Does the BMI need correcting?

29 January 2013 Last updated at 00:12 GMT By Wesley Stephenson BBC News A new way of calculating Body Mass Index (BMI) has been proposed - but does it really solve any of the BMI's well-known problems?

How often have we heard that Brad Pitt at the time of Fight Club, and England rugby player Jonny Wilkinson in his prime, were "overweight" - according to their BMI?

Any system that tells people whether they are "normal", "underweight", "overweight" or "obese" is bound to be controversial, but one obvious weakness of the BMI is that it doesn't distinguish between fat and muscle.

First devised by Adolphe Quetelet more than 150 years ago, BMI is calculated by taking your weight (in kilograms) and dividing it by your height squared (in metres).

In simple terms, it is a way to compare the weights of groups of people of different heights.

Continue reading the main story

Sir, The body-mass index that you (and the National Health Service) count on to assess obesity is a bizarre measure... As a consequence of this ill-founded definition, millions of short people think they are thinner than they are, and millions of tall people think they are fatter.

But mathematician Nick Trefethen, Professor of Numerical Analysis at Oxford University, thinks that the old formula is wrong, as he explained in a letter to the Economist newspaper published earlier this month.

He thinks that people have put too much trust in it in part because it looks so precise - like, say, Einstein's famous equation E=MC².

"That's an equation of physics and it's really right. The BMI formula looks similar. It seems to have the same character but it doesn't reflect a precise truth about our world, it's an approximation to a very complicated reality," he told the BBC.

With that in mind he has proposed a new formula: 1.3 x weight, divided by height to the power 2.5.

Calculate your BMI Continue reading the main story Your new BMI: 0

Your old BMI: 0

The change means that some tall people previously deemed "overweight" are "normal" under the new proposal, and some short people who were "normal" are now "overweight".

But why did Prof Trefethen choose those numbers - 1.3 and 2.5?

"That can't be explained simply. People do scaling arguments to explain as an animal gets longer how, if its bones aren't to break, how much thicker the need to be and out of this kind of mathematical analysis come some rather complicated and unexpected results," he says.

"My fundamental interest is in the physics and mechanics of how bodies behave and there is a body of literature that suggest [the power] should be 2.5, or even two and two-thirds."

But Prof Trefethen stresses he doesn't have a medical background and that his work isn't based on real life observations of people's weight and height.

One man who does have a medical background is Tim Cole, Professor of Medical Statistics at University College London. He says Prof Trefethen's new equation is just one of a long line of papers that have questioned the equation, and he's not convinced it will change anything.

Continue reading the main story Belgian mathematician Adolphe Quetelet noted in 1832 that "the weight increases as the square of the height" (though he sketched a formula similar to Prof Trefethen's in a later publication)Quetelet had no interest in obesity - his goal was to define the "average man"Actuaries began to study links between obesity and life insurance claims before World War I - the Quetelet Index came to be seen as a useful toolIt was re-christened the Body Mass Index in 1972, by Ancel Keys, an American scientist who studied the influence of diet on healthCategories such as "obese" or "overweight" were proposed by JS Garrow and JD Webster in 1980s"I think he's aware of the deficiencies of BMI but I don't think his index goes anywhere to addressing those shortcomings. BMI is an imperfect index and you can tinker about with the power of height as much as you like but [the equation] shouldn't be expected to do what it can't do which is to measure fatness, because it doesn't include fatness," he says.

"BMI can't do better than make a guess as to how much fat there is. If your weight is excessive then the implication is that the excess is fat and, of course, people's body composition varies enormously and BMI doesn't know anything about that so it's a very imprecise index when applied to individuals."

So why do we continue to use it?

"It is useful when applied to populations. The population does mean you get a more precise estimate of BMI simply by averaging over large numbers."

It's been a controversial measure in part because of the way it is divided up into different weight categories. "Underweight" is a BMI under 18.5. "Normal" is between 18.5 and 25. Between 25 and 30 is "overweight" and above 30 is "obese". Some countries have moved the boundaries to better reflect their populations. In India for example anyone over 23 is "overweight" and over 25 is "obese".

The boundaries, were proposed in the mid-1980s by two scientists, Garrow and Webster, and just kind of stuck. But are they in the right place?

"They are to some extent based on health premises as understood by Garrow and Webster in 1985 when the world looked rather different, but also they are a statistical construct," says Prof Cole.

Trying to draw a line somewhere on that spectrum and say below this cut-off is healthy, and above this cut-off is unhealthy, is obviously a rather arbitrary exercise.

The boundaries are the source of endless debate and a recent meta-study in the United States looking at 100 studies including three million people suggested that the people who were overweight had a slightly lower risk of early death than those in the normal category.

"I think the moral of this study is that these BMI categories are weight categories and they're not exact health categories," says Dr Katherine Flegal from the US National Center for Health Statistics who did the study.

"I don't think weight is synonymous with health and I think our study shows that at least it's not synonymous with mortality."

But are we likely to see a change to the way BMI is calculated or a move away from using it altogether?

Prof Cole doesn't think so.

"It's a cheap and cheerful way of getting a handle on whether or not you might be overweight. The alternatives are rather more complicated and expensive.

"You can go for an MRI scan or a dexa scan and those will measure your whole body fat, but that really is using a sledgehammer to crack a nut… BMI does separate those people who are normal from those who are obese and there is some area of uncertainty in the middle."

If people hear from their doctor that their BMI has gone up or down, they can usually be fairly sure that the change in their weight is connected with a change in fat rather than muscle. It's therefore a "good and simple indicator" of whether someone is gaining or losing fat, he says.

So it looks like BMI is here to stay but it's worth remembering that, strictly speaking, it is a measure of your weight relative to your height, not fatness or how healthy you are.

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Trinken Alter Gesetze erlauben geringere trinken Alter kann sich später trinken Muster auswirken.

AppId is over the quota
Niedrigere minimale gesetzliche trinken Alter (MLDA) Gesetze wurden kurzfristige Effekte wie eine größere Zahl von Verkehrstoten und Teen Selbstmorde zugeordnet. Eine neue Studie hat die langfristigen und dauerhaften Verbindungen zwischen permissive MLDA Gesetze und trinken Verhaltensweisen wie durchschnittliche Alkoholkonsum, Häufigkeit des Alkoholkonsums, Alkoholexzesse und moderaten trinken untersucht...

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Older fathers: what's behind the trend?

27 January 2013 Last updated at 01:52 GMT Men may be waiting until they feel they can properly provide for their children before becoming fathers Older fathers are no longer unusual. For the past 10 years, statistics show that nearly two-thirds of babies have been born to fathers aged 30 and over.

Are men taking longer to find their perfect mate - or has austerity just made them more focused and career-minded?

David Kesterton, parenthood and community project manager at the Family Planning Association, says there are a variety of sensible and practical reasons why men are having children later in life.

"There's the economic reason that causes people to delay having children, the desire to focus on careers and the difficulties of buying your own home when young," he says.

But he also speculates that it's to do with the rise in second marriages for men, sometimes with younger women, which can mean becoming a father again at a more advanced age.

And of course we are all feeling healthier and living longer too.

"Forty is the new 30. Both men and women feel they have the energy for parenting later in life," Kesterton says.

Stable family

Elizabeth Duff, senior policy adviser for the parenting charity NCT, agrees that potential parents are now tending to wait until they have the means to cope with bringing a baby into the world.

"This trend may be due to parents waiting until they are best placed to welcome their baby into a financially stable family setting, in addition to fewer teenage mothers, following moves to discourage very early parenthood."

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We can't see changes in sperm quality so we suspect there is something happening to his DNA - or he's having less sex.”

End Quote Dr Allan Pacey Sheffield University When the 2011 figures from the Office of National Statistics are broken down, 29% of fathers were 30-34, 21% were aged 35-39 and 10% aged 40-44. Only 4.6% were 45 years or over.

So much for the grey-haired brigade. The figures suggest that men who become fathers in their 50s and 60s, such as Rod Stewart (66), Sir Paul McCartney (61), Clint Eastwood (66), Frank Skinner (55) and Gordon Brown (55), are still relatively uncommon.

A good thing perhaps, since research shows that men - as well as women - have a biological clock.

While a woman's ability to reproduce greatly reduces after a certain age, which explains why only 0.3% of mothers in 2011 were over the age of 45, men can go on creating children as long as they can have sex.

Yet it is not all good news for the male of the species.

'Lower IQ'

Dr Yacoub Kalaf, consultant in reproductive medicine and surgery at Guy's Hospital, says that research suggests there is an age after which men suffer from reproductive ageing.

"Men over 45 may have offspring which have a higher likelihood of a neuro-cognitive disorders, such as autism and schizophrenia. They could also be expected to have a slightly lower IQ."

He cautions that these health risks are very small and that environmental factors must be taken into account as well. In the end, he says, when to have children is a very personal choice.

"Careers, experience, family - they all dictate when you start having children.

