Norovirus

Onto one of the biggest media stories that was reported on around Christmas time. Norovirus or the 'winter vomiting bug' was responsible for a large number of dramatic media headlines over the winter period with a BBC headline entitled "winter vomiting cases at 1.1 million", described by some as an outbreak, others as a superbug...but really? I for one don't know anyone who contracted norovirus this year yet the stats presented by the media corporations are very dramatic as if no-one is untouched by it?

The Health Protection Agency (HPA) (http://tinyurl.com/b9xw4gb) has up to date information on the number of laboratory cases reported of norovirus in England and Wales in each year from the year 2000 up to 2012 (but the 2012 data is at the moment provisional).

 

 

This graph, from the HPA website, shows the number of laboratory reports in each year (for precise figures see the URL above). Between 2000 and 2005 the levels fluctuated but rose steadily from 2005 to 2009 and then steeply in 2010. Since 2010 there have been large fluctuations in the number of reports and it will be interesting to see the levels in 2013.

 

In 2010 there was also a media storm about norovirus, once again being described as a pandemic and a superbug (this would presumably be down to the increase that can be observed in the graph above). The big issue in 2011 was to do with "norovirus being found in 76% of British oysters" (http://tinyurl.com/c5rb6ns).

Information at http://www.patient.co.uk/doctor/Norovirus.htm tells you all you need to know about norovirus but I will pick out the useful parts;

"Noroviruses (NVs) are a genus of the Caliciviridae family of viruses found in 'used' water. They are concentrated in shellfish, oysters and plankton."

"The numbers [of cases] seem to have risen since about 1993 and this may in part be spurious due to the introduction of a commercially available enzyme-linked immunosorbent assay (ELISA) test that made diagnosis much easier. However, it may also be due to the emergence of a new strain of NV which is even more virulent [infectious] than the original strain."

"Outbreaks tend to affect no more than about 50% within a community. Outbreaks tend to be within November to April when pressures on hospitals are at their greatest." This therefore indicates an issue with infection control within hospitals when there is great pressure/the capacities are high; such as the use of alcohol gels and the ability to isolate those with the virus.
  

"There is a risk of mortality especially in the frail, immunocompromised [where the immune system is unable to respond effectively] and at the extremes of age."

A headline reading "winter vomiting cases at 1.1 million" is definitely an alarming headline to read. But as we can see from the data in the above graph and the detailed values on the HPA website their cases are nowhere near the 1 million mark (only just reaching 10,000).

The 1.1 million value has therefore been quoted on the basis that "for each confirmed case, there are a further 288 unreported cases, as the vast majority of those affected do not seek healthcare services in response to their illness" (http://tinyurl.com/ae3a4xa). So based on the current 4,407 number of laboratory cases reported (as of yesterday rather than the BBC's report on the 2 January) the total number of cases is at 1,273,623 across England and Wales. So maybe the ground shaking figures on the BBC news website are relevant but still may not be completely accurate as 288 is only a rough guide to the levels of undiagnosed norovirus.

"John Harris, an expert in norovirus from the HPA said: “Norovirus activity always varies from year to year and although we might have expected cases to rise again now we have passed the New Year period this hasn’t been the case. We can’t read anything into this fall and don’t know how busy the rest of the season will be. The busiest months are normally from December to April, so further cases will occur but we can’t say if there will be further significant increases in the number of laboratory reports.

“There have been reports in the media of people with symptoms of norovirus attending their local hospital but we would urge people not to do this. If you think you may have the illness then it is important to stay away from any healthcare facility and care homes to avoid spreading it to people who may have underlying health conditions and already be vulnerable” (http://tinyurl.com/ae3a4xa).

But there is no need to worry, not as the NHS was  provided with "additional funding to help it cope with the added pressure that the winter brought" but also the statement from the Department of Health in England who "said 2.4% of beds were closed in the NHS due to norovirus symptoms compared with a peak of 2.9% last year." (http://www.bbc.co.uk/news/health-20889382)

Maybe we should just follow Charlie Brooker in his suggestion?
"If things go disastrously wrong, and you've shaken someone's revolting disease-sodden hand and you don't have immediate access to hot water and a sink, it's imperative to remember your hand is "evil" until you've had a chance to wash it. Don't eat with it, and don't pick your nose or rub your eye with it either or you will die. Keep it in a pocket. Or sit on it... Just don't use it. Now wash your hands." (http://tinyurl.com/bccsg7t) 

Start to 2013

As it's recently been New Year and Christmas (and I haven't posted for a while!) I thought I'd do a story based on alcohol, and whilst we are having a post about alcohol, why not tie in smoking too.

The BBC reported on January 2nd that "alcohol calories 'too often ignored'"...."people watching their weight should pay closer attention to how much alcohol they drink since it is second only to fat in terms of calorie content [reported by World Cancer Research Fund (WCRF)]. Eating or drinking too many calories on a regular basis can lead to weight gain. Unlike food, alcoholic drinks have very little or no nutritional value" (http://www.bbc.co.uk/news/health-20874204).

An interesting calorie calculator was embedded in the report (http://tinyurl.com/aswlqvf) showing the number of calories consumed with certain drinks, how many chocolate digestive biscuits that equated to and then how many minutes of brisk walking it would take to walk off that number of calories. As an example 2 standard glasses of wine equates to 3 chocolate biscuits in terms of calorie content and 52 minutes of brisk walking to burn those 248 calories off.

