New brain scan to diagnose autism

The computer scan shows up a distinctive pattern associated with autism

A brain scan that detects autism in adults could mean much more straightforward diagnosis of the condition, scientists say.

Experts at King's College London said the scan - tested on 40 people - identified tiny but crucial signs of autism, only detectable by computer.
Current methods of diagnosis can be lengthy and expensive.
But some experts say further research will be needed before the new technique can be widely used.

Autism Spectrum Disorder affects an estimated 1 in every 100 adults in the UK, most of them men. It varies from mild to very severe, and people with the condition can find the world appears chaotic and hard to understand.

Conventional diagnosis involves a team of experts who analyse behaviour and make a complex series of assessments.
The Medical Research Council study looked at 20 non-autistic adults and 20 adults with Autism Spectrum Disorder (ASD).
They were initially diagnosed using traditional methods, and then given a 15 minute brain MRI scan. The images were reconstructed into 3D and were fed into a computer, which looked for tiny but significant differences.

“Start Quote

It could help to alleviate the need for the emotional, time consuming and expensive diagnostic process which ASD patients and families currently have to endure”

End Quote Dr Christine Ecker Lead researcher

The researchers detected autism with over 90% accuracy, the Journal of Neuroscience reports.

"What the computer can do very quickly is to see that a patient has autism," said Professor Declan Murphy from the Institute of Psychiatry, who supervised the research, "even though their brain, to the naked eye, looks very normal."
Dr Christine Ecker, who led the study, said she hoped the findings might result in a widely available scan to test for autism.
"It could help to alleviate the need for the emotional, time consuming and expensive diagnostic process which ASD patients and families currently have to endure," she said.
Once a patient has a diagnosis, he or she is able to access help and support with managing the condition.
Visible confirmation
Joe Powell was diagnosed with Asperger's syndrome, a form of autism, 14 years ago. Before his diagnosis, he didn't speak at all.
Since then, he says he's made big progress in managing his condition.
His brain scan confirms his ASD. He says seeing his diagnosis charted in black and white made a big difference to him.
"You need to physically see it," he says.
"I know the autism is still there. The progress I've made in managing my condition is real, but it's still there."
The research team is now looking at whether the test would be effective on children.

Nicholas Joy describes what an Asperger's diagnosis meant for his health and treatment

The findings have been welcomed by the National Autistic Society, who say they add to the understanding of the condition. They say adults can find it very difficult to get a diagnosis of autism, and this may help.
However, they say without more awareness among doctors, it may be of limited use.
"There's still a woeful lack of awareness in GPs' knowledge of autism," said NAS centre director, Carol Povey.
"People with autism are often dismissed when they go to their GPs for help, so we have to make sure front-line professionals have awareness of autism so they can make appropriate referrals."
Professor Uta Frith from UCL Institute of Cognitive Neuroscience, said much more work would be needed before the scans could be used for diagnosis. "This study shows that the subtle brain abnormalities associated with autism show a distinctive pattern," she said. "It is crucial that we learn more about what the brain abnormalities mean."

News highlights

Adult autism diagnosis by brain scan

11 Aug 2010, PR 172/10


Scientists from the Institute of Psychiatry (IoP) at King’s College London have developed a pioneering new method of diagnosing autism in adults. For the first time, a quick brain scan that takes just 15 minutes can identify adults with autism with over 90 per cent accuracy. The method could lead to the screening for autism spectrum disorders in children in the future.


The team used an MRI scanner to take pictures of the brain’s grey matter. A separate imaging technique was then used to reconstruct these scans into 3D images that could be assessed for structure, shape and thickness – all intricate measurements that reveal Autism Spectrum Disorder (ASD) at its root. By studying the complex and subtle make-up of grey matter in the brain, the scientists can use biological markers, rather than personality traits, to assess whether or not a person has ASD.


ASD is a lifelong and disabling condition caused by abnormalities in brain development. It affects about one per cent of the UK population (half a million people), the majority of these being men (4:1 male to female). Until now, diagnosis has mainly relied on personal accounts from friends or relatives close to the patient – a long and drawn-out process hinged on the reliability of this account and requiring a team of experts to interpret the information.


Dr Christine Ecker, a Lecturer in the Department of Forensic and Neurodevelopmental Sciences from the IoP, who led the study, said: ‘The value of this rapid and accurate tool to diagnose ASD is immense. It could help to alleviate the need for the emotional, time consuming and expensive diagnosis process which ASD patients and families currently have to endure. We now look forward to testing if our methods can also help children.’


