The EU's main audit body says agricultural subsidies - the biggest item in the EU budget - often go to people who do little or no farming.
A new report by the European Court of Auditors complains of deficiencies in the Single Payment Scheme (SPS), which distributed about 29bn euros (£26bn) of subsidies in 2009.
It says payments "have become divorced from current farming conditions".
The EU is considering how to reform its Common Agricultural Policy (CAP).
The auditors have made various recommendations to the European Commission aimed at improving the SPS - the biggest area of spending in the CAP.
They say the SPS ought to direct aid to "active" farmers and provide more balanced funding so that a small number of big landowners no longer get the lion's share.
They also call for clearer definitions of land eligible for subsidies and of farming activities.
The report complains that the 17 EU countries applying the SPS use about 20 different variants of the payment scheme, making it too complex.
Absentee farmers
The SPS does not operate in 10 EU countries, which joined the EU in 2004 and 2007. All 10, except Cyprus, are former communist countries and they use a different system of farm support, called SAPS.
The auditors say the SPS has encouraged farmers to respond better to market demand and has benefited EU agriculture as a whole.
But they say the way the scheme's beneficiaries were defined "permitted persons or entities not, or only marginally, engaged in an agricultural activity to benefit from SPS payments".
In some cases landowners have carried on receiving the payments even though their land is worked by tenant farmers who do not get the subsidy.
In the UK the auditors found some individual beneficiaries receiving up to 1m euros annually or even more in SPS aid without having any agricultural activity on their land.
The report also highlights examples of non-agricultural land qualifying for SPS payments in France, Italy and Spain.
The European Commission has said EU farm spending should no longer be based on previous subsidy levels for farmers.
But the commission believes subsidies are still needed to protect Europe's food supplies and rural diversity. The proposals are contained in an EU blueprint for farming beyond 2013.
The study claimed non-smokers were more likely to be obese
Non-smoking woman are more likely to be obese and die of associated illnesses than those who smoke, according to research.
About 8,000 women were recruited to the Renfrew and Paisley study from 1972 to 1976. Of these, 40% had never smoked.
The authors, led by Dr Laurence Gruer from NHS Health Scotland, found 60% of non-smokers were overweight or obese compared with 40% of those who smoked.
The study claimed extra weight acted as a major contributor to premature death.
However, experts stressed that smoking was a "much stronger" risk factor than obesity.
The study of women aged 45 to 64, published in the British Medical Journal, said the highest rate of obesity among non-smokers was found in low income groups.
Almost 70% of women in this category were overweight or obese, according to the research.
Dr Gruer said: "You can certainly assume that if you are obese, you are more likely to die of things like diabetes, heart attacks and strokes."
It goes against the idea that if you live in a poor neighbourhood or came from a working class background, then your health will be worse, regardless”
End QuoteDr Laurence GruerNHS Health Scotland
Researchers also suggested declining numbers of female smokers over the past few decades may have had a direct impact on obesity levels - with fewer people using cigarettes in an attempt to suppress their appetites.
The study also found that non-smokers from a lower occupational group were no more likely to die early if they lived a healthy lifestyle.
Dr Gruer said: "If you never smoke and you keep your weight within the reasonable limit then even if you earn below average income and live in a more disadvantaged area, you can still expect to live a long and healthy life.
"You are not doomed to die early just because you happen not to have a high income or good job or live in a leafy suburb.
"It goes against the idea that if you live in a poor neighbourhood or came from a working class background, then your health will be worse, regardless."
Prof Johan Mackenbach from the Erasmus Medical Centre in Rotterdam welcomed the study but added: "It is important not to forget that smoking is a much stronger risk factor for mortality than most other risk factors, including obesity."
The NHS complaints system in England is failing patients and needs an overhaul in order to ensure justice, according to a committee of MPs.
The health select committee says a "more open culture" is needed when handling complaints and criticises the Health Ombudsman's role as too narrow.
The cross-party group says too few complaints are officially investigated by the ombudsman.
The Department of Health says new plans will make the NHS more accountable.
The ombudsman's office insisted it can review cases that merit it.
It is only relatively recently that NHS patients in England have been able to take their complaints direct to the Health Ombudsman.
