commented: “This is really big news for people with the primary progressive form of multiple sclerosis.
“It’s the first time a treatment has shown the potential to reduce disability progression for this type of MS, which offers a lot of hope for the future.”
The drug is being considered by the European Medicines Agency and the US Food and Drug Administration.
But Prof Giovannoni warned that patients in the UK may be disappointed as it may be hard for the NHS to fund everyone getting a drug that is likely to be expensive.
He told the BBC: “I would expect a narrow group of people to be eligible.”
Dr Peter Calabresi, from Johns Hopkins University in Baltimore, added: “This is the first drug to show a significant effect in slowing disability progression in a phase three trial in primary progressive multiple sclerosis and therefore represents a landmark study in the field.”
But he warned doctors to “stay vigilant” because of the risk of side-effects.
Weakening the immune system increases the risk of infection and of cancer emerging.
Hip pain may be ‘hangover from evolution’
Scientists at the University of Oxford say a hangover from evolution could help explain why humans get so much shoulder, hip and knee pain.
And if current trends continue they predict the humans of the future could be at even greater risk.
They studied 300 specimens from different species spanning 400 million years to see how bones changed subtly over millennia.
The changes came as man began standing up straight on two legs.
Other researchers have noticed similar evolutionary quirks in humans. Some people prone to lower back problems, for example, could have spines closer in shape to those of our nearest ape relative – the chimpanzee.
Dr Paul Monk, who led the research at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, was interested to explore why patients in his clinic came in with similar orthopaedic problems.
“We see certain things very commonly in hospital clinics – pain in the shoulder with reaching overhead, pain in the front of the knee, arthritis of the hip, and in younger people we see some joints that have a tendency to pop out.
“We wondered how on earth we have ended up with this bizarre arrangement of bones and joints that allows people to have these problems.
“And it struck us that the way to answer that is to look backwards through evolution.”
The team took detailed CT scans of 300 ancient specimens housed at the Natural History Museum in London, in Oxford, and the Smithsonian Institution in Washington.
Bringing the data together, they were able to create a library of 3D models, and spot changes to the shapes of single bones over millions of years.
As species evolved from moving around on four legs to standing up on two, for example, researchers say the so-called neck of the thigh bone grew broader to support the extra weight.
And studies show that the thicker the neck of the thigh bone, the more likely it is that arthritis will develop.
Scientists say this is one potential reason why humans are susceptible to so much hip pain.
The team then used their data to hazard a guess at the shape of human bones 4,000 years in the future – although they admit there are many uncertainties in future times that could not be accounted for.
Dr Monk said: “What is interesting is if we try and move these trends forward, the shape that is coming has an even broader neck and we are trending to more and more arthritis.”
In the shoulder, scientists found that a natural gap – which tendons and blood vessels normally pass through – got narrower over time.
The narrower space makes it more difficult for tendons to move and might help explain why some people experience pain when they reach overhead, say the scientists.
Using these predictions, the researchers suggest joint replacements of the future will have to be re-designed to accommodate the evolving shapes.
But they say it is not all bad news – the right physiotherapy and working on maintaining a good posture can help mitigate some of the downsides of our design.
Blood test for hidden heart disease
A cheap blood test can predict which apparently healthy patients are at high risk of a heart attack.
Experts say it could be better than just checking blood pressure and cholesterol to assess heart risk.
So far, they have tested it only on men, but the British Heart Foundation-funded researchers say it should work in women too.
The test, called troponin, looks for a protein released when the heart muscle is damaged.
Doctors already use the same blood test to help diagnose men and women who they suspect have just had a heart attack.
But researchers from Edinburgh and Glasgow universities say it should be used to help patients avoid ever reaching this point.
In their study, Prof Nicholas Mills and colleagues found men who had higher levels of troponin in their blood were more likely to have a heart attack or die of heart disease up to 15 years later.
But putting some of these high-risk men on preventive treatment, such as cholesterol-lowering drugs called statins, lowered their risk as well as their troponin levels.
The 3,300 men in the study had high cholesterol but no history of heart disease.
The scientists now plan to do more research involving women too.
Prof David Newby, one of the authors of the study published in the Journal of the American College of Cardiology, said: “Troponin is almost like a barometer of heart health. If it creeps up, that’s bad and your risk of heart problems increases. If it goes down, that’s good.