I also found an abstract for a study entitled "Alcohol consumption, nutrient intake and relative body weight among US adults" at (http://ajcn.nutrition.org/content/42/2/289.abstract). The study showed that  "drinkers had significantly higher intakes of total calories than non-drinkers, but only because of their intakes of alcoholic calories. Among drinkers, the intakes of non-alcoholic calories decreased as alcohol intakes increased, and it was estimated that between 15 and 41% of the alcoholic calories replaced non-alcoholic calories. Despite their higher caloric intakes, drinkers were not more obese than non-drinkers." It was therefore "suggested that alcoholic calories may be less efficiently utilized than non-alcoholic calories, or may interfere with utilization of non-alcoholic calories."

The smoking story was about research (carried out by the universities of Oxford, Cambridge and Kings College London) that challenged the "widely held belief that giving up smoking makes you more edgy and that smoking [itself] relieves stress". The story was run on the BBC, Medical News Today and also in The WEEK (Issue 902). On the Medical News Today website (http://www.medicalnewstoday.com/articles/254544.php) the following quote from researchers on the project was used. The researchers wrote:

 

"The belief that smoking is stress relieving is pervasive, but almost certainly wrong. The reverse is true: smoking is probably anxiogenic (causes anxiety) and smokers deserve to know this and understand how their own experience may be misleading."

 

"The researchers recruited 491 smokers who attended NHS smoking clinics, and tested their anxiety levels...when their anxiety levels were tested again, the quitters were found to have reduced their anxiety by nine points on average, whereas those who had failed to quit were feeling more anxious: their levels had increased three points" (The WEEK).

 

"The decrease in anxiety was particularly noticeable among the ex-smokers who used to smoke "to cope", compared to those who used to smoke "for pleasure" (Medical News Today article: above).

 

The researchers concluded saying "stopping smoking probably reduces anxiety and the effect is probably larger in those who have a psychiatric disorder and who smoke to cope with stress" (MNT article).




 

Organ Donation (Wales)

A BBC report last week (http://www.bbc.co.uk/news/uk-wales-politics-20583179) detailed the plans by the Welsh Assembly to bring in an opt-out scheme for organ donation instead of the current opt-in scheme. This means that if you die and you have not stated whether you would or would not like your organs to be donated then you will be taken to be a willing organ donor.

"If passed by the Welsh Assembly it could come into force by 2015" (as above). This move would mean that in the situation where your wishes have not been stated your family would not be able to decide against you having your organs donated as it was never changed in your lifetime.

"The main reason families stopped organs being taken was because they did not know what their relatives' wishes were." Therefore it has been encouraged that these conversations are had at home to discuss the idea of 'presumed consent' and come to a decision on whether to opt-out of the organ donation process.

However, although the general thought is that it will increase the numbers of organ donors in Wales; "there are lower rates of organ donation in some countries that have already implemented presumed consent so it's important that this scheme is not seen as the only way to increase donation rates." This enforces the argument that this issue needs to be openly talked about and publicity increased in Wales but also across the whole of the United Kingdom.

A BMJ article (http://www.bmj.com/content/340/bmj.c2188) published in 2010 says that "in practice, even when people have expressed their willingness to donate by either carrying a donor card or, since 1994, signing up to the computerised NHS Organ Donor Register, their relatives are always asked for consent and relatives’ refusal overrides the deceased would-be donor’s decision." This is clearly wrong as it goes against the wishes of the deceased person and it is the hope that this new law, as well as brining in a presumed consent scheme, will act to stop the overriding that occurs by the relatives of the deceased.

The BMJ article also says that "in 2008, Prime Minister Gordon Brown asked an Organ Donor Taskforce to consider the potential effect of an opt-out system for organ donation in the UK." The Taskforce then did research and collected data on "the effect of presumed consent on organ donation rates" but contrary to the data that they collected they "recommended no change to current policy but renewed effort to increase the number of donors opting in."

In their report (http://tinyurl.com/32y8ktp) they set out 14 recommendations that "taken together, would create a structured and systematic approach to organ donation in the UK" but they also state that "the wishes of the potential donor or their family are ascertained and respected." But as I mentioned earlier this is where the issues are coming in, the overriding by the family of the potential donor.

What really needs to be focussed on are checkpoints 4.47-4.50 of the report under the heading ('public recognition and promotion of donation'). These underline the issues of publicity of organ donation, the lack of donation amongst certain communities, the risks that some communities face and the necessity of people from that same community donating organs.

However the most shocking statistic (as of 2008 when this report was created) is that "it is still the case that nationally, the relatives of 40% of potential donors refuse consent for donation." Therefore this Bill tabled by the Welsh Assembly is trying to dramatically decrease this percentage and make sure that people think about the huge benefits to other people's lives (sometimes saving lives) by giving their organs after death.




 

Polypill

Student BMJ- The polypill: a magic bullet against cardiovascular disease?(http://student.bmj.com/student/view-article.html?id=sbmj.e6386)

The polypill is "a pill containing a number of medicines that all treat the same condition" (Oxford Dictionary) from 'poly', meaning many.

 

"Cardiovascular disease remains the leading cause of mortality in developed countries, and has been described as a “global epidemic.” In 2003, Wald and Law proposed a new polypill: six drugs combined into one tablet that would work to reduce cardiovascular risk. They proposed the polypill as a way of targeting modifiable cardiovascular risk factors, both for adults with pre-existing cardiovascular disease (secondary prevention) and, more controversially, for adults over 55 years old without cardiovascular disease (primary prevention)."

"Wald and Law argued that over 80% of myocardial infarctions and strokes could be prevented if this strategy was adopted. The polypill would contain six ingredients: three blood pressure lowering drugs (a thiazide diuretic, a β blocker, and an angiotension converting enzyme (ACE) inhibitor), a statin, aspirin, and folic acid. Their idea ignited great debate in the medical community regarding its potential to reduce the global burden of cardiovascular disease" (BMJ reference above).