Improved quality of life


Professor Declan Murphy, Professor of Psychiatry and Brain Maturation at the IoP, who supervised the research, said: ‘Simply being diagnosed means patients can take the next steps to get help and improve their quality of life. People with autism are affected in different ways; some can lead relatively independent lives while others need specialist support or are so severely affected they cannot communicate their feelings and frustrations at all. Clearly the ethical implications of scanning people who may not suspect they have autism needs to be handled carefully and sensitively as this technique becomes part of clinical practice.’


Professor Christopher Kennard, Chair of the Medical Research Council’s (MRC) Neuroscience and Mental Health funding board, said: ‘Bringing together the knowledge gained from neuroscience in the laboratory and careful clinical and neuropsychological evaluation in the clinic has been key to the success of this new diagnostic tool. In fact, this approach to research is a crucial theme throughout the MRC’s strategy. We know that an investment like this can dramatically affect the quality of life for patients and their families. The more we understand about the biological basis of autism, the better equipped we will be to find new ways of treating those affected in the future.’


The research studied 20 healthy adults, 20 adults with ASD, and 19 adults with ADHD. All participants were males aged between 20 and 68 years. After first being diagnosed by traditional methods (an IQ test, psychiatric interview, physical examination and blood test), scientists used the newly-developed brain scanning technique as a comparison. The brain scan was highly effective in identifying individuals with autism and may therefore provide a rapid diagnostic instrument, using biological signposts, to detect autism in the future.


The research was undertaken using the A.I.M.S. (Autism Imaging Multicentre Study) Consortium, which is funded by the MRC. Support funding was also provided by the Wellcome Trust and National Institute for Health Research (NIHR).


The paper, ‘Describing the brain in autism in five dimensions - MRI-assisted diagnosis using a multi-parameter classification approach’ is published in the Journal of Neuroscience today.


Notes to editors


At present, the Bethlam/ Maudsley Hospital clinic does not offer private assessments or scans. We recommend that people ask their GP or health professional for a referral letter to the Behavioural Genetics Clinic at the Bethlam/Maudsley Hospital, where the patient can then be seen and scanned. More information about the hospital can be found at: www.slam.nhs.uk


King's College London
King's College London is one of the top 25 universities in the world (Times Higher Education 2009) and the fourth oldest in England. A research-led university based in the heart of London, King's has nearly 23,000 students (of whom more than 8,600 are graduate students) from nearly 140 countries, and some 5,500 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.


King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £450 million.


King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.


King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: www.kingshealthpartners.org.

Rice yields falling under global warming

Dark clouds hang over future farming under climate change, the study suggests

Global warming is cutting rice yields in many parts of Asia, according to research, with more declines to come.

Yields have fallen by 10-20% over the last 25 years in some locations.
The group of mainly US-based scientists studied records from 227 farms in six important rice-producing countries such as Thailand, Vietnam, India and China.
This is the latest in a line of studies to suggest that climate change will make it harder to feed the world's growing population by cutting yields.

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We haven't seen a scenario where daytime temperatures cross over a threshold where they'd stop benefiting yields and start reducing them”

End Quote Jarrod Welch UCSD

In 2004, other researchers found that rice yields in the Philippines were dropping by 10% for every 1C increase in night-time temperature.

That finding, like others, came from experiments on a research station.
The latest data, by contrast, comes from working, fully-irrigated farms that grow "green revolution" crops, and span the rice-growing lands of Asia from the Indian state of Tamil Nadu to the outskirts of Shanghai.
Describing the findings, which are published in Proceedings of the National Academy of Sciences (PNAS), lead researcher Jarrod Welch said:
"We found that as the daily minimum temperature increases, or as nights get hotter, rice yields drop."
The mechanism involved is not clear but may involve rice plants having to respire more during warm nights, so expending more energy, without being able to photosynthesise.
By contrast, higher temperatures during the day were related to higher yields; but the effect was less than the yield-reducing impact of warmer nights.
However, if temperatures continue to rise as computer models of climate project, Mr Welch says hotter days will eventually begin to bring yields down.