"If the choice is between taking a small risk or not having a child together, the couple will always opt for going for a child."

Scientific studies show that around the age of 40, men also become less fertile.

'Don't wait'

Dr Allan Pacey, senior lecturer in andrology at Sheffield University, says experts do not yet know exactly why.

"We can't see changes in sperm quality so we suspect there is something happening to a man's DNA - or he's having less sex.

"Research suggests older men find it harder to become fathers - and that is probably a sexual function issue.

"In any event, my advice would be for men to have children as young as possible - don't wait until your 50s."

The Family Planning Association runs Speakeasy courses helping parents to communicate with their children about difficult subjects like growing up, relationships and sex.

Although David Kesterton says it is harder to attract fathers to participate, he says older fathers can have a different relationship with their children.

"On the one hand, the older generation fathers are more conservative in what they feel confident talking about - but they also have the perspective of wisdom.

"Younger parents can feel closer to their children, but be more caught up in their pressures."

Whatever your age, being an approachable father is always the best kind.

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'Skull in a suitcase' after fall

30 January 2013 Last updated at 08:25 GMT By Smitha Mundasad BBC News Lee Charie had part of his skull removed after a fall from a balcony Lee Charie does not remember falling off a balcony in Thailand.

But when he woke up, part of his skull had been removed.

Doctors in Thailand had cut out a portion to relieve the pressure building on his brain.

And Lee carried this piece of skull home in a polystyrene box, hoping surgeons in the UK would be able to use it to help reconstruct his head.

Lee, 32, from Hertfordshire, was on holiday on the island of Koh Tao when the injury happened.

His memories of the event are hazy, but his father flew out soon after the accident took place in December.

Peter Charie was told his son had fallen from a height of 25ft (7.6m) and was unconscious when found.

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Sometimes you literally need a kick in the head to sort yourself out and start doing what you really want to do”

End Quote Mr Lee Charie And Lee spent a month recovering in hospitals in Thailand before a flight home to the UK accompanied by medics.

His father carried the section of skull the doctors had removed.

He had had no trouble getting it past customs and security, he said.

Under pressure

Lee is currently recovering in hospital in the UK, where he is undergoing physiotherapy, medical tests and help for his pain.

When he realised he had had some of his skull taken away, he says he didn't stop crying for two weeks.

But he says he has been overwhelmed by the support of family and friends, some of whom are organising fundraising events to help him and others in similar situations.

Consultant neurosurgeon Colin Shieff says when the he brain is injured, swelling can push it against the protective bony casing of the skull.

"The brain doesn't work well under pressure. It is safer and can guarantee a better recovery if pressure is not allowed to build up," he says.

"It's a bit like if you sprain your ankle, you undo your shoe. It might look worse but it helps."

Sometimes the swelling is mild enough to subside on its own. In other cases, medication can be given to help reduce and control it, Mr Shieff says.

But in some situations unless a part of the skull is removed, the pressure can start to damage the brain.

Mr Shieff, a trustee of Headway, the Brain Injury Association charity, says in terms of everyday function the whole skull isn't essential - there are a lot of people with skull defects who carry on with their everyday lives.

Some are advised to wear a protective helmet to shield against further brain injury, which can be the greatest risk to people with such bony defects.

In fact surgeons have been operating on the skull for many years.

There have been cases from as far back as the Incas, Aztecs and ancient Egyptians of people who have clearly survived for some time with holes deliberately made in their skulls, Mr Shieff says.

Metal template

Many of Mr Shieff's current patients choose to have their skulls reconstructed.

At times the section that has been removed can be put back in place.

Another option is to construct a metal template using scans and computer models, which follows exactly the contour of the natural skull.

Lee says his surgeons are considering using the piece of skull he brought back to help shape a titanium mould for reconstruction.

He is recovering well, apart from a little pain when he uses his facial expressions too much.

And judging distances when walking up and down stairs can be difficult, he says.

Mr Shieff says: "Any fall from more than one's own body height can be very dangerous.

"Some people die following a fall from that height. To survive and survive unscathed from such a fall is an extremely good thing."

Luke Griggs, spokesman for Headway, says: "The effects of brain injury can be devastating. No two brain injuries are the same, so it is impossible to predict what the long-term effects will be when someone sustains a severe brain injury.

"But public perception needs to change. People with brain injuries are already battling with everyday life and yet sadly they are often unfairly judged and treated unkindly.

"With the right care, support and understanding, many people with brain injuries can lead happy and fulfilling lives."

Lee says: "It has made me re-think a lot of things about my life.

"Sometimes you literally need a kick in the head to sort yourself out and to start doing what you really want to do."

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Stiff upper lip 'harms cancer fight'

30 January 2013 Last updated at 02:52 GMT By Michelle Roberts Health editor, BBC News online Researchers surveyed nearly 20,000 adults in a number of countries The UK's "stiff upper lip" culture may explain why it lags behind other countries when it comes to beating cancer, say experts.

Researchers, who surveyed nearly 20,000 adults in six high-income countries, said they found embarrassment often stopped Britons visiting the doctor.

Respondents in the UK were as aware of cancer symptoms as those in Australia, Canada, Denmark, Norway and Sweden, but more reluctant to seek help, they said.

A third feared wasting a doctor's time.

One in six of the men and women aged 50-and-over surveyed in the UK was embarrassed about sharing their symptoms with a doctor, the researchers from King's College London and University College London, with help from Cancer Research UK and Ipsos Mori, found.

They said, in the British Journal of Cancer, that this may partly explain why the UK has a far lower cancer survival rate than other developed nations, despite good access to skilled medical staff and cutting-edge treatments.

Continue reading the main story

We don't know why British people feel like that. It may be that we are more stoic and have a war-time mentality”

End Quote Dr Lindsay Forbes Lead researcher The researchers surveyed people in England, Wales and Northern Ireland, but not Scotland.

'UK phenomenon'

Data shows that for cancer survival, the UK ranks behind many countries, including the five other nations looked at in the study.

According to estimates, the lives of more than 5,000 cancer patients could be saved each year in England alone if the country matched the best European survival rates.

Former Health Secretary Andrew Lansley pledged to achieve this target by the next general election in 2015, with the government's cancer strategy.

Lead researcher Dr Lindsay Forbes said: "This is a real UK phenomenon. UK people really stood out in our study.

"As a nation we are much more likely to say we are embarrassed about going to the doctor or we are worried that we will take up a doctor's time.

"We don't know why British people feel like that. It may be that we are more stoic and have a war-time mentality.

"We know that older people in particular can get a symptom and then wait for weeks or months before going to see their doctor."

Sara Hiom, of Cancer Research UK, said the charity "and others are working hard to understand and address these potential barriers to early presentation and encourage people to tell their doctor if they have noticed something different about their body".

"More work also needs to be done to tackle the poor awareness that cancer risk increases with age," she added.

The researchers note that Denmark also ranks relatively low for cancer survival. They suspect this could be due to delays in patients accessing timely hospital care - something which may also apply to the UK to some extent.

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VIDEO: Rare heart defect baby goes home

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Fatal op surgeon 'played God'

29 January 2013 Last updated at 17:07 GMT Penny found out she was pregnant with their third child after Louis had died "That surgeon took away my best friend and the best father children could want."

Penny Belcuore has had to "move on" following the death of her husband Luigi, known as Louis, in October 2009.

But the mother-of-three, from Morton Bagot in Warwickshire, has found that very difficult, especially because the surgeon, whose actions led to the death of her husband Luigi, was allowed to continue practising.

Mr Belcuore, 43, died after agreeing to take part in a clinical trial involving elective surgery on his right knee, in 2009, for which after more than three years, Mrs Belcuore has been awarded an undisclosed sum in compensation.

The operation went wrong after Prof James Richardson used an adapted spray gun to close a wound in his patient's knee, at The Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire.

An inquest in March 2011 heard the technique caused an air bubble to stop Mr Belcuore's heart, leading a jury at Shrewsbury Magistrates' Court to conclude the "modification contributed" to his death.

Mrs Belcuore said: "We used to walk a lot in the Cotswolds, we have two big dogs so it was one of our enjoyments.

Mrs Belcuore said she was "shocked" Professor Richardson had been allowed to continue working

"After we had the children Louis would take the girls in a papoose but very occasionally he got a bad pain in his knee and would stumble so he went to the doctor to see if he could find out exactly what was going.

"He was referred to a specialist and then referred to Professor Richardson and he came home very excited he was going to be part of this trial."

A Medical Practitioners Tribunal Service (MPTS) panel has been considering Prof Richardson's fitness to practise as a result of the incident on 20 October, 2009.

The tribunal has been adjourned on Friday after a partial-hearing, and will reconvene later this year to consider whether his actions amount to misconduct which impair his fitness to practise.

'Bittersweet' pregnancy

Mrs Belcuore has said that if he is not struck off as a result, she will know "justice hasn't been performed".