How well does the pill work?
"By using the right combination of active medicines, the Polypill can reduce the risk of a heart attack or stroke by two thirds. The key objectives of the medicines are to reduce blood pressure and cholesterol."

"In July 2012, the results of a Polypill trial conducted at the Wolfson Institute of Preventive Medicine, were published. The trial was conducted among individuals aged 50 and over without a history of cardiovascular disease and without selection on the basis of blood pressure or cholesterol. The reductions in blood pressure and cholesterol were recorded and compared with those predicted from published estimates of the effects of the individual components.
84 participants took a single Polypill (containing amlodipine, losartan, hydrochlorothiazide and simvastatin) each evening for 12 weeks and a placebo each evening for 12 weeks in random sequence (a randomised cross-over trial).

In this trial, participants and doctors did not know whether the Polypill or the placebo was taken during each period (double-blind). The reduction in blood pressure and cholesterol at the end of the Polypill period was compared with the levels at the end of the placebo period. The allocation of the placebo or the Polypill is coded, and is only revealed at the end of the study. This study design provides more precise and accurate estimates of the blood pressure and cholesterol lowering effects of the Polypill than other kinds of study. Systolic blood pressure was reduced by an average of 17.9 mmHg (12%) on the Polypill, diastolic blood pressure by 9.8 mmHg (11%), and LDL cholesterol by 1.4 mmol/L (39%). The results were almost identical to those predicted; 18.4 mmHg, 9.7 mmHg, and 1.4 mmol/L respectively" (https://www.polypill.com/evidence-for-polypill.html).

The two graphs below (https://www.polypill.com/evidence-for-polypill.html) show the effect that the polypill has on diastolic blood pressure and cholesterol respectively both lowering to almost the levl of a 20 year old.

 

Whilst showing a reduction in diastolic blood pressure and LDL (low density lipoproteins) cholesterol in the graphs, this considerably lowers the risk of coronary heart disease and also the risks of stroke (http://tinyurl.com/9ykwvnp and http://tinyurl.com/9uvkr6z).

 

"If people took the polypill from age 50, an estimated 28% would benefit by avoiding or delaying a heart attack or stroke during their lifetime" (http://www.bbc.co.uk/news/health-18883163).
 

However "The British Heart Foundation called for more research and said pills were not a substitute for a living a healthy life." (http://www.bbc.co.uk/news/health-18883163). This study was also a very small study of just "84" (BBC) over 50 year olds, a much larger study would have to be carried out to provide solid data and evidence to become valid and broadly used.



 

Medical Mash Up

BBC- NHS and US health system 'should share ideas' (http://www.bbc.co.uk/news/health-19913437)

Before reading the article you would think that it was a good suggestion to share ideas and learn from different mistakes made. However to compare the two nations proves difficult in the size of the population and also their distribution between built up and rural areas.

The Telegraph Online website shows the population densities of the UK: http://tinyurl.com/cq5gh2o and the USA: http://tinyurl.com/9a2xdf4 with the USA clearly showing that it has large areas of very low population density compard to the UK which has a very high population density across the whole country.

Specifics that one could learn for the other include "NHS, which is in the middle of a £20bn savings drive in England, could learn from the transparency and analytical rigour provided by bodies such as the Congressional Budget Office in the US. And lessons learned from the NHS's rollout of universal electronic health care records could prove helpful to the US, which is much further behind on the issue."

"But both countries are under pressure to get more value out of health care spending and reduce growth in expenditure to sustainable levels and are consequently experimenting with new ways to encourage clinicians, patients and institutions to help achieve this." But maybe not copying another system is the way to do this, maybe ingenuity is needed?

BBC-Kaylee Davidson-Olley marks 25 years with new heart (http://www.bbc.co.uk/news/uk-england-tyne-19915904)

"She said: 'I cannot believe that I am fit and healthy 25 years after my transplant. This was only made possible because of the generosity of a family who made that important decision about organ donation, a decision that saved my life. Without that family discussing organ donation, I simply would not be here.'"

"In total, 112 babies aged under a year have received new hearts in the UK during the past 25 years."

And...one of the most inpirational stories I have seen in a while! http://www.bbc.co.uk/news/world-middle-east-19914444...incredible!
 

Electronics for the Body

US scientists have created "ultra-thin electronics that dissolve inside the body" (http://www.bbc.co.uk/news/health-19737125). As can be seen from the video on the BBC website (link above), the electronic 'plate' appears to 'melt' away. "The components are made of silicon and magnesium oxide, and placed in a protective layer of silk. The speed of melting is controlled by the silk. The material is collected from silkworms, dissolved and then allowed to reform. Altering the way the dissolved silk crystallises changes its final properties - and how long the device will last" (http://tinyurl.com/cog5642).

These electronics are classed as "transient electronics" (http://tinyurl.com/cog5642). The aim is for the electronics to "function for medically useful time frames but then completely disappear via resorption [reabsorption] by the body" due to the "remarkable feature of modern silicon electronics  and its ability to remain physically invariant, almost indefinitely" (http://www.sciencemag.org/content/337/6102/1640.abstract).

In terms of medical uses the team of researchers are finding uses for the technology having testing in "rats a device that heats a wound to kill off bugs. There are also ideas around using the technology to slowly release drugs inside the body or to build sensors for the brain and heart. John Rogers, a mechanical science and engineering professor at the University of Illinois, said: 'Infection is a leading cause of readmission, a device could be put in to the body at the site of surgery just before it is closed up'" (http://tinyurl.com/cog5642). Another huge benefit is that "medical implants will never need to be surgically removed" (http://www.medicalnewstoday.com/articles/250791.php) meaning that surgery does not need to be repeated to remove what may have been out in place. So, the electronics can be programmed to completely disintegrate once they have performed their task.