“It also appears to predict who benefits from statins and opens a door to a whole new way of testing.”
He said it could be a useful addition to measures like blood pressure readings and smoking status when building up a picture of someone’s heart risk.
Prof Mills said: “Troponin testing will help doctors to identify apparently healthy individuals who have silent heart disease so we can target preventive treatments to those who are likely to benefit most.”
Dr Tim Chico, a cardiologist from Sheffield University, said: “The problem with heart disease is that it remains very difficult to detect the early signs in people without symptoms, so these findings may provide a way to help identify people at risk.
“Nevertheless, the best way to treat heart disease is to prevent it in the first place, and this is why a healthy diet, regular physical activity, not smoking, and maintaining a healthy weight and blood pressure is so important.”
Six pharmaceutical firms accused of price-fixing
US authorities have accused six pharmaceutical firms from the US, India and Australia of price-fixing.
It is alleged the companies conspired to raise the price of the antibiotic doxycycline and diabetes drug glyburide.
The civil lawsuit has been filed in 20 US states.
It follows criminal charges being brought against former executives at one of the accused firms.
‘Tip of the iceberg’
US drugmakers Mylan, Heritage Pharmaceuticals, Teva Pharmaceutical USA and Citron Pharma are named in the lawsuit alongside India’s Aurobindo Pharma and Australia’s Mayne Pharmaceuticals.
Mylan, Teva and Aurobindo have denied the allegations.
Heritage has been accused of being the “principal architect” of the case. On Wednesday the US Department of Justice charged two former executives with price-fixing. Heritage said it was co-operating fully with the probe and had filed its own civil complaint against the pair.
Australia’s Mayne confirmed it was among the companies named in the case brought by anti-trust investigators.
Its shares plunged 22% on the news, and while it did not comment on the allegations, it said the probe and legal proceedings would “not have a material impact on its future earnings”.
“No assurance can be given as to the timing or outcome of the investigation or legal proceedings,” a spokesperson added.
Citron Pharma is yet to comment.
The civil case follows a two-year investigation started by the office of Connecticut’s Attorney General George Jepsen – and alleges that firms conspired over steak dinners and “girls nights out.”
Mr Jepsen told Reuters that lawsuit was just “the tip of the iceberg”, saying price fixing in the generic industry was “widespread and pervasive”, involving “many other drugs and a number of other companies.”
One Democrat Senator claims the price of 500 doxycycline tablets rose in the US from $20 to $1,849 in just seven months.
Snapchat spectacles worn by UK surgeon while operating
UK teaching surgeon Dr Shafi Ahmed has livestreamed an operation using Snapchat spectacles, which are sunglasses with one small camera integrated, allowing the wearer to record what they are seeing.
The routine hernia repair procedure took place at the London Independent Hospital.
Clips from it were posted to Snapchat.
Another consultant pressed record on the glasses during the operation.
The young male patient featured in the video, which has now been posted on YouTube, has chosen to remain anonymous, but is recovering well from the routine operation.
Stepping out of a clinic to speak to the BBC, Dr Ahmed said the spectacles presented a unique opportunity because of the platform they offered for teaching.
“I’m always looking for ways to develop my teaching, especially using wearable technology. When I saw the Snap spectacles, I asked friends in New York to buy some and send them to me immediately.
“We have inequalities in medical education in different countries – I’m looking for ways we can use cutting-edge technology in relatively low-cost gadgets to teach people everywhere,” he said.
The operation was initially viewed by about 200 medical students and trainees. It has now had thousands of views on YouTube.
Snapchat allows users to post only short video clips, meaning Dr Ahmed had to carefully plan how he would record the operation.
“I had to think through the operation and what I’d show in each clip. I wanted to demonstrate techniques and break it down in a structured way.”
With hygiene in mind, Dr Ahmed had an assistant on hand to hit record on the $130 (£100) glasses.
“He is a consultant too, so he knew when to press the button. We had a pre-determined list of clips we wanted to get.”
Dr Ahmed’s colleague then posted the clips to Snapchat. The delay before posting allowed the opportunity to edit, important if anything had gone awry, the doctor explained.