She said she was "shocked" the surgeon was allowed to continue practising after the death of her husband.

"That is the fault of the system, if it was any other profession he would have been suspended and that angers me," she said.

"I don't have any feelings towards Professor Richardson, I don't wish him unwell but we need to be protected from people who try to play god."

Mrs Belcuore said life has had to move on for the sake of Louis 2, Lidia 6 and Sienna 5

Mrs Belcuore found out she was pregnant with their third child, a baby boy, after Luigi had died.

"I was overjoyed but it was bittersweet with tragedy and joy all in one, a very strange feeling," she said.

"But it helped me pull myself together for the sake of my baby and for [my two] girls.

"I feel my husband should be here with the boy he always wanted, being of an Italian family a baby boy was really exciting and I knew I'd name him after Louis."

Mrs Belcuore said she has had to find ways to cope without her husband.

"My father died in a car accident when I was six and my mum brought four of us up," she said.

"It's not in my nature to be a negative person, I was raised very positively and that's just what I have t do for the sake of the children.

"I've got many many great friends so I'm very lucky in a lot of ways."

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Die Auswirkungen der Alkoholexzesse auf die Leber

Alkoholische Leberkrankheit (ALD) ist gekennzeichnet durch eine Fettleber, Hepatitis, Fibrose und Zirrhose. Alkoholexzesse steigt weltweit und ist besonders häufig in den USA...

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Signifikanter Anstieg der Notaufnahme Besuche im Zusammenhang mit Buprenorphin Verwendung

AppId is over the quota
Es wurde eine signifikante Zunahme der Zahl der Notaufnahme Besuche mit Bezug zu der Droge Buprenorphin, ein Medikament zur Behandlung von opioid-sucht. Die Anzahl der Notfall Besuche durch Buprenorphin sprang von 3.161 2005 bis 30.135 2010 nach dem Substance Abuse and Mental Health Services Administration (SAMHSA).Buprenorphin wurde durch die US genehmigt...

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The battle over alcohol pricing

30 January 2013 Last updated at 01:15 GMT Saskatchewan started using minimum pricing in 2003 Saskatchewan is a long way from the British boozer and the aisles of High Street supermarkets.

But the experience of the Canadian prairie province could have a defining impact on our society.

The region, home to just over one million people, is one of the few places in the world to have first-hand experience of minimum pricing for alcohol.

And as such it is forming one of the key pieces of evidence as ministers weigh up whether to push ahead with what would be a controversial policy.

In England and Wales the consultation on a 45p minimum unit price finishes next week. In Scotland a 50p price has been put forward.

Evidence from Saskatchewan, which has a slightly different policy as there are different minimum prices for different types of drinks, has shown that a 10% rise in price leads to an 8% fall in alcohol consumption.

The findings are backed by Sheffield University experts who have been asked by ministers to analyse what effect a minimum price would have here.

Their work suggests the 45p proposals could cut consumption by 2.4%, which after 10 years would result in 10,000 fewer deaths and more than 300,000 fewer hospital admissions.

But of course it is not an exact science with the researchers admitting they can only give "best estimates".

Predicting behavioural change is notoriously difficult, doubly so when the intervention is aimed at something such as drinking that the public are clearly so attached to.

Unlike smoking where the government can simply say it is bad for you, the message for alcohol has to be much more nuanced as there is no evidence that drinking within recommended levels is harmful and some research has even suggested it may be beneficial to health.

'Compelling'

And this has allowed industry, which unsurprisingly is against the introduction of a minimum price, to claim it is sticking up for Joe Public at a time when household budgets are already stretched.

The Wine and Spirit Trade Association launched a campaign this week called "Why should responsible drinkers pay more?"

Miles Beale, the group's chief executive, is clear he thinks the government is making a mistake.

"Evidence shows that there is no simple link between alcohol price and harm and we do not believe that increasing the price of alcohol will effectively tackle problem drinking."

The campaign is also highlighting the fact that alcohol consumption is on the way down in the UK - dropping by 13% since 2004.

That is true, but those who support a minimum price believe drinking rates need to be seen in a much wider context.

While the last few years has seen alcohol consumption tail off, the current figure is still 40% higher than it was 40 years ago.

Where we are drinking has also changed dramatically.

In the early 1970s, 90% of alcohol was consumed in pubs and restaurants, but these days the rise in the availability of cheap alcohol in supermarkets means the split between drinking in and out of home is now almost 50:50.

But to many the clinching factor in support of a minimum price is that the evidence suggests it will hit the problem drinkers the hardest.

As hazardous drinkers are more likely to drink to excess and buy the cheaper alcohol, it is estimated a minimum price would cost them nearly £130 a year compared to just under £7 a year for the moderate drinker, according to the Sheffield University figures.

Dr James Nicholls, of Alcohol Research UK, believes the case for change is "compelling".

In fact, he - like many health campaigners - suggests England and Wales should consider going further and match the 50p put forward in Scotland.

"That is the price at which you begin to affect wine. It would have a much bigger impact."

Ministers certainly have much to consider.

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Self-help books 'treat depression'

19 January 2013 Last updated at 00:42 GMT Can a self-help book aid depression? Prescribing self-help books on the NHS is an effective treatment for depression, a study suggests.

Patients offered books, plus sessions guiding them in how to use them, had lower levels of depression a year later than those offered usual GP care.

The effect was seen in addition to the benefits of other treatments such as antidepressants, Scottish researchers report in the journal Plos One.

Such an approach may help the NHS tackle demand for therapy, they said.

More than 200 patients who had been diagnosed with depression by their GP took part in the study, half of whom were also on antidepressant drugs.

Some were provided with a self-help guide dealing with different aspects of depression, such as being assertive or overcoming sleep problems.

Patients also had three sessions with an adviser who helped them get the most out of the books and plan what changes to make.

After four months those who had been prescribed the self-help books had significantly lower levels of depression than those who received usual GP care.

A year later, those in the self-help group were more likely to be keeping on top of their depression.

Study leader Prof Christopher Williams, from the University of Glasgow, who also wrote the books called Overcoming Depression and Low Mood, said the guided sessions were the key to getting people engaged.

The sessions can be delivered in general practice without referral to a specialist, taking pressure off waiting lists.

In Scotland, a telephone support service has now been set up to help support those using the books, which can be freely copied and disseminated, he added.

"We found this had a really significant clinical impact and the findings are very encouraging," he said.

"Depression saps people's motivation and makes it hard to believe change is possible."

The challenge for the NHS, where self-help books are already used in many places, is how to implement this model so people have easy supported access in primary care, he said.

'Worth investing in'

There has been huge investment in better treatment for depression in the UK in recent years with the Improving Access to Psychological Therapies programme in England set up to widen access.

It has been estimated this approach could save the NHS up to £272m and the wider public sector £700m.

But, says Prof Williams, despite the huge levels of investment, it is just not possible to refer everyone with depression to mental health services.

Dr Paul Blenkiron, consultant in adult psychiatry at Leeds and York Partnership NHS Foundation Trust, said the results showed that guided self-help is effective and is "something the NHS should be investing in".

He is currently advising on behalf of the Royal College of Psychiatrists, on a National Books On Prescription Scheme, to be rolled out across UK public libraries this year.

Thirty books, including the one used in the study, have been selected.

But Dr Blenkiron said self-help would not be suitable for everyone: "The key thing is that the person is committed to doing some work."

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New method to diagnose lung cancer

16 January 2013 Last updated at 06:32 GMT By Julian Fowler BBC News Julian Fowler reports for BBC Newsline

A new technique for detecting lung cancer without the need for surgery is helping patients in Enniskillen, County Fermanagh.

A thin flexible telescope, called an endobronchial ultrasound, is inserted through the patient's mouth and provides camera pictures and ultrasound images.

Samples can also be taken which can lead to faster diagnosis.

Dr Terence McManus uses the device in the South West Acute Hospital.

The 30-minute procedure is carried out under local anaesthetic and patients can normally return home the same day.

Dr McManus, a respiratory consultant, said: "It's a new technique that allows us to biopsy and diagnose conditions at an earlier stage.

"It can, in some cases, avoid the need for more invasive surgery techniques.

"Using this technique we can diagnose conditions such as cancer, inflammatory conditions, and sometimes infections as well."

Lung disease

He said it allowed doctors to "establish a diagnosis and then determine what is the most appropriate treatment for a patient as quickly as possible".

Approximately 900 people in Northern Ireland are diagnosed with lung cancer each year.

It is the second most common cancer among men and the third most common among women.

Stephen Hogan from Florencecourt, County Fermanagh, has lung disease and has undergone the procedure.

He described it as very simple and added it had no unpleasant side effects.

"The big difference for me is knowing where I'm at with the diagnosis and the referral on to the oncologist and then I know what my treatment options are. So, it actually gives you a sense of relief and it saves a lot of time.