"As for concerns of toxicity, they say the materials are non-toxic and that in one device they used less of the mineral magnesium than is found in a multivitamin" (http://tinyurl.com/cjyps88).


 

News Bias

"Can spending less time sitting down add years to your life?"

The first paragraph of this BBC report (http://www.bbc.co.uk/news/health-18767278) on whether spending time sitting down actually increases your risk of death or not appears misleading to the research that has actually been produced. They say "limiting the time we spend sitting to just three hours a day could add an extra two years to our life expectancy." The key word in this sentence is the word 'could'. Later in the report it is reported that "experts say the US estimates are too unreliable to predict personal risk" and even that "the researchers themselves acknowledge there are flaws that make its findings less than reliable." So why have the BBC published this report and why do other news corporations publish research in their papers/websites that doesn't appear to give a conclusion? For example, I found another website that published this story but had a completely different angle that seemed to suggest it was firm. The website (http://tinyurl.com/bmbwxot) did not publish anything about the fact that the research may have had flaws and only suggested that it was unreliable was when they stated "they used the data to extrapolate the effects of sitting down on the health of an entire population" but to the eye of someone who doesn't understand the term extrapolation in terms of data this would mean nothing and would presume that the data was in fact reliable.

But why would 'Healthcare Today' take to the side of the argument that the data is reliable? What is their motive for giving a bias to the data? Going to the root of the data, the actual paper itself from BMJOpen, I found that Dr Peter Katzmarzyk, the man who conducted the research, came to the conclusion that "reducing sedentary behaviours such as sitting and television viewing may have the potential to increase life expectancy in the USA" (http://tinyurl.com/d4jlx8w) and that the rise in life expectancy is in the bounds of "1.39 and 2.69 years for sitting and 0.48 and 2.51 years for television viewing" (as above). This is a published piece of research and it is now the job of other scientists to research this further and test the conclusions of Dr Katzmarzyk, so in the future we will see the validity of the data.

But the point I was trying to illustrate was that you should never take the first news story you see as truth, always try to get opinion from lots of news corporations to account for all of the sides of the story that they are trying to portray. This means that you can build a picture of the story and the different angles to it. The best items to read would be the paper itself so that you get the pure data and can draw your own opinion. I learnt this by reading a book called 'Bad Science' by Ben Goldacre who shows how to get past the media angle and at the data and opinions that are valued in the science community i.e. leading researchers/scientists.

Student Debt

Top news story on the BBC today was student debt who ran with the headline "Debt 'putting off' medical students, BMA warns" (http://www.bbc.co.uk/news/health-18128637).

Let me do the maths for you.
Every medical course at a British Universities will cost £9,000 per year for tuition fees by next year (September 2012). A medical course, for an undergraduate who has the correct A-levels and does not need to do a Foundation year, can last either 5 or 6 years depending on whether an intercalated degree is undertaken.

The NHS provide financial support whereby "from year five onwards, tuition fees will be paid by the NHS Student Bursary Scheme" (http://www.nhscareers.nhs.uk/details/default.aspx?id=557), so year five and year six of the degree will be paid for. Therefore in terms of tuition fees it will be £36,000 for the course. Of course the living costs at different universities varies so you could be looking at vast differences; for example London and Aberystwyth. Lets say a general £500-£600 per month which is £6000-£7200 per year.

Tuition: £36,000
Expenditure (Accommodation and Food):£36,000-£43,200 (6 years) OR £30,000-£36,000 (5 years)
Total Cost (in the region of) £75,600 (6 years) OR £69,000 (5 years)

From these figures (don't quote me on the expenditure figures because they depend entirely on location and the student lifestyle) we can see that it is indeed very expensive to attend medical school; but I wouldn't let it put you off and you will see why.

1. I was informed on a conference I attended that it costs around a £250,000 to put a student through medical school so the cost payed for tuition is not even 15% of the total cost of the degree.
2. If you want to become a doctor then surely there is nothing that will stop you doing what you most want to do in your life and inevitably is what you will spend the rest of your life doing.
3. When you pay back your student loan, even though it is a huge amount of money and you may be paying it back for a lot of your working life, they won't take so much away that you cannot live or sustain yourself. They also don't start taking money out of your pay until you reach a threshold of £21,000 and if you don't end up paying it off it is wiped at the age of 68.

But if your not convinced and you don't think it is right to be paying so much then there are other options. You could study abroad where the fees are less, for example Holland or other European countries but be aware that the British student loan companies do not provide loans for students studying abroad. But if you don't fancy that then you can do a different course such as a Biomedical degree that you can do Medicine afterwards/not at all. But also be aware that student loan companies do not provide loans for your second degree.

Hip Surgery and Prescriptions

Odd combination but I haven't done a post for a while, so I thought I would do a couple of topics together.

Earlier in the year it was reported that thousands of pounds were lost to the NHS due to prescriptions every year i.e. in Wales where prescriptions are free (as in Scotland and Northern Ireland) it was reported that "people in Wales received an average of 22 items on prescription last year, costing the NHS £594m" (http://www.bbc.co.uk/news/uk-wales-politics-14738797).

But the news is that the cost of the prescriptions have risen in England (while the other UK nations stay free). I'm not going to list figures because that would be boring and that's not what matters here really, it's still a fairly low price to pay; but yes, the price has has gone up and that may be an issue for some people i.e. those who have long term conditions who need constant prescriptions. Maybe there should be funding schemes set up to help these people, but then again there is so much funding being lost these days it would be hard to see that happen.