This is not the first time Dr Ahmed has put his work in the spotlight. In April this year he used a 360-degree camera rig to create a virtual reality film of an operation. Some 55,000 people watched it in 180 countries.
He has also operated while wearing Google glasses.
The challenge of the Snap spectacles was the tinted lenses because they are designed to be used as sunglasses.
“We rigorously tested them beforehand to see what the view was like and whether they impinged my view at all. It was a superficial operation and the glasses didn’t restrict me,” said Dr Ahmed.
With plans to use the spectacles for teaching, the lenses are set to be replaced with clear glass by a US company.
“In terms of teaching and learning the spectacles have enormous value. The feedback has already been good – students understand what we are doing here.
“I’m going to do more operations but also clinical skills lessons too, looking at lumps and talking through diagnostics techniques and so on,” Dr Ahmed said.
Snap spectacles have received a lot of attention due to the limited release.
Brain tests predict children’s futures
Brain tests at the age of three appear to predict a child’s future chance of success in life, say researchers.
Low cognitive test scores for skills like language indicate less developed brains, possibly caused by too little stimulation in early life, they say.
These youngsters are more likely to become criminals, dependent on welfare or chronically ill unless they are given support later on, they add.
Their study in New Zealand appears in the journal, Nature Human Behaviour.
The US researchers from Duke University say the findings highlight the importance of early life experiences and interventions to support vulnerable youngsters.
Although the study followed people in New Zealand, the investigators believe that the results could apply to other countries.
They followed the lives of more than 1,000 children. Those who had low test scores for language, behavioural, movement and cognitive skills at three years old went on to account for more than 80% of crimes, required 78% of prescriptions and received 66% of social welfare payments in adulthood.
It is known that disadvantaged people use a greater share of services. While many of the children in the study who were behind in brain development came from disadvantaged backgrounds, poverty was not the only link with poor futures.
When the researchers took out children below the poverty line in a separate analysis they found that a similar proportion of middle class children who scored low in tests when they were three also went on to experience difficulties when they were older.
The researchers stress that children’s outcomes are not set at the age of three. The course of their lives could potentially be changed if they receive support later in life, for example through rehabilitation programmes when they are adults.
Prof Terrie Moffitt, from Duke University in North Carolina in the US, who co-led the study, told BBC News: “The earlier children receive support the better.
“That is because if a child is sent off on the wrong foot at three and not ready for school they fall further and further behind in a snowball effect that makes them unprepared for adult life”.
Prof Moffitt said nearly all the children who had low scores in cognitive assessments early on in life went on to fall through “society’s cracks”.
“We are able to predict who these high cost service users will be from very early in life.
“Our research suggests that these were people who, as very young children, never got the chance that the rest of us got. They did not have the help they needed to build the skills they need to keep up in this very complicated and fast-paced economy”.
She said society should rethink their view of these people who are often condemned as “losers” and “dropouts” and instead offer more support.
Prof Moffitt conducted the study with her husband, Prof Avshalom Caspi, from King’s College London. He said he hoped that the study would persuade governments to invest in those in most need early on in life.
“I hope what our study does is not feed into prejudice,” he told BBC News. “I hope that our research will create the public compassion and political will to intervene with children and more importantly offer services to families of children so they can get a better start in life”.
Successive governments have invested in expanding nursery education in the UK over the past 20 years. According to Josh Hillman, who is the director of education for the Nuffield Foundation, policy makers already realise the value of early years education.
“But this new research suggests that they may have underestimated its importance,” he said.
“The issue now in the UK is to provide more high quality nursery provision and to consider targeting it to those disadvantaged groups that would benefit the most.”
Participants were members of the Dunedin longitudinal study, an investigation of the health and behaviour of a representative group of the population of 1,037 people born between April 1972 and March 1973 in Dunedin, New Zealand.
As adults these people account for only 20% of the population – but they use 80% of public services in an analysis of a group of people in New Zealand whose lives were tracked for 40 years.
Vitamins & its Myths
For Linus Pauling, it all started to go wrong when he changed his breakfast routine. In 1964, at the age of 65, he started adding vitamin C to his orange juice in the morning. It was like adding sugar to Coca Cola, and he believed – wholeheartedly, sometimes vehemently – that it was a good thing.