Before April 2009, any complaints not settled locally between the parties involved were reviewed by the Healthcare Commission and referred up to the ombudsman if necessary.
That mismatch between patients' expectations and what the ombudsman does in practice needs to be closed”
End QuoteStephen DorrellHealth select committee chairman
In a bid to simplify and speed up resolutions, the Healthcare Commission stage was scrapped.
But some critics are concerned that the streamlined system now means some complaints are falling by the wayside. In 2009-2010, the ombudsman investigated 3% of about 15,000 health complaints it received, although many more were examined unofficially.
There appears to be something of a "black hole" into which the many complaints which would have been reviewed by the Healthcare Commission and upheld have fallen, Action Against Medical Accidents said.
The committee of MPs agreed.
Chairman Stephen Dorrell said the ombudsman's current remit excluded a number of cases sent for review.
"Patients should feel entitled to an independent review. That mismatch between patients' expectations and what the ombudsman does in practice needs to be closed," he said.
A complaint is accepted for formal investigation or intervention by the ombudsman only if the person has suffered injustice or hardship as a result of poor service or maladministration, and only if there is the prospect of "a worthwhile outcome".
In one instance the ombudsman declined to investigate because missing medical records meant the family were unlikely to get a "worthwhile" response.
'Complex' system
Click to play
Health select committee chairman, Stephen Dorrell, on the need for a proper NHS complaints process.
The committee also wants healthcare providers to be more open and adhere to a "duty of candour", which requires them to publish information about the complaints they receive and the progress they make.
Action Against Medical Accidents chief executive Peter Walsh said: "We are very pleased that the committee has accepted our and other participants' calls for better access to independent review of complaints.
"Only a fraction of people who had independent reviews under the old system can get the ombudsman to investigate."
A spokeswoman for the Health Ombudsman said: "Where our assessment reveals clear evidence of maladministration or injustice, we consider whether we can resolve the issue quickly and effectively through our intervention rather than a full investigation."
She added: "The system for handling NHS complaints is a complex one. We welcome the report's endorsement of the current system's design and potential, its emphasis on listening to patients and support for advocacy and the committee's call for a greater focus on complaints data and learning from complaints."
A Department of Health spokesman said: "The revised plans we set out last week, in response to the independent NHS Future Forum, will safeguard the future of the NHS and put patients at the heart of our health service.
"Under the plans, patients will have a stronger voice and the NHS will be more accountable for the quality of care it provides for patients.
"In addition, Local HealthWatch will champion the views and experiences of patients, helping to drive improvements in the quality of health and social care services."
Officials are investigating a possible link between seeds sold by a UK firm and an E. coli outbreak in France.
News agency AFP said 10 people have been affected by E. coli in Bordeaux.
It is thought a number of them had eaten rocket and mustard vegetable sprouts, believed to have been grown from seeds sold by Thompson and Morgan.
The Ipswich-based company told the BBC it had no evidence of a link. The Food Standards Agency (FSA) said no E. coli cases had been reported in the UK.
However, it has revised its guidance and is advising people not to eat raw sprouted seeds, including alfalfa, mung beans (or beansprouts) and fenugreek.
The agency said these should only be eaten if cooked until steaming hot throughout.
A spokeswoman for Thompson and Morgan said the company sold "hundreds of thousands of packets of these seeds" throughout France, the UK and other parts of Europe every year.
"We are very confident the problem is not with our seeds. People can still grow these seeds and use these seeds with absolute confidence," she said.
Do not eat sprouted seeds such as alfalfa, mung beans (or beansprouts) and fenugreek raw
Cook sprouted seeds until steaming hot throughout
Clean equipment which has been used for sprouting seeds
Wash hands after handling seeds intended for planting or sprouting
"For such a small number of people to have been affected, it does suggest that the problem is perhaps in the local area, how the seeds have been handled or how they have been grown, rather than the actual seeds themselves."
The company was co-operating fully with investigations, she added.
Paul Hansord, the company's managing director, said: "We make sure that everything we do is to a high standard."
He said the firm bought its seeds in bulk from suppliers around the world. The affected seeds may have been sourced from Italy.
Thompson and Morgan also said they did not raise any seeds, instead selling packets via mail order to gardeners.