The question is, why can't England have free prescriptions like the rest of the United Kingdom? Well; "The government says abolishing prescription charges in England would leave the NHS £450m short each year" (http://www.bbc.co.uk/news/health-17576096), which is a fair argument but they aren't dealing with the losses they are making in Wales (as illustrated earlier). There were a number of opinions expressed in the comments on the BBC website. Some were for the rises but others were unhappy with the rises and thought that it was 'unfair' (a very common term used in the report). What I suggest is that we be thankful for the NHS and what they do for us for free and we just accept these extra payments. If you are in a critical condition and on the brink of death they will perform life saving surgery without asking any questions, how about that for healthcare. I've been to other countries and seen their standards of healthcare where they can barely put up all the people in a hospital who need treatment. What are people suggesting? That we go private? Then things will be ten times more expensive because healthcare will no longer be good practice, it will be a business, charging people to live because they know that people want one thing; and they will pay anything to keep their lives. Honestly, what do people think is the alternative to what services we have?!

In terms of the hip surgery story, it is much like the PIP breast implant story; "surgeons have been warned to stop using a particular type of metal-on-metal hip implant because it has an 'unacceptably' high failure rate" (http://www.bbc.co.uk/news/health-17590832). The BBC reported that over a 4 year period "10.7%" had to be replaced which is almost 29 out of the "270" who have been given the "Mitch TRC and Accolade" hip replacements. There is a lot of investment and research put into things like hip replacements and other structures that are put into the body. This is because it has to be accepted by the body and also try to act as if it is natural/meant to be there; for example making sure the bones can move with it in place or making sure the metal doesn't rust in the body.

One way of performing hip replacement surgery is to do 'anterior approach' which is said to be better because "rehabilitation is simplified and accelerated, dislocation risk is reduced, leg length is more accurately controlled, and the incision is small" (http://www.hipandpelvis.com/patient_education/totalhip/intro.html). It was interesting to find that (written in a report in 2007) it wasn't the preferable choice of hip surgery in the USA because apparently "there are several reasons: lack of familiarity, traditional teaching, and lack of the necessary instrumentation and equipment" (as above). However the techniques may have improved since the report was written.

Although this is a very long surgical video (almost 2 hours) detailing the whole procedure, if you flick through it you can see the basic outline of how the anterior approach surgery is carried out with a small incision.

To finish, back to the H5N1 story which is raging on in America at the moment; news is out that a "US panel has approved the publication of two controversial H5N1 bird flu studies, after they were revised" (http://www.bbc.co.uk/news/world-us-canada-17569494). There was controversy over whether to release the publications in case bioterrorists got hold of them. But the "panel said the publications no longer revealed details that could lead to abuse by terrorists" (link as above).

News Round Up

A couple of stories, "PIP Breast Implants" and "Worldwide Flu Pandemic?", that I have covered in the last two months have come up again in the news recently with new developments.

Firstly in the "PIP Breast Implant" story, the BBC reported that "Lloyds TSB refunds cost of woman's faulty breast implants" (http://www.bbc.co.uk/news/business-17361122). Lloyds paid out £3,700 to the lady "on the grounds she was sold faulty goods" (http://www.bbc.co.uk/news/business-17361122). This is the first story I can find of someone being refunded the money that they paid for the faulty PIP breasts but the private clinics that fitted them are still refusing to pay out to the patients.

Secondly when I wrote the "Worldwide Flu Pandemic?" story there was a lot of talk at the time of closing/suspending research over risks of the H5N1 escaping and causing a flu pandemic. I then recently read in New Scientist (28th January 2012 (page 6)) that the "controversial flu research is on hold" on the basis that some "experiments could cause the H5N1 bird flu virus to spread more easily." It then went on to say "US bio-security experts say some details must be withheld, in case bioterrorists get hold of them." I'm not so sure about how big the risk of bioterrorism is though.

However, in the Telegraph it was reported "Scientists clone cashmere goats in bid to increase wool production" (http://tinyurl.com/7cztex2). This is a goat that was cloned in India to increase the production of "pashmina wool, or cashmere" (http://tinyurl.com/7cztex2). "Noori was cloned by Dr Riaz Ahmad Shah, a veterinarian in the animal biotechnology centre of Sher-i-Kashmir University and took two years to clone Noori, using the relatively new 'handmade' cloning technique involving only a microscope and a steady hand" (http://tinyurl.com/7cztex2). This is only one in a list of animals that have been cloned, but what about the ethics of cloning?

Exotic Diseases

I found in the WEEK that it was reported in the Sunday Times last Sunday "exotic diseases are heading our way" (The WEEK 10th March 2012 page 14). I can't find the article on the internet so I will give you the gist of what it was saying; "climatologists' predict and influx of exotic diseases from warmer climes, with cattle farms experiencing infections of Schmallenberg virus, which causes stillbirths and deformities in young livestock. How long before illnesses that have reached Spain and Portugal get to us? Or human diseases such as malaria and encephalitis?" (The WEEK 10th March 2012 page 14).

So what are the issues we face here? Firstly, in terms of malaria risk, by having the Anopheles mosquitoes coming to Britain the risk of getting malaria does increase (not all mosquitoes cause malaria-only the female Anopheles). Malaria is caused by a parasite known as Plasmodium (four main types; P. vivax, P. ovale, P. malariae and P. falciparum) getting into the Anopheles mosquito through a blood meal that it takes from a person already with malaria. The mosquito then acts as a vector for the Plasmodium, which breaks into its salivary gland. When the mosquito takes another blood meal, the Plasmodium is passed directly into the human's (second host's) blood in the saliva from the mosquito. The parasite then invades the liver cells where they multiply, then escape out into the blood and the red blood cells where they continue to multiply and break out into more and more red blood cells. The cycle then continues. There are a number of ways of trying to prevent the transmission of malaria such as bed nets and sprays, but what biologists are hoping will be the best solution is the RTS,S vaccine that has been in development for the last 25 years.