"I'm dependent on some degree of oxygen so travelling between A and B is a bit of an issue and we're very lucky to have this brand new facility, so it's brilliant."

The South West Acute Hospital, which opened its doors six months ago, is the first in Northern Ireland to offer this service.

Joe Lusby, deputy chief executive of the Western Health Trust, said it demonstrated how the latest technology is benefiting patients in the new state-of-the-art hospital.

"Anything that provides a faster and more accurate diagnosis of lung disease is bound to be good for the patient," he said.

"This hospital is built for the next 60 years at least so what we were doing is not just transferring services across from the former Erne Hospital.

"We were determined to add services that were appropriate to provide locally so that people don't have to travel great distances to access these services."

About 90% of lung cancer cases are caused by smoking cigarettes and Dr McManus has also seen patients getting the disease at a younger age.

He said: "It can affect any age. Smoking is certainly the biggest risk factor so we would always emphasise the importance of stopping smoking as soon as possible, it's never too late to stop smoking."

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VIDEO: Councils invest millions in tobacco firms

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VIDEO: Long-term ventilation support

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Weight loss 'fights off gut worms'

18 January 2013 Last updated at 03:50 GMT Mice were infected with a worm called Trichinella spiralis in the study Weight loss following infection with intestinal worms is the body's way of fighting off the parasites, University of Manchester researchers have said.

The immune system hijacks a hormone that controls when to stop eating, their study of mice suggests.

This then triggers the type of immune response needed to expel the worms from the gut, PLoS Pathogens reports.

The finding could lead to new ways to treat people with intestinal worms, researchers say.

Researchers first saw a potential link when they were measuring levels of a hormone called cholecystokinin in volunteers after they had been fed a meal.

One man had incredibly high levels and on further investigation it was found he had an intestinal worm infection he had picked up on holiday.

Joining forces with a team specialising in gut worm infections the researchers did a study in mice infected with a worm called Trichinella spiralis.

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Naturally you would think that if you are losing weight you are going to have less energy to fight off infection.”

End Quote Dr John Worthington University of Manchester They found that immune cells called T-cells responded to the worm infection by driving up levels of cholecystokinin.

This increase has a knock-on effect of driving down another hunger hormone, leptin, which influences what type of immune response the body needs to produce.

When they artificially added leptin back into the infected mice, the immune system mounted the wrong response and the intestinal worms remained in the gut for longer.

Global problem

Nearly one in every four of the world's population are infected with gastrointestinal parasites.

It has long been known that these infections often result in a period of reduced appetite and weight loss but why or how this happens was not understood.

Study author Dr John Worthington said the researchers had looked at only one type of parasitic worm but were now doing tests to see if the same response was produced in response to other worms.

"Naturally you would think that if you are losing weight you are going to have less energy to fight off infection," he said.

"This does the opposite of what you would expect."

Dr Worthington added that eventually they would be looking at whether different treatment or nutrition strategies could be designed to boost this immune effect in people affected with intestinal worms.

Dr Mark Robinson, lecturer in parasite proteomics at Queen's University Belfast, said that diseases of humans and animals caused by parasitic worms were among the most widespread and economically devastating throughout the world and drug resistance was becoming a problem.

"The best way to combat worm infections in the future will be the development of vaccines which represent safer, more environmentally-friendly, alternatives to drugs," he said.

"At present, vaccine development is hampered by a lack of basic understanding of how parasitic worms interact with, and influence, our immune system, so research in this area will hopefully contribute to making new anti-parasite vaccines a reality."

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Cancer drug fund 'uncertain future'

16 January 2013 Last updated at 07:52 GMT In England the cancer drug fund has helped more than 25,000 patients Many cancer patients could face an uncertain future over funding for their drugs, a parliamentary report says.

A government initiative increasing access to cancer drugs ends this year, but the system promised to replace it is "nebulous" and ill-defined, say MPs.

The Department of Health insists in the future patients will not miss out on drugs that they currently receive.

But the report criticises the government for delays in explaining its new plans to price all drugs.

The new pricing system is set to start in 2014 and could affect many medicines used by the NHS, not just cancer drugs.

But a big concern is that it replaces the temporary Cancer Drug Fund, which was introduced in 2011 to help people access cancer drugs currently not approved by the health regulator the National Institute for Health and Clinical Excellence (NICE).

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Where an individual patient is one a course of treatment it is important there isn't a cliff edge...”

End Quote Stephen Dorrell Chair, health select committee The Health Select Committee says the lack of clarity on the future of the scheme puts cancer patients and doctors in the dark.

Committee chairman Stephen Dorrell said: "Where an individual patient is on a course of treatment it is important there isn't a cliff edge, that the patient has continuity of care."

The Department of Health said it would "ensure arrangements are in place to protect individual patients who are receiving treatment with drugs funded by the Cancer Drugs Fund as the end of the fund approaches."

The new drug pricing system due to come in is known as value-based pricing.

This aims to give NHS patients better access to effective and innovative medicines.

It means the clinical worth of a drug will be taken into account when setting a price tag.

But the health select committee says the government has done little to explain how the system will work in practice, despite the plans being under discussion since 2010.

Mr Dorrell said: "What we were told during our inquiry indicates that the move to value-based pricing of drugs will be a more modest change than has been suggested, but there is a lack of clarity around the whole issue which has persisted too long."

The committee wants the government to crystallise its plans by March this year.

A Department of Health spokesman said: "We are engaging a range of groups including patients, the NHS and industry as we develop plans for value-based pricing.

"However, as negotiations between the Department of Health and the Association of the British Pharmaceutical Industry are under way, it would be inappropriate to comment further at this stage."

Sarah Woolnough, Cancer Research UK's executive director of policy and information, said: "The Department of Health should urgently publish details of its plans for value-based pricing - as recommended today by the health committee.

"It is vital that the new system works for cancer patients and we want to see proposals that guarantee this."

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Care home abuse sanctions urged

16 January 2013 Last updated at 17:26 GMT Six people were jailed for their role in abuse at Winterbourne View private hospital Companies who own care homes in England where abuse is carried out should face unlimited fines and criminal sanctions, a former minister has said.

Lib Dem MP Paul Burstow has argued for new laws to ensure care providers are held criminally accountable for abuse and neglect on their premises.

This would have tackled a "culture of cruelty" at the Winterbourne View hospital, near Bristol, he added.

Ministers said there was a "clear gap" in regulation to be addressed.

Mr Burstow, who was care services minister until leaving the government in September, outlined proposed legislation in the Commons, which he said would see justice for future victims of abuse and their families

'Thugs'

He said he did not want to see a repeat of the Winterbourne View care scandal that led to the conviction of six people for their role in abuse and neglect at the private hospital near Bristol, but for which he claimed there had been "no corporate accountability".

His proposals, which are likely to need government support if they are to become law, include:

Amending existing legislation to make a corporate body guilty of an offence if the way in which its activities are managed by its board or senior management neglects or is a substantial element in the existence and/or possibility of abuse or neglectOffences should be punishable by unlimited fines, remedial orders and publicity ordersThose with relevant information about suspected abuse or neglect must supply information to Adult Safeguarding Boards if requested to do so.

Speaking in the Commons, Mr Burstow said "no stone should be left unturned" when it came to protecting vulnerable people and reputable owners had "nothing to fear" from his proposed legislation.

"When things go wrong, when terrible abuse and neglect takes place, the public expect those who take the fee to be held to account," he told MPs. "This new law would act as a deterrent. It would force weak boards of directors to pull their socks up."

"At Winterbourne View staff carried out horrific acts because of the opportunities a culture of cruelty created. This bill would help to remove some of those opportunities."

'Duty of oversight'

Gary Fitzgerald, chief Executive of Action on Elder Abuse, which is supporting the MP's plans, said: "While it is right that abusing care workers should feel the full impact of the courts and sentencing, it is equally important that those who employ and direct those workers should also face justice.

"The public expect no less."

Mr Burstow's bill will be debated for the first time in March.

Ministers have indicated they are prepared to look at criminal sanctions as one of a number of future options.

"We need to have a situation where people who run and own care organisations, in the public, private or voluntary sector, know that they will be held accountable for the services they provide and that there will be consequences for those who fail in their duties of oversight," said Norman Lamb, who took over Mr Burstow's government role.

"When I first took on this job in September, I identified a clear gap in the regulatory framework - one which I am determined will be addressed. This spring we will announce proposals to address the gap in the law on effective corporate accountability."

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Light in womb 'gives healthy eyes'

16 January 2013 Last updated at 18:21 GMT By James Gallagher Health and science reporter, BBC News Light passing through the body and into the womb has an important role in the developing eye, US researchers have discovered.

A study, published in the journal Nature, showed that mice spending pregnancy in complete darkness had babies with altered eye development.

It indicated tiny quantities of light were needed to control blood vessel growth in the eye.

The researchers hope the findings will aid understanding of eye disorders.

Light or dark?