Before this, his breakfasts were nothing to write about. Just that they happened early every morning before going to work at California Institute of Technology, even on weekends. He was indefatigable, and his work was fruitful.
At the age of 30, for instance, he proposed a third fundamental way that atoms are held together in molecules, melding ideas from both chemistry and quantum mechanics. Twenty years later, his work into how proteins (the building blocks of all life) are structured helped Francis Crick and James Watson decode the structure of DNA (the code of said building blocks) in 1953.
The next year, Pauling was awarded a Nobel Prize in Chemistry for his insights into how molecules are held together. As Nick Lane, a biochemist from University College London, writes in his 2001 book Oxygen, “Pauling… was a colossus of 20th Century science, whose work laid the foundations of modern chemistry.”
But then came the vitamin C days. In his 1970 bestselling book, How To Live Longer and Feel Better, Pauling argued that such supplementation could cure the common cold. He consumed 18,000 milligrams (18 grams) of the stuff per day, 50 times the recommended daily allowance.
In the book’s second edition, he added flu to the list of easy fixes. When HIV spread in the US during the 1980s, he claimed that vitamin C could cure that, too.
In 1992, his ideas were featured on the cover of Time Magazine under the headline: “The Real Power of Vitamins”. They were touted as treatments for cardiovascular diseases, cataracts, and even cancer. “Even more provocative are glimmerings that vitamins can stave off the normal ravages of ageing,” the article claimed.
Sales in multivitamins and other dietary supplements boomed, as did Pauling’s fame.
But his academic reputation went the other way. Over the years, vitamin C, and many other dietary supplements, have found little backing from scientific study. In fact, with every spoonful of supplement he added to his orange juice, Pauling was more likely harming rather than helping his body. His ideas have not just proven to be wrong, but ultimately dangerous.
Pauling was basing his theories on the fact that vitamin C is an antioxidant, a breed of molecules that includes vitamin E, beta-carotene, and folic acid. Their benefits are thought to arise from the fact that they neutralise highly reactive molecules called free-radicals.
In 1954, Rebeca Gerschman then at the University of Rochester, New York, first identified these molecules as a possible danger – ideas expanded upon by Denham Harman, from the Donner Laboratory of Medical Physics at UC Berkeley in 1956, who argued that free radicals can lead to cellular deterioration, disease and, ultimately, ageing.
Throughout the 20th Century, scientists steadily built on his ideas and they soon became widely accepted.
Here’s how it works. The process starts with mitochondria, those tiny combustion engines that sit within our cells. Inside their internal membranes food and oxygen are converted into water, carbon dioxide, and energy. This is respiration, a mechanism that fuels all complex life.
But it isn’t so simple. In addition to food and oxygen, a continuous flow of negatively charged particles called electrons is also required. Like a subcellular stream downhill powering a series of watermills, this flow is maintained across four proteins, each embedded in the internal membrane of the mitochondria, powering the production of the end product: energy.
This reaction fuels everything we do, but it is an imperfect process. There is some leakage of electrons from three of the cellular watermills, each able to react with oxygen molecules nearby. The result is a free radical, a radically reactive molecule with a free electron.
Oxygen is the breath of life, but it also holds the potential to make us old, decrepit, and then dead
In order to regain stability, free radicals wreak havoc on the structures around them, ripping electrons from vital molecules such as DNA and proteins in order to balance its own charge. Although inconceivably small in scale, the production of free radicals, Harman and many others posited, would gradually take its toll on our entire bodies, causing mutations that can lead to ageing and age-related diseases such as cancer.
In short, oxygen is the breath of life, but it also holds the potential to make us old, decrepit, and then dead.
Shortly after free radicals were linked to ageing and disease, they were seen as enemies that should be purged from our bodies. In 1972, for example, Harman wrote, “Decreasing [free radicals] in an organism might be expected to result in a decreased rate of biological degradation with an accompanying increase in the years of useful, healthy life. It is hoped that [this theory] will lead to fruitful experiments directed toward increasing the healthy human lifespan.”
He was talking about antioxidants, molecules that accept electrons from free radicals thereby diffusing the threat. And the experiments he hoped for were sown, nurtured, and replicated over the next few decades. But they bore little fruit.