Secondly, the other disease mentioned in the article was encephalitis; "inflammation of the brain usually caused by a viral infection" (http://www.patient.co.uk/health/Encephalitis.htm). There are a number of different viral infections that can cause encephalitis including "herpes simplex virus (the virus that causes cold sores and genital herpes), varicella zoster virus (the chickenpox virus), mumps virus, measles virus and flu viruses" (http://www.patient.co.uk/health/Encephalitis.htm). But in other areas of the world there are other ways of getting encephalitis such as through mosquitoes which is where this article is coming from in terms of increased risk with the change in climate. In the UK the most common cause through viral infection  "is herpes simplex virus" (http://www.patient.co.uk/health/Encephalitis.htm). But not to worry because at the moment encephalitis is very uncommon, but just if you do get it get to hospital very quickly because "in many people, encephalitis is a serious condition and can be life-threatening" (http://www.patient.co.uk/health/Encephalitis.htm).

Personally I think that the risks are low and that for the time being we should not be worried about these exotic diseases coming to our country because we have the capability of dealing with them if we need to and the healthcare is good enough to aid us. The issue that needs to be addressed is that of malaria in other countries, we are a long way towards that goal with the RTS,S vaccine and the other solutions that we have developed.

Another interesting story; about Coca-Cola and Pepsi, and the effect that their current ingredients have on cancer http://www.bbc.co.uk/news/world-us-canada-17308181, and the warnings that they may have to put on their cans if they don't change their ingredients.

Smoking; Cigarette 2 pence rise?

News on the BBC today says that "health campaigners are asking for more substantial rises in cigarette duty in this month's Budget" (http://www.bbc.co.uk/news/health-17237159). The campaigners from "91 organisations" want the price to rise by "2 pence per cigarette" (http://www.bbc.co.uk/news/health-17237159). Statistics from the NHS 'smoke free' website say that a "20-a-day smoker will spend more than £900 over the next 6-months" (http://smokefree.nhs.uk/). If the cost was to be raised by 5% (as being campaigned for) then that figure would rise by £45 over 6 months or £90 over a whole year, which is a significant increase for those who may be struggling to pay for it at current prices.
Is this the best way of stopping people smoking? A 5% rise in the cost ofeach cigarette is a big increase if you are smoking one/two/three packets per day and would definitely build up over the years. "Prof John Britton, director of the UKCTCS (UK Centre for Tobacco Control Studies), said hitting smokers in the pocket was the best way to get them to stop" (http://www.bbc.co.uk/news/health-17237159). By raising the costs of smoking it will hopefully force the people who are on the brink of quitting the ideal way of getting out, with regards to the rises of £45 over 6 months and £90 over the whole year (as an average), this could force people to give up.

There are fears that the smuggling rates of tobacco would go up if the prices of cigarettes goes up. But this doesn't seem to be a very good argument against raising the cost of smoking and the "chief executive of ASH (Action on Smoking and Health) said; 'as ever the industry is clutching at straws with its ill-founded arguments'" (http://www.bbc.co.uk/news/health-17237159).

I would argue; based on the BBC's viewpoint and the known effects of smoking that it would be beneficial to increase tax on smoking which would hopefully persuade some people to give up smoking or to get on a stop smoking course such as the NHS 'smoke free'. I disagree with Mr Simon Clark's statement for Forest "(Freedom Organisation for the Right to Enjoy Smoking Tobacco)" (www.forestonline.org/) who says that "ideally we'd like to see a reduction in duty” (http://tinyurl.com/6s7h26x). The issue here is that this would encourage more people to smoke, and may increase the likelihood of younger people smoking if it was cheaper or more easily accessible. Although levels of smoking have decreased in children and adults over the last 20 years as shown in the tables on thiese two websites (http://ash.org.uk/files/documents/ASH_108.pdf) and (http://ash.org.uk/files/documents/ASH_106.pdf).

A quote from Sir Ronald Harwood says; "tobacco is not an illegal substance yet the government is persecuting a minority. I think that's a disgrace in a social democracy" (http://www.forestonline.org/). I can see where he is coming from because if the government raises the price above what people can pay then they are effectively taking it away from people and that doesn't seem very democratic since it is their choice if they want to smoke and the government would be taking away that choice. 

The Last Month

In the past month I have reported on a number of issues that have been prevalent in the media. The issues of the "Should Doctors Strike?" and "Assisted Suicide" were both cases which involved ethical issues. The post that I enjoyed writing most was "Cardiothoracic Surgery" mainly because of the videos but also because of the surgery side, which requires huge amounts of skill.

I have learnt so much in the past month about the medical world by doing this blog but have also learnt that I am only scratching at a tiny part of the huge surface that is the medical world. I realise this every time I write a post; when I'm try to back up what I am saying with quotes and ideas from leading doctors and scientists I find myself with a wall of academic papers, newspaper articles, published research and people's opinions but know that I don't have the time to wade through all of it to find out what I need... I resign myself to the fact that I can't wade through and understand everything there is in this world!

As it goes ethics are extremely important in medicine (although the most boring part of Biology AS!) because everything that a doctor does will be scrutinised by the hospital he works in or even by the media if the mistake is bad enough.

For example, even today, a story came out about assisted suicide. The man in question is a severely disabled man who "wants the court to rule that a doctor should be able to help him to die" (http://www.bbc.co.uk/news/uk-16957125). The man suffers from 'locked-in syndrome' where the "patient is mute and totally paralysed, except for eye movements, but remains conscious" (http://www.bbc.co.uk/news/uk-16957125).