If you could journey inside a mouse or a person, there would not be enough light to see. However, tiny quantities of light do pass through the body.

This effect has already been used to film an infection spreading through the body.

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It's not something subtle here, it's a major effect on the way the retina develops”

End Quote Prof Richard Lang Cincinnati Children's Hospital Now scientists - at the University of California, San Francisco, and Cincinnati Children's Hospital Medical Center - believe that body-penetrating light can alter the development of the eye, at least in mice.

Normally, a network of blood vessels known as the hyaloid vasculature is formed to help nourish the retina as it is constructed.

However, the blood vessels would disrupt sight if they remained, so they are later removed - like scaffolding from a finished building.

The researchers said this did not happen when the pregnancy was spent in total darkness.

The critical period was around 16 days - which is very late in mouse gestation, but corresponds to the first trimester in people.

"It's not something subtle here, it's a major effect on the way the retina develops that requires light going through the body," said Prof Richard Lang, from Cincinnati Children's Hospital.

He said it was a "huge surprise" that this was happening.

Premature babies

The researchers hope their findings may aid understanding of human diseases of the eye, as many are down to blood vessels.

Some babies born prematurely develop "retinopathy of prematurity", when the blood vessels in the eye grow abnormally resulting in damage to the retina and a loss of vision.

Prof Lang said: "In retinopathy of prematurity there is overgrowth of blood vessels and that's what you see in these mice."

The researchers showed that light was activating in the mice a protein, melanopsin, which also has a role in regulating the body clock, and is present in people. However, whether the same processes take place in people or other animals is unknown.

Prof Robin Ali, from University College London, said it was a "fascinating study".

He said more research was still needed, but the findings may lead to considerations of light levels during pregnancy and efforts to grow retinas in the laboratory.

He said: "It gives us a whole new aspect to consider in in the development of the retina.

"It illustrates how much we've yet to understand about the eye."

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Donated genetic data 'privacy risk'

18 January 2013 Last updated at 09:29 GMT Genetic data was used to identify 50 people Researchers have identified people in the US who anonymously donated their DNA for use in medical research - raising concerns about privacy.

They could uncover a person's identity using records of donated DNA coupled with other readily available sources of information on the internet.

It was made possible because of large "genetic genealogy" databases which help people trace their family tree.

The study was reported in the journal Science.

Weak male link

There is a strong link in men between their surname and unique markings on the male, or Y, chromosome.

These genetic markings are a useful tool when investigating a family tree as they are passed from father to son and are used in "genetic genealogy" databases.

Researchers from the Whitehead Institute for Biomedical Research used this freely available data to create a computer programme which could match unique markers to surnames.

This was used to hunt through an academic database - the 1,000 genomes project.

It contains the entire genetic code of volunteers who donated their DNA anonymously. The only record is of the donor's age and their home state.

The computer programme, however, could now work out surnames as well. This was enough, combined with a basic internet search, to work out the identities of around 50 people.

Privacy

One of the researchers, Yaniv Erlich, said: "This is an important result that points out the potential for breaches of privacy in genomics studies."

But he stressed very strongly that he would not want to see public sharing of genetic information curtailed, rather that people were aware of the realities.

"More knowledge empowers participants to weigh the risks and benefits and make more informed decisions when considering whether to share their own data.

"We also hope that this study will eventually result in better security algorithms, better policy guidelines, and better legislation to help mitigate some of the risks described."

The team shared their findings with officials at the US National Human Genome Research Institute who then removed ages of participants from the publicly-accessible genome database.

In an accompanying editorial Eric Green, director of the Institute, says there needs to be a balance between the rights to privacy of those taking part in research and the benefits to society to be gained from the sharing of biomedical research data.

Hit rate

Frances Rawle, head of policy at the UK's Medical Research Council, said: "This paper is useful and also timely as there is currently a great deal of discussion about the sharing of data both between researchers and more widely.

"The potential benefits to be gained from sharing genetic data relating to individuals must be balanced with the potential harm of unintended disclosure of personal information."

Prof Mark Jobling, a Wellcome Trust senior fellow at the University of Leicester, said if the same study was done in the UK the hit rate might be even higher because their had been less changing of surnames over time.

He added that a lot of effort was still required to identify individuals and even if someone had your genetic profile, most human traits are not easily predictable from DNA.

"When people sign up to genetic testing, you have to make it clear that that there is an outside chance someone could identify you. It is the very basis of informed consent."

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Remarkable drugs at remarkable prices

16 January 2013 Last updated at 00:20 GMT By Ken Macdonald BBC Scotland Science Correspondent The orphan drug market is currently said to be worth $50bn and is growing at about a rate of 6% per year It's one of the oldest debates in economics: what's the difference between what something costs and what it's worth?

The debate has been given new life by the advent of orphan drugs.

The term was coined in the US. They are "orphan drugs" for the simple reason that they were designed to treat orphan diseases - conditions so rare that only a relative handful of people are affected.

Lesley Loeliger, who lives just to the south of Glasgow, remembers the day she was diagnosed with the orphan disease Paroxysmal Nocturnal Haemoglobinuria - PNH for short. The doctor explained it was a bone marrow disease with a median survival rate of just 10 years.

Its effects were dreadful.

"I was having to be carried up and down the stairs," she says.

Lesley's life has been transformed by the orphan drug Soliris

"I was having to be dressed and undressed. I just couldn't do anything for myself. Sometimes, when I was so bad, and I was so exhausted I couldn't even turn over in bed."

Since then, Lesley's life has been transformed by an orphan drug called Soliris.

It's an exceptional treatment at an exceptional price. At £250,000 per patient, per year, Soliris is the world's most expensive drug.

Scotland's medicines watchdog, the Scottish Medicines Consortium, says Soliris isn't cost effective and doesn't recommend its use in the NHS. But Lesley and eight other patients are receiving the treatment because the Scottish government accepts there is no other treatment suitable for them.

'Big business'

Soliris's makers Alexion say its price is fair as they bore "enormous costs and risks" in the drug's development.

They say one-third of patients died within five years before Soliris was available, and governments and private insurers in more than 35 countries recognise its value.

Soliris is exceptional but not unique. More than 60 orphan drugs are approved for use in Europe. Not all are as expensive as Soliris, but taken together the sector spells big business.

Dr Kiran Meekings, of Thomson Reuters Life Sciences, has been analysing the sector.

Continue reading the main story

We could start swamping healthcare payers with costs across the board with these very expensive drugs”

End Quote Dr Carl Heneghan Director of the Centre for Evidence Based Medicine She says the potential profits are huge: "The orphan drug market at the moment we know is $50bn and growing ... at about a rate of 6% per year.

"Soon that's going to become a very large sum of money, so with regard to the future projections, it'd be interesting to see what the market can bear."

The drugs industry says the prices of orphan drugs reflect the cost of research.

Dr Frances Macdonald, from the Association of the British Pharmaceutical Industry, says it costs roughly £1bn to bring a new drug to market.

"Also," she says, "the one medicine that makes it to market has to recover the cost of those that didn't.

"And of molecules that go into basic research, only about one in 5,000 will come through. And of those that start in phase 1 clinical trials, only about one in 10 will come through."

It seems counterintuitive - and contrary to the time-honoured teaching about economies of scale - that medicines targeted at a relatively small number of patients could be worth the effort of the pharmaceutical industry.

That was the argument which led the authorities on both sides of the Atlantic to offer incentives to develop orphan medicines: subsidies for research, tax breaks and marketing monopolies.

The Scottish government is investing £21m in a fund to pay for orphan drugs

But Dr Carl Heneghan, director of the Centre for Evidence Based Medicine at Oxford University, fears this could backfire to the cost of the NHS.

"There are lots of orphan drugs and lots of orphan diseases still to be tackled," he says, "and actually we could start swamping healthcare payers with costs across the board with these very expensive drugs.

"And they get overwhelmed and just say actually we can't look at any of these - there's too many coming our way."

The Scottish government is investing £21m in a fund to pay for orphan drugs. A wider review is also under way into how new drugs become available on the NHS.

Ultimately, it'll come down to that difference between how much things cost - and what they're worth. And to Lesley Loeliger, Soliris is priceless: "To me this drug is a miracle.

"My family had to face the possibility of me going in 10 years. My husband had to face the chance of bringing up the children on his own.

"My mum and dad faced the possibility of losing their daughter. And I appear to be getting better."

BBC Scotland Investigates: Life, Drugs and Enormous Amounts of Money is on BBC One Scotland at 10:35 on Wednesday 16 January, and for a week afterwards on the BBC iPlayer.

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Extra heart check for over-65s

16 January 2013 Last updated at 03:26 GMT The check can be carried out while doctors are monitoring blood pressure A new blood pressure measuring device which can also detect a dangerous heart condition has been backed by the NHS watchdog.

The National Institute for Health and Clinical Excellence says GPs could use it routinely to spot more patients with atrial fibrillation (AF).