The results were the largely the same: an excess of antioxidants didn’t quell the ravages of ageing, nor stop the onset of disease
In the 1970s and into the 80s, for example, many mice – our go-to laboratory animal – were prescribed a variety of supplementary antioxidants in their diet or via an injection straight into the bloodstream. Some were even genetically modified so that the genes coding for certain antioxidants were more active than non-modified lab mice.
Although different in method, the results were the largely the same: an excess of antioxidants didn’t quell the ravages of ageing, nor stop the onset of disease.
“They never really proved that they were extending lifespan, or improving it,” says Antonio Enriquez from the Spanish National Centre for Cardiovascular Research in Madrid. “Mice don’t care for [supplements] very much.”
What about humans? Unlike our smaller mammalian kin, scientists can’t take members of society into labs and monitor their health over their lifetime, while controlling for any extraneous factors that could bias the results at the end. But what they can do is set up long-term clinical trials.
The premise is pretty simple. First, find a group of people similar in age, location, and lifestyle. Second, split them into two subgroups. One half receives the supplement you’re interested in testing, while the other receives a blank – a sugar pill, a placebo. Third, and crucially to avoid unintentional bias, no one knows who was given which until after the trial; not even those administering the treatment.
The incidence of lung cancer increased by 16% in the group given vitamin supplements
Known as a double-blind control trial, this is the gold standard of pharmaceutical research. Since the 1970s, there have been many trials like this trying to figure out what antioxidant supplementation does for our health and survival. The results are far from heartening.
In 1994, for example, one trial followed the lives of 29,133 Finish people in their 50s. All smoked, but only some were given beta-carotene supplements. Within this group, the incidence of lung cancer increased by 16%.
A similar result was found in postmenopausal women in the U.S. After 10 years of taking folic acid (a variety of B vitamin) every day their risk of breast cancer increased by 20% relative to those women who didn’t take the supplement.
It gets worse. One study of more than 1,000 heavy smokers published in 1996 had to be terminated nearly two years early. After just four years of beta-carotene and vitamin A supplementation, there was a 28% increase in lung cancer rates and a 17% increase in those who died.
These aren’t trivial numbers. Compared to placebo, 20 more people were dying every year when taking these two supplements. Over the four years of the trial, that equates to 80 more deaths. As the authors wrote at the time, “The present findings provide ample grounds to discourage use of supplemental beta-carotene and the combination of beta-carotene and vitamin A.”
Of course, these notable studies don’t tell the full story. There are some studies that do show benefits of taking antioxidants, especially when the population sampled doesn’t have access to a healthy diet.
But, according a review from 2012 that noted the conclusions of 27 clinical trials assessing the efficacy of a variety of antioxidants, the weight of evidence does not fall in its favour.
Just seven studies reported that supplementation led to some sort of health benefit from antioxidant supplements, including reduced risk of coronary heart disease and pancreatic cancer. Ten studies didn’t see any benefit at all – it was as if all patients were given the sugar pill also (but, of course, they weren’t). That left another 10 studies that found many patients to be in a measurably worse state after being administered antioxidants than before, including an increased incidence of diseases such as lung and breast cancer.
The idea that antioxidant supplements are a miracle cure is completely redundant – Antonio Enriquez
“The idea that antioxidant [supplementation] is a miracle cure is completely redundant,” says Enriquez. Linus Pauling was largely unaware of the fact that his own ideas could be fatal. In 1994, before the publication of many of the large-scale clinical trials, he died of prostate cancer. Vitamin C certainly wasn’t the cure-all that he cantankerously claimed it was up until his last breath. But did it contribute to a heightened risk?
We’ll never know for sure. But given that multiple studies have linked excess antioxidants to cancer, it certainly isn’t out of the question. A study published in 2007 from the US National Cancer Institute, for instance, found that men that took multivitamins were twice as likely to die from prostate cancer compared to those who didn’t. And in 2011, a similar study on 35,533 healthy men found that vitamin E and selenium supplementation increased prostate cancer by 17%.
Ever since Harman proposed his great theory of free radicals and ageing, the neat separation of antioxidants and free radicals (oxidants) has been deteriorating. It has aged.
Antioxidant is only a name, not a fixed definition of nature. Take vitamin C, Pauling’s preferred supplement. At the correct dose, vitamin C neutralises highly charged free radicals by accepting their free electron. It’s a molecular martyr, taking the hit upon itself to protect the cellular neighbourhood.