So the question is; let him die or not?
From the doctors perspective it's a firm "no" (in all cases of assisted suicide) because of the Hippocratic Oath taken by all doctors to swear that they will practice medicine ethically. The man could be taken to Dignitas to die peacefully, but the doctor will not be allowed to take him, the family would have to take him. Doctors cannot be seen to take someone to die; it would be a media storm. The sad thing is that the doctors personal opinion cannot be known to influence his duty to keep patients alive, even if they believe the patient has the right to die if he wants too.

From the family point of view it would most probably be "yes/no". Yes, because they must be in so much emotional stress and pain and to be put out of their pain might be the best thing for the family as a whole. But on the other hand, this man is someone's son, maybe husband and uncle; he is part of the family, a living human being. It would be devastating for the family to lose him, so they may say no and take side with the doctors.

Whatever decision is made, this is an extremely sad case but is one that has come up before and will come up again in the future, the question is, what is the right thing to do in the circumstances?

Hospital: Weekend Death Rates

I picked up on news today that patients are more likely to die if they are admitted on a weekend compared to a weekday. This has come after a study was carried out in "the Journal of the Royal Society of Medicine" (http://www.bbc.co.uk/news/health-16868428).

Let's look at the stats (all from http://www.bbc.co.uk/news/health-16868428);
1. Research was carried out by UCL (University College London), UEA (University of East Anglia) and Birmingham University.
2. It covered more than 14 million hospital admissions and 187,300 patients who died within 30 days of being admitted (during 2009/2010).
3. For every 100 deaths on a Wednesday there were 116 on a Sunday.
4. The results were consistent with data from 254 not-for-profit hospitals in the United States, which they also analysed.

So the obvious issue here is that more patients are dying on the weekend than in the weekday. This is maybe because of the lack of senior medical staff/consultants working on the weekend; as suggested by Professor Domenico Pagano on the BBC website. The lack of senior staff could have a major impact because of the experience that they offer in emergency situations; experience that can only come with time for junior doctors.

Another issue is what action to take now that this study has been carried out. What really needs to happen is that there needs to be more experienced doctors in the hospitals or close enough to the hospitals to be there in an emergency rather than on call (not very practical though). If there are more consultants consistently in the hospitals over the whole week, then the death rate should theoretically be lowered, based on the idea that experienced staff around means less deaths (but not no deaths).

It would be interesting to get some statistics on the mortality rates against the number of consultants and junior doctors working on the wards to see if there is a correlation between mortality rate and the experience of the staff on duty.

'PathFinder' Brain Surgeon Robot

In reference to last weeks post, Worldwide Flu Pandemic?, the story has developed, with the BBC posting an article on the 20th of January saying "scientists who created a potentially more deadly bird flu strain have temporarily stopped their research amid fears it could be used by terrorists" (http://www.bbc.co.uk/news/world-us-canada-16662346), full story on that URL.

In 2001, news arrived that the "first medical robot designed to operate on the brain has begun clinical trials at Queen's Medical Centre in Nottingham, UK" (http://tinyurl.com/6vcogut). This sounds quite astounding if you think about the level of accuracy and precision that surgeons need to have and; in terms of ethics, surely we couldn't give over the job of neurosurgery to a robot? This video shows neurosurgery that was carried out with an awake patient and underlines the accuracy that a neurosurgeon needs (http://www.youtube.com/watch?v=FD8ckoy9NVU). They are able to do it while the patient is awake because there are no pain receptors in the brain and there can be "anaesthetic administered locally, to the scalp" (http://tinyurl.com/7dbrwec).

The robot that began its trials in 2001, called the "PathFinder, will not be able to do operations that are not already possible, but it could do them much faster and more accurately" (http://tinyurl.com/6vcogut). PathFinder can "align the surgical tools to within 1mm" (http://tinyurl.com/6wrqgnz) which is incredible and is certainly more accurate than conventional surgery, because of the movement of the surgeons hand with the instruments.

The PathFinder is also very safe, otherwise it would not pass the trials or even be used; as this New Scientist article illustrates, "despite the name, surgical robots are not automatic and do not operate in any way like factory assembly-line robots. Rather, they are precision machines controlled remotely by a surgeon" (http://tinyurl.com/6nfeb4b). Another article, http://www.imperial.ac.uk/college.asp?P=7449, shows an experiment that was carried out based on the precision of knee surgery by a robot called 'Acrobot' and also illustrates the precision of these robots.

Another example of a robot used for neurosurgery is the 'NeuroArm'. The team on the NeuroArm Project had to overcome a number of challenges, including "how could a machine be created to be as precise and dexterous as the human hand, without compromising surgical technique?" (http://www.neuroarm.org/project/). This is one of the questions that all of the companies who make robots for surgery must ask themselves. Another video (http://tinyurl.com/7383jft) shows the NeuroArm in action.

Ten years on from when PathFinder was first unveiled I have been unable to find any statistics on the performance of the robot at all or in fact many other articles on the robot. But there are other surgical robots that have been developed (worth looking at) since 2001, such as the NeuroArm (http://www.neuroarm.org/project/) and also the ROBOCAST (http://tinyurl.com/7pk33h9).

PIP Breast Implants

I didn't really know a lot about the recent breast implant story but I decided to find out about it...this is what I came up with.