Seven of those affected by the E. coli outbreak, who ate the sprouts at a country fair at Begres near Bordeaux, needed hospital treatment.
Click to play
Helen Johns, Thompson and Morgan: 'It does suggest the problem is in the local area'
Close contact
The FSA says it is asking the company for more information about the seeds.
There is no suggestion of a link to the German E. coli outbreak, which came from bean sprouts grown on an organic farm, but two people are said to be infected with a similar strain.
Frederic Lefebvre, France's secretary of state for consumer affairs, was quoted by AFP recommending "consumers who bought these same products not use them".
Mr Lefebvre added: "The link between the symptoms and eating of the sprouts so far has not been definitively established."
The sale of the three seed types - mustard, rocket and fenugreek - has been halted in France.
Thompson and Morgan have provided samples of these seeds to investigators in the UK.
An FSA spokesman told the BBC: "We have been in contact with the French authorities about this outbreak and are aware that a UK business has been named in connection with it.
"No cases of food poisoning have been reported in the UK linked with the outbreak in France but we are in close contact with the Health Protection Agency.
"We have asked for further information from the French authorities with regard to the three named type of seeds to help us carry out investigations in the UK."
MPs voted to ban wild animals in circuses last night after David Cameron's attempts to bully Conservative backbenchers into voting against the measure backfired and ended in a humiliating public defeat. In a decision hailed by campaigners as an "historic victory for animal welfare and protection", MPs of all parties unanimously backed a ban and the Government signalled that it would introduce one, ending forever the days of lions, tigers, elephants and other wild animals in the big top.
In an act of desperation, Conservative whips had warned they would impose the most serious parliamentary voting sanction, a three-line whip, to bring recalcitrant backbenchers to heel and get them to support the Government's alternative proposal of a licensing system. But in a victory for The Independent's campaign for a ban and for the long campaigns waged by animal welfare organisations, Downing Street backed down when it became apparent that it would lose the vote despite what backbenchers described as "desperate" measures. One of the three MPs who brought the cross-party motion for a ban disclosed that he had first been offered a government job – and then threatened that the Prime Minister would look "very dimly" on his recalcitrance – unless he amended or withdrew the motion. Mark Pritchard, a Conservative backbencher, stood firm and insisted that the measure be voted upon.
As astonished MPs listened, Mr Pritchard said: "Well I have a message for the whips and for the Prime Minister of our country – and I didn't pick a fight with the Prime Minister – I may just be a little council house lad from a very poor background but that background gave me a backbone. It gives me a thick skin and I'm not going to be cowed by the whips of the Prime Minister on an issue I feel passionately about and have conviction about
"There may be some other people with backbones on this side and they will speak later, but we need a generation of politicians with a bit of spine, not jelly. And I will not be bullied by any of the whips."
MPs from all sides of the House including the Liberal Democrat MP Don Foster, Labour's Nia Griffiths and the Green leader Caroline Lucas attacked the Government's position, saying that both public and parliamentary opinion was in support of a ban.
The motion was to "direct" the Government to introduce a ban.
Shortly before the vote, the Animal Welfare minister, Jim Paice, said: "If at the end of this debate the House were to approve this motion then of course we will have to respect that."
Animal welfare groups were ecstatic. The RSPCA said: "This is a win for democracy as well as animal welfare." It said it hoped the Government would quickly and formally announce a ban.
Animal Defenders International, the group which shot undercover footage of the beating by a Romanian groom of Anne the elephant at Bobby Roberts Circus, said: "This debate and vote has exposed the Government and demonstrated just how out of touch they have been with their peers, the public, and animal welfare groups."
Mary Creagh, the shadow Environment Secretary, said: "The public will be absolutely delighted that MPs from all parties have stood up to the Tory-led Government on this issue to achieve such a fantastic result. The vote brings to an end 48 hours of chaos and confusion from the Government about their position on a ban. It is extraordinary that David Cameron used such bully-boy tactics to threaten his own MPs and tried to impose a three-line whip on the vote."
The Government had initially planned to ban wild animals from circuses but the Department of the Environment, Food and Rural Affairs was forced to do a U-turn, and instead proposed a licensing system, after Mr Cameron, a keen hunter and shooter, blocked the move.