AF is an erratic and often fast heartbeat affecting 800,000 people in the UK and is a major cause of stroke.

The device NICE is recommending in England is called WatchBP Home A.

It looks like a normal blood pressure monitor, with an inflatable cuff that goes around the patient's arm.

At the same time as measuring blood pressure, it can check a patient's pulse.

Hidden cases

NICE says GPs should consider using it for anyone who they suspect has high blood pressure or anyone who is having a check for high blood pressure.

In this way, more cases of undiagnosed AF could be picked up and treated, which would ultimately save lives.

People with suspected AF, either because of their test result or symptoms like to dizziness, shortness of breath and palpitations, should still be sent for a heart trace called an ECG to confirm the diagnosis.

If people over 65 were to be checked with the WatchBP Home A device, it could save the NHS about £26m and benefit about 400,000 people, says NICE.

Prof Carole Longson from NICE said: "The guidance is not about screening for atrial fibrillation, but about the benefits that the device offers in helping to pick up atrial fibrillation by chance in people with suspected high blood pressure or those being screened for high blood pressure, in primary care."

The British Heart Foundation said: "Atrial fibrillation is a potentially dangerous condition that affects roughly one in 100 people in the UK and can increase four-fold the risk of a stroke.

"With appropriate treatment that risk can be substantially reduced so early diagnosis is vital."

AF can be treated with medicines to thin the blood and control the abnormal heartbeat.

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Pregnancy advice 'scaremongering'

3 January 2013 Last updated at 05:00 GMT Pregnancy is a huge, life-changing period in a woman's life and there is no shortage of advice about what is best for your unborn child. But in this week's Scrubbing Up, Linda Geddes, the author of Bumpology, argues this can sometimes be misleading and scaremongering.

Expectant parents are bombarded with advice about what they should and shouldn't be doing.

Pregnant women mustn't eat too much as it may raise the baby's risk of obesity or diabetes, but they mustn't diet as that could have a similar effect.

Neither should they exercise for fear of triggering a miscarriage, or get too stressed out because that's bad for the baby too. And if they do get stressed, they can't drink alcohol or go for a spa treatment to relax.

You might start to think that staying at home would be the sensible thing to do, only this too is ridden with potential dangers for your unborn child: from ice-cream, to pet shampoo, to hair dye. Even lying down or your back can allegedly cut off your baby's blood supply.

When I fell pregnant three years ago, I felt paralysed and somewhat patronised by all the conflicting advice out there.

I was also obsessed with the little life that was growing inside me, and desperate for more information about what it was doing in there.

Could it taste the curry I was eating; hear the songs I was singing; or sense when I took a swim in the freezing outdoor swimming pool near my home?

So I began a quest to investigate the truth behind the old wives' tales, alarming newspaper headlines and government guidelines, and to probe deeper into the inner world of the developing child. So Bumpology was born.

Booze and breastfeeding

Some of what I discovered while researching the book amused and amazed me: I learned that parents who already have a couple of boys are statistically more likely to go on having boys, though no-one really understands why; that the shape of a woman's bump provides no clues as to the gender of the baby within, but that women with severe morning sickness are slightly more likely to be carrying a girl; and that contrary to the received wisdom, babies actually can focus on objects further than 30cm away (even if they often under- or overshoot).

I also learned that much of the research underpinning medical advice on things like alcohol consumption - and even the health benefits of breastfeeding - is far from clear-cut and often aimed at the general population, rather than taking the individual into consideration.

In the case of alcohol, there's clear evidence that heavy drinking is harmful -- and even a daily glass of wine may increase the odds of a baby being born underweight, which carries additional risks to its health.

However, below this level, there is a massive grey zone where scientists simply don't yet have an answer to whether or not alcohol causes harm.

When it comes to breastfeeding, it's quite true that breast milk is best for babies, or at least better than formula milk in terms of protecting them against infections in the short term.

But when it comes to the much-touted long-term benefits of breastfeeding, such as protection against obesity, diabetes or allergy, the research is less convincing.

Certainly women who can't breastfeed for whatever reason, and who live in countries with a decent standard of health care, shouldn't waste too much time worrying that they are causing long-term damage to their baby's health.

'Overblown'

However, what alarmed me the most was the realisation that much of what women are told about the risks of medical interventions during labour - things like induction, epidural anaesthesia and undergoing a c-section - are overblown.

At the same time, statistics about the odds of needing medical assistance or on complications like tearing during a vaginal birth are frequently not talked about.

I believe that access to this kind of information could have a big influence on women's expectations of labour and on some of the decisions they make when planning for the birth of their child.

I also think it could help women to come to terms with things if labour doesn't go according to plan and they need additional help getting their baby out.

Having a baby can be one of the greatest joys that life bestows. However, it is also hard work and new parents can do without the unnecessary guilt, anxiety and doubt that misleading pregnancy advice brings.

It is also a time of great wonder and through my research I have learned things about my own children that will never cease to amaze me. I believe it's time to push aside the scaremongering and allow parents the freedom to enjoy this precious period of their lives.

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'Grief and anxiety are not mental illnesses'

18 January 2013 Last updated at 03:01 GMT By Peter Kinderman Professor of Clinical Psychology Everyday anxieties could become targets for medical treatment in an updated US psychiatric manual The forthcoming edition of an American psychiatric manual will increase the number of people in the general population diagnosed with a mental illness - but what they need is help and understanding, not labels and medication.

Many people experience a profound and long-lasting grieving process following the death of a loved one. Many soldiers returning from conflict suffer from trauma. Many of us are shy and anxious in social situations or unmotivated and pessimistic if we're unemployed or dislike our jobs.

For a few of us, our experiences of abuse or failure lead us to feel that life is not worth living. We need to recognise these human truths and we need to offer help. But we should not regard these human experiences as symptoms of a mental illness.

Psychiatric diagnoses are not only scientifically invalid, they are harmful too. The language of illness implies that the roots of such emotional distress lie in abnormalities in our brain and biology, usually known as "chemical imbalances".

This leads us to be blind to the social and psychological causes of distress.

More importantly, we tend to prescribe medical solutions - anti-depressants and anti-psychotic medication - despite significant side-effects and poor evidence of their effectiveness.

Continue reading the main story

The criteria for "generalised anxiety disorder" would be significantly relaxed, making the worries of everyday life into targets for medical treatment.”

End Quote Prof Peter Kinderman This is wrong. We should not be diagnosing many more people with meaningless "mental illnesses", telling them these stem from brain abnormalities, and prescribing medication.

Sex addiction

An extremely influential American psychiatric manual used by clinicians and researchers to diagnose and classify mental disorders has been updated for publication in May 2013.

But this latest edition of the American Psychiatric Association's Diagnostic and Statistical Manual, or DSM-5, will only make a bad situation worse because it will lower many diagnostic thresholds and increase the number of people in the general population seen as having a mental illness.

The new diagnosis of "disruptive mood dysregulation disorder" will turn childhood temper tantrums into symptoms of a mental illnessNormal grief will become "major depressive disorder", meaning people will turn to diagnosis and prescription as a response to bereavementThe criteria for "generalised anxiety disorder" will be significantly relaxed, making the worries of everyday life into targets for medical treatmentLower diagnostic thresholds will see more diagnoses of "adult attention deficit disorder", which could lead to widespread prescription of stimulant drugsA wide range of unfortunate human behaviours, the subject of many new year's resolutions, will become mental illnesses - excessive eating will become "binge eating disorder", and the category of "behavioural addictions" will widen significantly to include such "disorders" as "internet addiction" and "sex addiction" Stigma of diagnosis

Standard psychiatric diagnoses are notoriously invalid - they do not correspond to meaningful clusters of symptoms in the real world, despite the obvious importance that they should. Diagnoses fail to predict the effectiveness of particular treatments and they do not map neatly onto biological processes.

In current mental-health systems, diagnosis is often seen as necessary for accessing services. However, it also sets the scene for the misuse and overuse of medical interventions such as anti-psychotic and anti-depressant drugs, which have worrying long-term side-effects.

Scientific evidence strongly suggests distressing experiences result not from "faulty brains", but from complex interactions between biological, but more importantly, social and psychological factors.

But diagnosis and the language of biological illness obscure the causal role of factors such as abuse, poverty and social deprivation. The result is often further stigma, discrimination and social exclusion.

Therapeutic approach

There are humane and effective alternatives to traditional psychiatric diagnoses.

It is relatively straightforward to generate a simple list of problems that can be reliably and validly defined. There is no reason to assume that these phenomena cluster into diagnostic categories or are the consequences of underlying illnesses.

We can then use medical and psychological science to understand how problems might have originated, and recommend therapeutic solutions.

This approach would yield all the benefits of the current diagnosis-and-treatment approach without its many inadequacies and dangers.

Prof Peter Kinderman is head of the Institute of Psychology, Health and Society at the University of Liverpool.