But by accepting an electron, the vitamin C becomes a free radical itself, able to damage cell membranes, proteins and DNA. As the food chemist William Porter wrote in 1993, “[vitamin C] is truly a two-headed Janus, a Dr Jekyll-Mr Hyde, an oxymoron of antioxidants.”
Thankfully, in normal circumstances, the enzyme vitamin C reductase can return vitamin C’s antioxidant persona. But what if there’s so much vitamin C that it simply can’t keep up with supply? Although such simplifying of complex biochemistry is in itself problematic, the clinical trials above provide some possible outcomes.
Divide and conquer
Antioxidants have a dark side. And, with increasing evidence that free radicals themselves are essential for our health, even their good side isn’t always helpful.
Without free radicals, cells would continue to grow and divide uncontrollably
We now know that free radicals are often used as molecular messengers that send signals from one region of the cell to another. In this role, they have been shown to modulate when a cell grows, when it divides in two, and when it dies. At every stage of a cell’s life, free radicals are vital.
Without them, cells would continue to grow and divide uncontrollably. There’s a word for this: cancer.
We would also be more prone to infections from outside. When under stress from an unwanted bacterium or virus, free radicals are naturally produced in higher numbers, acting as silent klaxons to our immune system. In response, those cells at the vanguard of our immune defense – macrophages and lymphocytes – start to divide and scout out the problem. If it is a bacterium, they will engulf it like Pac-Man eating a blue ghost.
It is trapped, but it is not yet dead. To change that, free radicals are once again called into action. Inside the immune cell, they are used for what they are infamous for: to damage and to kill. The intruder is torn apart.
From start to finish, a healthy immune response depends on free radicals being there for us, within us. As geneticists Joao Pedro Magalhaes and George Church wrote in 2006: “In the same way that fire is dangerous and nonetheless humans learned how to use it, it now appears that cells evolved mechanisms to control and use [free radicals].”
Put another way, freeing ourselves of free radicals with antioxidants is not a good idea. “You would leave the body helpless against some infections,” says Enriquez.
Thankfully, your body has systems in place to keep a your inner biochemistry as stable as possible. For antioxidants, this generally involves filtering any excess out of the bloodstream into urine for disposal. “They go in the toilet,” says Cleva Villanueva from Instituto Politécnico Nacional, Mexico City, in an email.
“We’re very good at balancing things out so that the affect [of supplementation] is moderate whatever you do, which we should be grateful for,” says Lane. Our bodies have been selected to balance the risk of oxygen ever since the first microbes started to breathe this toxic gas. We can’t change billions of years of evolution with a simple pill.
No one would deny that vitamin C is vital to a healthy lifestyle, as are all antioxidants, but unless you are following doctor’s orders, these supplements are rarely going to be the answer for a longer life when a healthy diet is also an option. “Administration of antioxidants is justified only when it is evident that there is a real deficiency of a specific antioxidant,” says Villanueva. “The best option is to get antioxidants from food because it contains a mixture of antioxidants that work together.”
“Diets rich in fruits and vegetables have been shown generally to be good for you,” says Lane. “Not invariably, but generally that’s agreed to be the case.” Although often attributed to antioxidants, the benefits of such a diet, he says, might also hail from a healthy balance of pro-oxidants and other compounds whose roles aren’t yet fully understood.
After decades of unlocking the baroque biochemistry of free radicals and antioxidants, hundreds of thousands of volunteers, and millions of pounds spent on clinical trials, the best conclusion that 21st Century science has to offer is also found within a child’s classroom – eat your five-a-day.
UK pushes ahead with sugar tax
The UK government has published draft legislation for a tax on sugar-sweetened drinks, which is set to begin from April 2018.
There will be two bands – one for soft drinks with more than 5g of sugar per 100ml and a higher one for drinks with more than 8g per 100ml.
Ministers hope it will help tackle the nation’s obesity problem.
Many companies have already begun cutting the amount of sugar in their drinks.
Pure fruit juices will be exempt – but health officials stress people should limit consumption of these beverages to no more than 150ml per day.
Likewise, sugary milkshake and yogurt drinks will also be excluded.
Ministers were concerned that teenagers, particularly girls, were not getting enough calcium and so taxing these drinks might be counterproductive.