Mr Paice blamed a court challenge to a ban in Austria for the decision, but there was no court challenge and he was forced to admit during an emergency debate, called because of the misinformation, that he had misled the Commons. The Government's subsequent claim that a ban could be challenged under the Human Rights Act or the EU Services Directive was challenged by lawyers and the European Commission.
The Government and MPs came under intense pressure from voters. More than 32,000 signed The Independent's online petition calling for the Government to change its mind, and supporters of the protest group 38 Degrees, which had forced Defra to abandon plans for its forests sell-off, deluged MPs' offices with hundreds of emails, letters and phone calls.
During the debate, MPs said the issue was emblematic of wider animal welfare issues. But the most astonishing contribution came from Mr Pritchard who had secured the backbench debate, which should have had a free vote. He said: "On Monday if I offered to amend my motion or drop my motion or not call a vote on this motion – and we're not talking about a major defence issue or an economic issue or an issue of public-sector reform, we're talking about a ban on wild animals in circuses – I was offered reward and incentive. If I didn't call for a ban – I was offered a job. Not as a minister, it was a pretty trivial job.
"Then it was ratcheted up to last night and I was threatened. I had a call from the Prime Minister's Office directly and I was told unless I withdrew this motion that the Prime Minister himself would look upon it 'very dimly indeed'."
He told MPs: "It remains a mystery why the Government has mounted such a concerted operation to stop there being a vote on this motion."
strange people these meat eaters , circuses are cruel , but not the vile factories where they grow and torture their food .
could increase risk of diabetes,” theDaily Mail reported. The newspaper said that people taking intensive courses ofstatins, the cholesterol-lowering medicines, are 12% more likely to get the disease.
These findings come from a review that combined the results of previous trials to compare the effects of intensive-dose stains with moderate-dose statins. It found that the risk of diabetes was higher in people given the intensive dose, with one extra case of diabetes expected for each 498 people treated in this way for one year. However, the intensive regime would also be expected to prevent an additional three people from having a cardiovascular event, such as a heart attack or stroke.
This research provides a good illustration of the balance of benefits and risks that exists with any drug. In this case, doctors need to weigh up the circumstances of each patient, assessing whether the reduced risk of cardiovascular events with intensive statin therapy is worth the additional risk of diabetes. Overall, the results of this research suggest that the benefits are likely to outweigh the risk in people with a greater chance of cardiovascular events.
As the Mail importantly noted, people should not stop taking their statins because of this research.
Where did the story come from?
The study was carried out by researchers from the University of Glasgow and other research centres in the UK, US and Australia. No sources of funding were reported for the current study. The study was published in the peer-reviewed Journal of the American Medical Association.
Both The Daily Telegraph and Daily Mail covered this story well, noting that the cardiovascular benefits of intensive-dose statins in high-risk individuals are likely to outweigh the risks, and that people should not stop taking their statins as a result of this research. The Telegraph also helpfully provided absolute figures that allow readers to gauge the effects of these treatments, rather than just percentage increases or reductions in risk, which can be difficult to interpret.
The Daily Express took another angle, suggesting that “cheaper statins on NHS can put patients in danger”. The newspaper said the study found that the drug simvastatin “recommended by the National Institute for Health and Clinical Excellence does not protect against coronary events as effectively as the alternative drug atorvastatin among patients taking high doses” and that the researchers call for NICE “to recommend the more expensive pill instead”. This does not represent the aims or conclusions of this research paper, and the researchers did not make such as recommendation.
The study did not aim to compare atorvastatin and simvastatin. Instead, it was concerned with comparing the effects of different doses of statin. While one analysis carried out in the study did find that intensive dose simvastatin did not reduce risk of cardiovascular events compared with moderate dose statins, this was not the main aim of the paper, and therefore these results need to be treated with caution until this observation can be investigated further.
What kind of research was this?
This systematic review and meta-analysis compared the risk of developing diabetes associated with intensive-dose statin therapy and moderate-dose statin therapy.