Recently there has been a lot of coverage in the news about PIP (Poly Implant Prothese) breast implants due to "a health scare, after French authorities found a rupture rate of 5% and recommended implants were removed" (http://www.bbc.co.uk/news/health-16395244). Poly Implant Prothese was a French firm that "were banned in 2010, after their implants were found to contain industrial grade silicone gel, rather than medical grade" (http://www.bbc.co.uk/news/health-16395244). This supposedly led to a higher risk of the implants rupturing.

Andrew Lansley, the Health Secretary for England, launched a review, at the beginning of the week, due to the conflicting evidence for the rupture rates of the PIP implants. Some sources claimed that there was only a "1% (rupture rate) - in line with other implants" (statistics from the Medicines and Healthcare products Regulatory Agency (MHRA) (http://www.bbc.co.uk/news/health-16395244). Fergus Walsh, the medical correspondent for the BBC, has written an article at http://www.bbc.co.uk/news/health-16401016 about warnings of the statistics that have been produced and how some of it can be misleading due to the way that the data has been set out and collected.

In essence, this story is about the peoples reaction to the story. "40,000 British women have been fitted with the implants" (http://www.bbc.co.uk/news/health-16395244). Essentially, the data that Andrew Lansley is trying to get is the data that these women want to know; how many British women have had ruptured implants?

The options aren't very good at the moment for the women who have had the PIP implants. "Private clinics are refusing to replace the implants free of charge" (http://tinyurl.com/7w9o556). Looking at Attwood Solicitors website I found that those with the PIP implants can put a claim in for compensation but it's  not guaranteed. They also directed me to other websites for 'patient advice'.

I looked at three of the five websites that they advised the patients to look at;
- Harley Medical Group quoted The Chief Medical Officer (Dame Sally Davies), she said, "there is not enough evidence to recommend routine explantation (removal) of these breast implants". HMG have decided to find out which of their patients were given PIP implants and deal with those people, but have decided not to give free removals. (http://tinyurl.com/6prsrpq).
-Surgicare Medical Group have said that they have not been recommended to remove these implants and say they have been monitoring their rupture rates over several years and have not found any data that is a cause for concern. (http://tinyurl.com/6p7c9x9).
-Transform Cosmetic Surgery Group commented saying that they do not have sufficient data of ruptures in the PIP implants to remove them free of charge for their patients. (http://www.transforminglives.co.uk/latest-news.html).

Andrew Lansley said today that "private clinics that fitted implants have a "moral duty" to remove them" and that "the NHS would pay to remove, but not replace, implants if a private clinic refused" the issue with this is for the taxpayer who will then have to foot the bill; but he then said that "if the NHS was forced to remove an implant "the government would pursue private clinics to seek recovery of our costs" (http://www.bbc.co.uk/news/uk-16523464).

Assisted Suicide

As most people know Dignitas is the Swiss suicide clinic founded in 1998. I decided to go on the internet and find out some news stories about it after the news that "there is a strong case for allowing assisted suicide for people who are terminally ill in England and Wales" (http://www.bbc.co.uk/news/health-16410118). The case, made by The Commission on Assisted Dying, was that "it was possible to allow assisted dying within a strict set of rules to ensure it was not abused" (http://www.bbc.co.uk/news/health-16410118), the whole story is on the BBC News link.
Digging around on the internet I found an article on MailOnline on the 20th October 2011 about nurses not being able to tell patients about Dignitas or even offer it up as a suggestion even if asked about it by patients. They were even told they could go to prison for talking to patients about assisted dying, (whole story at http://tinyurl.com/7z6op7d).

Another story, run by The Telegraph on the 8th January 2012, gives information about a "clampdown" on the clinic because of the increasing number of British people who are travelling to Switzerland to die. Legalisation that could be put in place aims to make the patients have a longer counselling service to make sure that they want to die, (whole story at http://tinyurl.com/ldqh75).

The final story, a famous one, about a 23 year old rugby player who took his life at Dignitas. He was one of the youngest British man to take his life at Dignitas and was the first time it was really noticed by the British public, (whole story http://www.guardian.co.uk/uk/2008/oct/18/11).

These stories really bring the ethical issues to light, that people do really want to end their lives for one reason or another, as they don't see that it's worth living for anymore. The issue for doctors is that it is their duty to keep these patients alive, and giving them an option of suicide doesn't follow with their duty.

Blood Donation

There are fears that in the year of 2012 the United Kingdom will have a blood shortage, which may cause issues at the Olympic Games and other events, with "extra bank holidays leading to a drop in donations as most people give blood during the working week" (http://www.bbc.co.uk/news/health-16338795).

Blood, after being taken from donors, is collected in plastic bags which "contain anticoagulents and other preservatives" (http://tinyurl.com/d7zfw2h). Anticoagulents are drugs used to thin out blood and stop it clotting (coagulating), therefore making it useable for transfusions. The bags that the blood is stored in have a "material that allows for diffusion of gasses permitting optimum cell preservation" (http://tinyurl.com/d7zfw2h).

Once it has been bagged and taken to where it is to be stored, it is then "tested for Hepatitis B and C, HIV as well as other infectious diseases" (http://tinyurl.com/d7zfw2h) to make sure it is fit for use. It is then "stored in a fridge for up to 42 days, or frozen for up to 10 years" (http://tinyurl.com/d7zfw2h).

This means that a huge volume of blood can be stocked. On the National Blood Service website (http://www.blood.co.uk/StockGraph/stocklevelstandard.aspx) there are a number of graphs to show the stocks that are donated daily and also the stocks in the whole country (except for blood held in hospitals).

So on the BBC News website there is a quote from NHS Blood and Transplant that we will need "2 million pints (1.1 million litres) of blood plus an extra supply for Olympic visitors" (http://www.bbc.co.uk/news/health-16338795).

HRH Prince Phillip left Papworth Hospital yesterday morning and is home with his family.