The government has said it expects the levy to raise £520m in the first year.
The Office for Budget Responsibility estimates the levy could add 18p to 24p to the price of a litre of fizzy drink if the full cost is passed on to the consumer.
This amounts to an extra 6p on a regular can of Fanta and Sprite, and an extra 8p on a regular can of Coca-Cola, Pepsi and Irn-Bru.
Health campaigners have broadly welcomed the initiative.
Dr Max Davie, of the Royal College of Paediatrics and Child Health, said: “We are very pleased to see government moving forward with this draft legislation.
“The sugary drinks that will be affected by this tax have no nutritional benefit and often contain levels of sugar that are above a child’s daily recommended limit.
“These drinks are a major contributor to the high sugar intakes of children, particularly teenagers, and we are in no doubt that they are, in part, contributing to this country’s obesity crisis.”
Sugar in fizzy drinks
The amount of sugar in a 330ml can of Coca-Cola (7 teaspoons)
The recommended max. intake of sugar per day for those aged 11+
- £520m The amount George Osborne expects the sugar tax to raise
Cancer Research UK estimates a 20% tax on sugary drinks could prevent 3.7 million cases of obesity over the next decade – something the soft drinks industry rejects.
Gavin Partington, of the British Soft Drinks Association, said: “There is no evidence worldwide that taxes of this sort reduce obesity, and it is ironic that soft drinks are being singled out for tax when we’ve led the way in reducing sugar intake, down over 17% since 2012.
“We’re also the only category to have set a 20% calorie reduction target for 2020.”
HIV ‘game-changer’ now on NHS
A drug that dramatically reduces the risk of being infected with HIV will now be given to patients by the NHS in England.
The health service lost a court battle in the summer after arguing responsibility for paying for it should fall to local authorities not the NHS.
Now at least 10,000 people will be given the “Prep” drug in a three-year-long clinical trial.
NHS England says this will help them understand how to offer it more widely.
Pre-exposure prophylaxis or Prep is a daily pill that disables HIV before it gets a stranglehold in the body.
It costs £400 a month per person and trials suggest it can cut the risk of being infected by up to 86%.
NHS England, which fought not to offer the drug, said in a statement there was “strong” evidence that it was effective.
However, it said there were still questions to be answered about how it is used on a wide scale across England.
Its trial on at least 10,000 people will try to figure out how to get the drugs to the right people, how popular it would be and for how long they would take Prep.
Dr Ian Williams, chairman of NHS England’s group on HIV, said: “This announcement demonstrates NHS England’s commitment to fund Prep and provides the chance to best prepare England for optimal roll-out following this large-scale clinical trial.
“For now, the trial will provide access to Prep for thousands of people most at risk of acquiring HIV.”
Men who have sex with men are one of the groups at the highest risk of contracting HIV.
In London, one in eight gay men has HIV, while the proportion in the rest of the UK is one in 26.
‘This is about saving lives’
Harry Dodd, 25, is one of about 500 homosexual men in England who are taking Prep as part of a trial called Proud.
He says: “I’ve seen the panic on the face of previous boyfriends when they are awaiting their [HIV test] results – it’s a huge fear and it affects everything you do.
“To be able to have sex without having that fear hanging over you all the time is huge.”
Harry says taking Prep has still not become socially acceptable.
“Too many people seem to think it will encourage a hedonistic lifestyle, but for me this is about saving lives,” he says.
“People reacted with cynicism when the contraceptive pill for women was first introduced.
“For me, taking Prep has helped me to trust again, have relationships and build bridges and that shouldn’t be taken away.”
Dr Michael Brady, medical director of the Terrence Higgins Trust, said the evidence on Prep was “overwhelming” but the new trial could help understand how it will work in real life.
He added: “However, we do still need answers to many questions about the trial, in terms of how exactly the trial will work in practice, how those at risk will be able to access Prep, no matter where they live, and what will happen after the trial.”
Deborah Gold, chief executive of the National Aids Trust, said: “We are absolutely delighted that following our wins in court, NHS England, working with Public Health England and local government, will be now making Prep available on a large scale, and quickly, to those who need it.”
The NHS in Wales, Scotland and Northern Ireland have not yet made a decision on Prep.