Statins are drugs used to reduce the levels of cholesterol in the blood, with the aim of reducing the risk of cardiovascular events such as heart attacks. In 2010, the authors of this study published a similar study which found that statin therapy was associated with an increased risk of developing type 2 diabetes. In the current study, they looked at whether the risk varied depending on the dose of statin used. As statins aim to reduce the risk of cardiovascular events, the researchers also wanted to see how the dose of statin affected the risk of cardiovascular events, such as heart attacks, strokes or death from these events.
A systematic review is the best way to summarise the evidence currently available on a particular question. Pooling the results from the available studies can lead to a more robust estimate of the effects of a treatment. However, the studies included need to have sufficiently similar methods in order for the pooled results to be meaningful and valid.
What did the research involve?
The researchers searched various research databases to identify randomised controlled trials published between 1996 and 2011 that met their inclusion criteria. They also asked other researchers in the field to provide details of any additional relevant unpublished studies. To be included, the trials had to have compared intensive-dose statin therapy and moderate-dose statin therapy in over 1,000 participants, and followed them up for at least a year.
The researchers used the search terms “intensive” or “aggressive” to identify relevant trials, but did not provide a specific definition of what they considered constituted moderate- or intensive-dose therapy. All trials used statin doses that were within the licensed dosing range for the drug, with intensive doses tending to be at the maximum recommended dose (such as 80mg of simvastatin or atorvastatin daily), while moderate doses tended to be the lower starting doses (for example, 10mg or 20mg daily).
The researchers asked the people who conducted the eligible trials to provide data that could be used in their analyses. These included the number of participants in their trials who had diabetes at the start of the study, and the number of people who developed diabetes or had cardiovascular events. They also collected data on the participants’ characteristics such as body mass index (BMI) and levels of cholesterol, other blood fats and glucose.
They then used accepted statistical methods to pool these results to see if the risk of diabetes or cardiovascular events differed between intensive-dose and moderate-dose statins. They also used statistical methods to assess how similar the trial results were. If the results were very different, this would suggest that the studies might be too different to be pooled in this way.
What were the basic results?
The researchers identified five trials that included 32,752 participants without diabetes. Three of these trials compared different doses of the same statin (simvastatin or atorvastatin), while two compared an intensive dose of one statin against a moderate dose of another statin (atorvastatin versus either pravastatin or simvastatin).
During an average of 4.9 years’ follow-up, 2,749 participants (8.4%) developed diabetes. This included 1,449 (8.8%) of those receiving intensive-dose statin therapy and 1,300 (8.0%) of those receiving moderate-dose statin therapy. This represented two more cases of diabetes per 1,000 patient years in the intensive-dose statin group than in the moderate-dose group (rising from about 17 cases per 1,000 patient years to about 19 cases per 1,000 patient years). This means that 498 people would need to be treated with intensive-dose therapy for a year to lead to one additional case of diabetes over and above what would be seen with moderate-dose statins.
During follow-up, 6,684 participants had a cardiovascular event. This included 3,134 (19.1%) of those receiving intensive-dose statin therapy and 3,550 (21.7%) of those receiving moderate-dose statin therapy. This represented 6.5 fewer cases of cardiovascular events per 1,000 patient years in the intensive-dose statin group than the moderate-dose group (reduced from 51 cases per 1,000 patient years to 44.5 cases per 1,000 patient years). This means that 155 people would need to be treated with intensive-dose therapy for one year to prevent one additional person having a cardiovascular event compared to what would be seen with moderate-dose statins.
How did the researchers interpret the results?
The researchers concluded that “intensive-dose statin therapy was associated with an increased risk of new-onset diabetes compared with moderate-dose statin therapy”. However, they note that intensive-dose statin therapy does reduce the risk of cardiovascular events compared with moderate-dose statins. They say that their findings “suggest that clinicians should be vigilant for the development of diabetes in patients receiving intensive statin therapy”.
Conclusion
This systematic review and meta-analysis suggest that intensive-dose statin therapy is associated with an increased risk of diabetes compared to moderate-dose statins. However, intensive use also reduces the risk of cardiovascular events, such as heart attacks or strokes. The study used appropriate methods to investigate this question and, importantly, gives us an idea of the trade-off between benefits and harms of intensive-dose statin therapy.