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Most sunbeds 'fail safety limit'

17 January 2013 Last updated at 01:55 GMT Sunbeds in England need tighter regulation, researchers say Nine out of 10 sunbeds in England fail to meet British and European safety standards, research in the British Journal of Dermatology suggests.

The levels of ultraviolet (UV) radiation emitted by 400 sunbeds were on average two times higher than recommended limits, the study found.

Researchers warn the number of skin cancers may increase if stricter controls are not put in place.

But sunbed manufacturers say regulation is making them safer to use.

The Cancer Research UK funded study examined 402 sunbeds across England between 2010 and 2011.

Continue reading the main story

We need proper regulation, covering issues like safety of equipment and health warnings for clients”

End Quote Nina Goad British Association of Dermatologists The researchers from the University of Dundee also looked at the risk of developing skin cancer from sunbeds compared with the risk associated with tanning in the Mediterranean sun.

They found the cancer risk from sunbeds was more than twice that of spending the same length of time in the midday sunshine.

Yinka Ebo, at Cancer Research UK, said: "Research has already shown that using sunbeds for the first time before the age of 35 increases the risk of the skin cancer malignant melanoma by 87%.

"Sunbeds are not going to do you any good - the best-case scenario is they will age and damage your skin. The worst-case scenario is a cancer diagnosis and potentially death."

Regulation on sunbeds came into force in 2009, but the researchers suggest stricter control measures are required to prevent an increase in the number of skin cancers.

Nina Goad, of the British Association of Dermatologists, said: "England is sadly trailing behind the rest of the UK in this matter.

"We need proper regulation, covering issues like safety of equipment and health warnings for clients."

But Gary Lipman, chairman of the Sunbed Association, which represents companies that manufacture and operate tanning stations, said the study findings were out of date.

"The Sunbed Association has been working with its members, non-members and... local authorities since 2009 to inform them about the change in UV emission levels, and advise how to become compliant.

"Sun bed users should check with their salon that the sun bed is 0.3 compliant - that means its UV emission levels are guaranteed to be no higher than the midday Mediterranean sun."

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Disabled people 'could be forgotten'

17 January 2013 Last updated at 01:46 GMT By Nick Triggle Health correspondent, BBC News Tony Averis, who is registered blind and has mobility problems, says he "would just be stuck at home" under social care reforms

Adults with disabilities in England are being deprived of basic care and support and are at risk of being forgotten in the wider reform of the social care system, campaigners say.

Much of the focus on care has been centred around the crisis facing the elderly.

But a coalition of charities has warned people with disabilities under the age of 65 are being neglected too.

They said the squeeze on council care meant many were already missing out.

And the groups, including Mencap, Scope, the National Autistic Society, Leonard Cheshire Disability and Sense, warned the situation could deteriorate under the forthcoming reform of the system.

Ministers are soon expected to announce a cap will be placed on the costs people face for care.

But this will largely benefit older people who have built up substantial assets through savings, pensions and property.

Ration care

Younger adults with disabilities are less likely to have such assets, and as a result get care free through the means-tested system.

About 500,000 working age adults get social care support - a third of the total number getting help.

Continue reading the main story

Times are tough for everyone but being able to eat, wash and leave your home is not a luxury”

End Quote Richard Hawkes Scope But the figure has been falling in recent years as councils have started to ration care so that only those with the most severe needs get help.

Research carried out for the charities indicated there were now 90,000 fewer people receiving help than in 2008 - at a time when there are more people living with disabilities.

The study also warned if the reform of the system was pushed through it could lead to more being excluded.

This is because the government's desire to have national eligibility criteria could result in those areas that have yet to ration care imposing tighter restrictions.

Meanwhile, the research also raised concerns about the quality of services being provided.

A survey of 600 people receiving social care found nearly 40% were failing to get enough help to ensure their basic needs, including eating properly, washing and dressing, were met.

Overall, the report estimated there was a £1.2bn funding gap for younger disabled adults.

Scope chief executive Richard Hawkes: "The government has got a fantastic opportunity at the moment to get this right"

Scope chief executive Richard Hawkes said: "This is shocking evidence of a system that has failed disabled people, effectively condemning them to a life without basic dignity and invisible to society.

"Times are tough for everyone but being able to eat, wash and leave your home is not a luxury."

Mark Goldring, of Mencap, added: "It is unforgivable. The government cannot ignore this damning evidence."

Care Minister Norman Lamb said he recognised there was "pressures" on the system and the government was trying to target resources at social care.

But he said even in the present conditions there were examples of local authorities "redesigning services to find more efficient ways of working".

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VIDEO: MP: We are fattest country in Europe

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Bacteria use 'biological alchemy'

18 January 2013 Last updated at 03:50 GMT By James Gallagher Health and science reporter, BBC News Infectious bacteria have for the first time been caught performing "biological alchemy" to transform parts of a host body into those more suited to their purposes, by a team in Edinburgh.

The study, in the journal Cell, showed leprosy-causing bacteria turning nerves into stem cells and muscle.

The authors said the "clever and sophisticated" technique could further therapies and stem-cell research.

Experts described the discovery as "amazing" and "exciting".

Alchemists may have failed to morph base metals into gold, but a team at the University of Edinburgh has shown that bacteria can transform parts of the body into something more valuable to them.

It is a feat that scientists have already achieved in the laboratory. Skin cells have been transformed into flexible stem cells that can become any of the body's building blocks from heart muscle to brain cells.

One of the researchers, Prof Anura Rambukkana, said: "Our body's cells can be manipulated and why would a bacterium not take advantage of that?"

Master manipulators

Experiments on mice and cells grown in the laboratory showed the leprosy bug infected nerve cells. Then over a period of a few weeks the bacteria began to subvert the nerves for their own ends. The chemistry of the cells changed and they became stem cells.

Continue reading the main story

The ability of bacteria to convert one mammalian cell type to another is 'alchemy' by nature on a grand scale”

End Quote Prof Chris Mason Stem cell scientist These can grow and spread around the body, unlike the static nerves.

"This is a stem cell that is generated by the body's own tissue so the immune system does not recognise it and they can get any place they want without being attacked," said Prof Rambukkana.

Those cells could lodge inside muscle and become muscle cells.

"We realised, 'Wow, this is something very, very striking'.

"It's the first time a bacterial infection has been shown to make stem cells, that's the big thing here."

'Alchemy'

He hopes the findings will increase understanding of leprosy and lead to new ways of developing stem cells - which have been touted as future treatments for a range of diseases.

Prof Rambukkana also believes it is "probable" that other species of bacteria would have evolved the same ability to reprogramme their host.

Prof Chris Mason, a specialist in stem cell research at University College London, said: "The ability of bacteria to convert one mammalian cell type to another is 'alchemy' by nature on a grand scale.

"Whilst this amazing discovery is in a mouse model, it highlights the extraordinary complexity of the interactions between mammals and bacteria and the ingenuity of scientists to uncover disease mechanisms that a decade ago would have been beyond science fiction.

"The next essential step is to translate this valuable piece of knowledge into tangible benefits for patients - a process that may take a decade before its relevance to clinical medicine is fully understood."

Prof Diana Lockwood, from the London School of Hygiene and Tropical Medicine, said: "Their finding that bacteria can reprogramme cells is very interesting and exciting."

However, she cautioned that there was "quite a gap between this and clinical leprosy and I don't think it's going to lead to new treatments".

Dr Rob Buckle, head of regenerative medicine at the Medical Research Council, said: "This discovery is important not just for our understanding and treatment of bacterial disease, but for the rapidly progressing field of regenerative medicine."

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'Paperless NHS' would save billions

16 January 2013 Last updated at 03:16 GMT Health Secretary Jeremy Hunt wants the NHS to be paperless by 2018 - a move a report says could help save the health service billions of pounds a year.

In a speech, Mr Hunt will say a first step is to give people online access to their health records by March 2015.

And by April 2018, any crucial health information should be available to staff at the touch of a button.

PwC suggests a potential £4.4bn could be put back into the NHS with better use of information and technology.

This information technology revolution has been long in the offing.

It was Mr Hunt's predecessor Andrew Lansley who first pledged in 2010 to start an information revolution to ensure patients could use the web to report their experiences, rate NHS organisations and access their records so there would be "no decision about me, without me".

Continue reading the main story

Patients are waiting too long in A&E and being treated in under-staffed hospitals - they will not thank him for making this a priority”

End Quote Labour's shadow health minister Jamie Reed A couple of years on and progress has been patchy, with some parts of the NHS offering a big digital presence and others lagging.

Previous attempts to transform NHS information technology have run into trouble. Labour's scheme, Connecting for Health, allowed X-rays and scans to be stored and sent electronically.

But other parts of the programme - launched in 2002 - became mired in technical problems and contractual wrangling and the national programme has effectively been disbanded and local parts of the health service asked to proceed with upgrading IT systems.

Priorities

In a speech to think tank Policy Exchange, Mr Hunt will say hospitals should plan to make information digitally and securely available by 2014-15.