There are some points to note:
The trials that were included varied in their methods of diagnosing diabetes, which could affect the reliability of the pooled results. However, the researchers performed statistical tests and applied different types of analyses to the data. This suggests that, despite these differences in method, the trials all had similar findings. This increases our confidence in the findings of this review.
The pooled trials all included people who had established coronary disease and were at high risk of having future cardiovascular events. This means that the results may not represent what might happen in groups of people with different characteristics and who might be prescribed statins. For example, this could include people with a higher risk of developing diabetes or people with certain risk factors that had not yet developed heart disease or had cardiovascular disease events (such as people with raised cholesterol due to the hereditary condition of familial hypercholesterolemia, who are often treated with high-dose statins as “primary prevention” against them developing cardiovascular disease).
Most of the trials (four out of five) did not regularly test for diabetes so some cases may have been missed. The researchers say that it is possible that people given intensive statin therapy may have had more side effects than those on moderate-dose statins, and may therefore have seen their doctors more regularly, and received medical checkups more regularly. This could have led to diabetes being picked up more often in people receiving intensive statin therapy, with those receiving moderate-dose statin therapy remaining undiagnosed.
This research provides more information about the potential link between statin treatment and the risk of developing diabetes. It provides a good illustration of the balance of benefits and risks that exists with any drug. In this case, doctors need to weigh up for each patient whether the reduction in risk of cardiovascular events seen with intensive statin therapy is worth the additional risk of diabetes.
As echoed by most newspapers, the absolute increase in the risk of diabetes was relatively low compared to the absolute reduction in risk of cardiovascular events. Therefore, overall the benefits of statins outweigh the side effects. However, it is also worth remembering that statins are used in different ways and that this balance of benefit and risk may vary in the different groups who are prescribed the drugs. These include, people at high risk of diabetes or who take the statin as “primary prevention” to stop them developing cardiovascular disease and people who are prescribed them after an event such as a heart attack.
Links to the headlines
High-dose statins 'increase Type 2 diabetes risk'. The Daily Telegraph, June 22 2011
High doses of statins could increase risk of diabetes. Daily Mail, June 22 2011
Cheaper statins on NHS can put patients in danger. Daily Express, June 22 2011
Links to the science
Preiss D, Kondapally Seshasai SR, Welsh P et al. Risk of Incident Diabetes With Intensive-Dose Compared With Moderate-Dose Statin Therapy. A Meta-analysis. Journal of the American Medical Association. 2011;305(24):2556-2564
Further reading
Taylor F, Ward K, Moore THM, Burke M, Davey Smith G, Casas JP, Ebrahim S. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2011, Issue 1
Vale N, Nordmann AJ, Schwartz GG, de Lemos J, Colivicchi F, den Hartog F, Ostadal P, Macin SM, Liem AH, Mills E, Bhatnagar N, Bucher HC, Briel M. Statins for acute coronary syndrome. Cochrane Database of Systematic Reviews 2011, Issue 6
Risk of Alzheimer's can be predicted with 80% accuracy, says report
A protein in spinal fluid could be used to predict the risk of developing Alzheimer's disease, according to German researchers.
Patients with high levels of the chemical - soluble amyloid precursor protein beta - were more likely to develop the disease, they found. Doctors said in the journal Neurology this was more precise than other tests. Alzheimer's Research UK said early diagnosis was a key goal, and the study represented a potential new lead. Doctors analysed samples of spinal fluid from 58 patients with mild cognitive impairment, a memory-loss condition which can lead to Alzheimer's. The patients were followed for three years. Around a third developed Alzheimer's. Those who developed the illness had, on average, 1,200 nanograms/ml of the protein in the spinal fluid at the start of the study. Those who did not started with just 932 nanograms/ml. Beta amyloid proteins have already been implicated in Alzheimer's itself, but not as a "predictor" of the disease. The researchers said that a combination of soluble amyloid precursor protein beta, defective tau proteins, which are involved in the structure of brain cells, and a patient's age was 80% accurate in predicting the onset of the disease. Early diagnosis crucial There is no cure for Alzheimer's disease. If a treatment is developed, it is thought that it would need to be delivered early, before any permanent damage was done. Dr Robert Perneczky, from the Technical University Munich, said: "Being able to identify who will develop Alzheimer's disease very early in the process will be crucial in the future. "Once we have treatments that could prevent Alzheimer's disease, we could begin to treat very early and hopefully prevent the loss of memory and thinking skills that occurs with this devastating disease." More than 800,000 people have dementia in the UK, and that figure is expected to rise as populations get older. Rebecca Wood, chief executive of Alzheimer's Research UK, said: "The ability to diagnose Alzheimer's early is a key goal for doctors and researchers. This small study provides a potential new lead to follow up. "We will need to see larger trials before we can know how accurate this method could be as a diagnostic test. It will also be important to see how measurements of these proteins compare to those found in healthy people."
Combinations of commonly used drugs - for conditions such as heart disease, depression and allergies - have been linked to a greater risk of death and declining brain function by scientists.
They said half of people over 65 were prescribed these drugs. The effect was greatest in patients taking multiple courses of medication, according to the study in the Journal of the American Geriatrics Society. Experts said patients must not panic or stop taking their medicines. The researchers were investigating medicines which affect a chemical in the brain - acetylcholine. The neurotransmitter is vital for passing messages from nerve cell to nerve cell, but many common drugs interfere with it as a side effect. Eighty drugs were rated for their "anticholinergic" activity: they were given a score of one for a mild effect, two for moderate and three for severe. Some were given by prescription only, while others were available over the counter.
A combined score was calculated in 13,000 patients aged 65 or over, by adding together the scores for all the medicines they were taking.
A patient taking one severe drug and two mild ones would have an overall score of five. Deadly consequences Between 1991 and 1993, 20% of patients with a score of four or more died. Of those taking no anticholinergic drugs only 7% died. Patients with a score of five or more showed a 4% drop in ratings of brain function. Other factors, such as increased mortality from underlying diseases, were removed from the analysis.
Do not stop your medicines without taking advice first”
End QuoteDr Clare GeradaRoyal College of GPs
However, this study cannot say that the drugs caused death or reduced brain function, merely that there was an association.
Dr Chris Fox, who led the research at the University of East Anglia, said: "Clinicians should conduct regular reviews of the medication taken by their older patients, both prescribed and over the counter, and wherever possible avoid prescribing multiple drugs with anticholinergic effects. Dr Clare Gerada, chairman of the Royal College of GPs, said the findings of the study were important. She told patients: "The first thing is not to worry too much, the second thing is to discuss it with your doctor or the pharmacist, and the third thing is do not stop your medicines without taking advice first." She said doctors reviewed medication every 15 months and were aware of the risks of combining different drugs. Dr Fox said he wanted to conduct further research to investigate how anticholinergic drugs might increase mortality.
Electrical signals cannot cross the gap between brain cells; neurotransmitters pass the message on
A more modern study is also thought to be desirable. Practices and drugs have changed since the data was collected two decades ago. Ian Maidment, an NHS pharmacist in Kent and Medway, believes the situation may now be even worse. He said the use of anticholinergic drugs had "probably increased as more things are being treated and more drugs are being used." Brain decline Reduction of the neurotransmitter acetylcholine has already been implicated in dementia. The drug Aricept is given to some patients with Alzheimer's disease to boost acetylcholine levels. Dr Susanne Sorensen, head of research at the Alzheimer's Society, said a 4% drop in brain function for a healthy person would feel like a slow, sluggish day. "If you are at a level where one little thing pushes you over into confusion, then that is much more serious," she added. "However, it is vital that people do not panic or stop taking their medication without consulting their GP." Rebecca Wood, chief executive of Alzheimer's Research UK, said: "This comprehensive study could have some far-reaching effects. The results underline the critical importance of calculated drug prescription."
Have you been affected by the issues raised in this story? Send us your comments using the form below:
Newcastle University researchers found the low-calorie diet reduced fat levels in the pancreas and liver, which helped insulin production return to normal.
Seven out of 11 people studied were free of diabetes three months later, say findings published in the journal.
More research is needed to see whether the reversal is permanent, say experts.
Type 2 diabetes affects 2.5m people in the UK. It develops when not enough insulin is produced in the body or the insulin that is made by the body doesn't work properly.
When this happens, glucose - a type of sugar - builds up in the blood instead of being broken down into energy or fuel which the body needs.