This will means that different professionals involved in one person's care can start to share information safely on their treatment.

"We need to learn those lessons - and in particular avoid the pitfalls of a hugely complex, centrally specified approach. Only with world-class information systems will the NHS deliver world-class care," he will say.

Mr Hunts comments come as a report by PwC suggests a potential £4.4bn could be put back into the NHS by using better use of information and technology.

Using electronic prescribing and electronic patient records would also give staff more time to spend with patients.

The John Taylor Hospice near Birmingham found that using laptops more than doubled the amount of time clinicians could spend with patients.

Labour says the public will struggle to understand why the government is making information technology a priority at a time when NHS spending has been cut.

Labour's shadow health minister, Jamie Reed, said: "As winter bites, the NHS is facing its toughest time of the year and the government has left it unprepared.

"Patients are waiting too long in A&E and being treated in under-staffed hospitals - they will not thank him for making this a priority. He should sort out the bread and butter issues first."

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Could Big Data herald a new era of medicine?

17 January 2013 Last updated at 06:17 GMT By Susan Watts Newsnight Science editor, BBC News Often, you are barely aware of it, but hop on a train, spend some time in the shops, watch a movie or a match or visit your GP, and the chances are you will have contributed to half a dozen collections of mass data.

Government and companies now collect, store and analyse as much information as they can about the way we interact with them.

Their goal is the pursuit of efficiency, and to find ways to save, or make, money. There is even a phrase for it - "big data".

The idea is not just to collect this data, but to analyse it.

Take healthcare. In December 2012, the government announced a big data plan for perhaps our most intimate of data, the DNA read-out of 100,000 people with rare diseases and cancer.

Continue reading the main story Big data involves the gathering and analysis of data on a large scaleThe data can come from our purchase records, digital photos, social media posts, mobile phone GPS signals etcCompanies can use it to help predict who is facing a divorce, planning a baby, looking to move house or change jobsSupermarkets use big data to send money-off vouchers and offers for products they know their customers will likeIn March 2012 the White House set up a $200m Big Data Research and Development Initiative to explore how it could help address problems facing the governmentUS Police departments use big data to predict crime hot spots and deploy officers before it happensIt is a colossal sequencing effort. Not only does each patient have a unique DNA code, but so do their cancer tumours. And some patients will respond to certain drugs better than others, depending on the genetic variants they carry.

The claim is that a mass DNA database could herald a new era in medicine, and make the nation richer too. Aside from highlighting British innovation and attracting investment, the initial focus is to help people who are already sick.

For the rest of us, the argument goes, if enough people are on the database, trends will become clear.

So we could be more confident that our personal DNA read-out can be checked against those trends and might warn us we are more at risk of certain diseases, and do something about it like changing our lifestyle of getting screened.

We might also be able to avoid drugs known to be toxic in people that carry a similar genetic make-up to our own.

Prof Sir John Bell is one of the government-appointed "champions" for the Life Sciences industry, and chair of the government's Human Genomics Strategy Group. He sees genomics in the NHS as a vital tool and said it is quite a "dramatic change in the way that medicine is likely to evolve".

The struture of DNA was discovered in 1953

The big data at the heart of this is the DNA double-helix.

It is made of four chemicals - essentially a code with four letters. The string of letters that spells out a human being is huge - it took about eight years and cost billions of dollars, to unravel the first human genome.

But now, the computer technology that made that possible is far more powerful, and cheaper.

These days, it takes a little over a day to unravel the DNA sequence of a single individual. And though it is not yet possible, there is talk of a £60 price tag.

Aside from cheaper, more powerful technology, it is also scale that brings the real power.

If the plan takes off, then the sheer numbers of patients involved will allow researchers, both public and private, to ask all sorts of questions of the dataset.

The NHS already has big data projects in place, notably, a system that enables scientists to carry out research on our clinical information, once anonymised, and smaller scale genetics research databases, such as UK Biobank, but what is new is the idea of bringing all of this together.

A national gene database might aid epidemiology

"The great thing about the UK, and particularly the English NHS, is 50 million people and it's at that scale that you're probably going to have the power to detect all kinds of things that are very powerful in terms of the management of disease, and have quite a profound impact," said Prof Bell.

He said he does not stand to make any money from the project himself, though he told us he sits on the board of Roche and Genentech, pharmaceutical companies which may benefit from genomics being applied more widely in healthcare in the UK.

There is some agreement that having genetic information from somebody who is already sick can help to find the best treatment for them.

What is less clear is how much the entire genetic read-out of a healthy person can tell you about the illnesses they might get in the future.

Just because someone carries a particular change in their genes, in most cases, it is far from definite that they will go on to become ill.

We are into the realm of probability and risk, which are notoriously difficult to assess and convey.

Identification by data

There is also the issue of privacy.

Professor of security engineering at University of Cambridge, Ross Anderson, has been asked by the Nuffield Council on Bioethics to join a team that will examine the pros and cons of big data and genomics in the NHS.

The government says the information in the new database will be anonymised. But if it is linked to medical records, that will bring new risks, according to Prof Anderson.

Continue reading the main story

The 'grand bargain' that the government is offering us is that if we give them our DNA then they are going to revolutionise healthcare”

End Quote Stuart Hogarth Bioethicist, King's College London He said medical data is especially hard to protect because it is so rich in information and his primary concern is that individuals, and their data, could be identified by a process of triangulation: "If you look at the typical person's medical record they may have some things that are known to their friends and family, such as that you broke your leg on the 17 January 1991, and some things that you don't want all your friends and family to know, such as that you had a treatment for depression.

"The problem is that if you make de-identified medical records available, then everyone from whom the subject wants privacy knows part of the record - namely the leg break, which is enough to identify that record out of many records - and they can therefore get access to the sensitive information, namely the treatment for depression."

Prof Bell said there are already robust methods in place to protect people's privacy in medical research which rely in part on limiting access to the data to trusted research partners.

"You probably can't get around the issue that no data in any setting is absolutely anonymised and secure," he said.

"But I think the constraints in the system that have already been thought about for other types of clinical data are probably pretty secure."

That is not enough for Prof Anderson, who wants the government to make details public.

"What we actually need is for anonymisation mechanisms to be open to the public, so that we can work out for ourselves whether the protection is adequate.

"I want to be able to test them. I want to be able to kick the tyres, and if the government's lying, I want to expose them, and embarrass them for it."

Bioethicist Stuart Hogarth, of King's College London, said he is not sure people are ready: "The 'grand bargain' that the government is offering us is that if we give them our DNA then they are going to revolutionise healthcare.

"Well it's not clear in fact that we need so much genomic data to understand the genetic basis of health and disease.

"It's not clear that the government has the capacity to put in place the large-scale IT project of the sort that would be necessary to do this, and it's not clear that the British public is willing to accept that bargain."

Watch Susan Watts' full Newsnight report on Big Data and the DNA database

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Phone apps 'delay skin diagnosis'

17 January 2013 Last updated at 12:19 GMT Researchers say you must seek medical advice if you are concerned about a mole Using a smartphone app to decide whether a mole is cancerous could delay sometimes life-saving treatment, according to American researchers.

The University of Pittsburgh scientists put four applications to the test by showing them 188 pictures of cancers and less concerning skin conditions.

Three of the apps wrongly labelled the cancerous lesions as unproblematic in almost a third of cases.

Doctors warn using phones rather than seeking expert help could be harmful.

The research, published in the journal JAMA Dermatology, looked at four commonly used applications.

The images selected to test the apps were all of skin lesions that were later removed and checked for an accurate diagnosis.

Three of the apps analysed the pictures using automated algorithms, without the involvement of doctors.

But users submitting pictures to the fourth app had their images reviewed by a qualified skin specialist.

In this case only one out of 53 cancerous legions was misdiagnosed, but this app cost $5 (£3.10) per use.

Prof Laura Ferris, lead researcher of the study, said: "It is important that users don't allow their apps to take the place of medical advice and physician diagnosis.

"If they see a concerning lesion but the smartphone app incorrectly judges it to be benign, they may not follow up with a physician," she added.

Deborah Mason, of the British Association of Dermatologists, said: "There are a number of mole-check apps on the market - those that purport to offer diagnosis should be treated with caution.

"A diagnosis can only be made by a medical professional and anyone with a suspicious mole should speak to their GP or dermatologist about it."

The researchers also raised concerns about the lack of regulation of applications purporting to give medical advice.

The US Food and Drug Administration is currently looking at the possibility of regulating some applications related to health.

Last year in America two application developers were fined for making unsubstantiated claims that their software could treat acne using a coloured light from a smartphone.

The UK regulator, the Medicines and Healthcare Products Regulatory Agency, said: "The regulation of software such as these health applications is complex and needs to be looked at on a case-by-case basis.

"Work is progressing at the European level to produce the appropriate guidance to most effectively regulate this rapidly growing area."

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