The 11 participants in the study were all diagnosed with Type 2 diabetes within the previous four years.
They cut their food intake drastically for two months, eating only liquid diet drinks and non-starchy vegetables. Fat loss
After one week of the diet, researchers found that the pre-breakfast blood sugar levels of all participants had returned to normal.
MRI scans of their pancreases also revealed that the fat levels in the organ had decreased from around 8% - an elevated level - to a more normal 6%.
Three months after the end of the diet, when participants had returned to eating normally and received advice on healthy eating and portion size, most no longer suffered from the condition.
“Start Quote
It offers great hope for many people with diabetes.”
End QuoteProf Keith FraynUniversity of Oxford
Professor Roy Taylor, director of Newcastle Magnetic Resonance Centre at Newcastle University and lead study author, said he was not suggesting that people should follow the diet.
"This diet was only used to test the hypothesis that if people lose substantial weight they will lose their diabetes.
"Although this study involved people diagnosed with diabetes within the last four years, there is potential for people with longer-standing diabetes to turn things around too." Susceptibility question
Dr Ee Lin Lim, also from Newcastle University's research team, said that although dietary factors were already known to have an impact on Type 2 diabetes, the research showed that the disease did not have to be a life sentence.
"It's easy to take a pill, but harder to change lifestyle for good. Asking people to shift weight does actually work," she said.
However, not everyone in the study managed to stay free of diabetes.
"It all depends on how much individuals are susceptible to diabetes. We need to find out why some people are more susceptible than others, then target these obese people. We can't know the reasons for that in this study," Dr Lim said.
Professor Edwin Gale, a diabetes expert from the University of Bristol, said the study did not reveal anything new.
"We have known that starvation is a good cure for diabetes. If we introduced rationing tomorrow, then we could get rid of diabetes in this country.
"If you can catch people with diabetes in the early stages while beta cells are still functioning, then you can delay its onset for years, but you will get it sooner or later because it's in the system."
But Keith Frayn, professor of human metabolism at the University of Oxford, said the Newcastle study was important.
"People who lose large amounts of weight following surgery to alter their stomach size or the plumbing of their intestines often lose their diabetes and no longer need treatment.
"This study shows that a period of marked weight loss can produce the same reversal of Type 2 diabetes.
"It offers great hope for many people with diabetes, although it must be said that not everyone will find it possible to stick to the extremely low-calorie diet used in this study."
Dr Iain Frame, director of research at Diabetes UK, which funded the study, said the diet was not an easy fix.
"Such a drastic diet should only be undertaken under medical supervision. Despite being a very small trial, we look forward to future results particularly to see whether the reversal would remain in the long term."
Too much alcohol, drugs, and sex, coupled with poor hygiene, can be a health risk at festivals, an expert is warning.
Sunburn, heat stroke, sprains and other minor ailments make up most casualties at music events, says Dr Mark Salter of the Health Protection Agency.
But there are occasional reports of sexual health problems, heart attacks and chest complaints.
Avoiding doing anything to excess is the best way to stay healthy, he adds.
Dr Salter, a consultant in communicable disease control at the HPA's Health Protection Unit in the South West has been attending festivals, including Glastonbury, for 20 years, to offer health protection advice.
Anyone who is unwell before a festival, particularly with diarrhoea and sickness, should not go to prevent spreading infection
Take a good supply of existing medicines and pack them in luggage
Find out where health services are at the festival, and seek help if you fall ill
Drinking water should be taken from potable water taps which are signposted
Source: Dr Mark Salter, HPA
His "top tips" for surviving festivals include using condoms, drinking plenty of water from a safe source, wearing a hat and sunscreen, and washing hands thoroughly after using the toilet.
Dr Salter said: "Avoid doing anything to excess is the best way to protect your health if you are visiting a festival this year.
"My experience of providing health advice and assistance at festivals for over 20 years tells me that people generally end up being unwell due to the combination of too much alcohol, drugs, sex and less than ideal hygiene.
"It is inevitable when suddenly thousands of people crowd together at a rural site with no fixed toilet system or bathing facilities and lots of alcoholic drinks that some people will become unwell as the risk of infection increases.
"It is therefore essential to follow good hygiene practices and wash your hands thoroughly after using the toilets."
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