Warmer climates will bring changes to rainfall, potentially causing drought

"We see a benefit of [higher] daytime temperatures principally because we haven't seen a scenario where daytime temperatures cross over a threshold where they'd stop benefiting yields and start reducing them," he told BBC News.
"There have been some recent studies on US crops, in particular corn, that showed the drop-off after that threshold is substantial," said the University of California at San Diego researcher.
The 2007 assessment of climate impacts from the Intergovernmental Panel on Climate Change (IPCC) concluded that although a modest temperature rise could increase crop yields in some regions, for "temperature increases more than 3C, average impacts are stressful to all crops assessed and to all regions".
A study published at the begining of last year concluded that half of the world's population could face a climate-induced food crisis by 2100, with the most extreme summers of the last century becoming routine towards the end of this century

Is it safe to consume milk and meat from cloned cattle?

By Katia Moskvitch Science reporter, BBC News

The Food Standards Agency (FSA) will investigate reports that milk from a cloned cow's offspring has reached Britain's supermarket shelves.

BBC News looks deeper at the reports and at the issues surrounding produce from cloned animals.

Animal cloning has been around for years

What is being claimed?

The New York Times has reported that a British dairy farmer, who wished to remain anonymous, was selling milk from a cow bred from a clone.

He did not want to disclose his identity, the newspaper said, because "the British public regarded cloning as so distasteful that buyers would stop taking his milk…[and] he did not want to be required to get rid of a valuable cow." The paper also reports that the farmer was selling embryos from the same cow to breeders in Canada.

Continue reading the main story

“Start Quote

This technique raises serious issues about animal welfare, reduction of biodiversity, as well as ethical concerns ”

End Quote Corinne Lepage European Parliament

However, not everyone is convinced that the story is true. Professor Grahame Bulfield, former director of the Roslin Institute, where Dolly the Sheep was cloned, said: "Given that the farmer wishes to remain 'anonymous', it is very difficult to evaluate this story so it should be taken with a pinch of salt. I don't know of any cloned animals in the UK so I would be very suspicious."

What is a clone?

A clone is a genetic copy of an animal. Scientists say that clones are similar to identical twins, but born at different times.

Animal cloning has been around for more than two decades. The first mammal cloned from the cell of an adult animal was Dolly the sheep, born in 1996. She died in February 2003.

Most cloning nowadays is done using somatic cell nuclear transfer:

• Scientists remove the gene-containing nucleus from an egg taken from a female animal
• They then add to the egg the nucleus of a cell from an animal they wish to clone
• The egg cell begins to form into an embryo in the laboratory
• The embryo is then implanted in the uterus of a host animal which carries it to term and delivers it like her own offspring

According to the Genetic Science Learning Centre of the University of Utah, the success rate ranges from 0.1% to 3%. That means that only one to 30 clones are made for every 1,000 attempts.

Is it safe to consume milk and meat from cloned animals and their offspring?

According to a research paper done by scientists in the US and Japan in 2005, milk and meat from cloned cattle appear safe for consumption.

Hundreds of cloned animals exist today, but many clones die shortly after birth

The team, led by Jerry Yang from the University of Connecticut, compared the produce from two beef and four dairy clones with that from normal animals of similar age and breed.

The scientists found that the cloned cow meat was slightly higher in fat and fatty acids, but still within beef industry standards. Other than that, there were no significant differences, and produce from cloned cattle was said to be safe to eat and drink.

Dr Brendan Curran, a geneticist from the School of Biological and Chemical Sciences at Queen Mary, University of London, said cloning was "an extension of the process by which identical twins arise in nature".

"Therefore if you have a healthy cow that is producing milk, it will produce healthy milk. I would argue that once the animal has been certified by veterinary surgeons as a fit animal, I can't see how it would be in any way dangerous."

The US' Food and Drug Administration has a similar opinion.

It has concluded, based on the results of a number of studies, that "meat and milk from clones of cattle, swine (pigs), and goats, and the offspring of clones from any species traditionally consumed as food, are as safe to eat as food from conventionally bred animals".

What does the European Union think of the sale of foods from cloned cattle?

In July, the European Parliament called for a ban on the sale of dairy products and meat from cloned animals.

Continue reading the main story

“Start Quote

There is no genetic modification... they are just normal animals, and I do not understand the EU position on this”

End Quote Professor Robin Lovell-Badge National Institute for Medical Research

The governments of the 27 EU member states will finalise the rules of the bill with EU legislators in September.

"Although no safety concerns have been identified so far with meat produced from cloned animals, this technique raises serious issues about animal welfare, reduction of biodiversity, as well as ethical concerns," said Corinne Lepage, a French member of the European Parliament.

In the UK, milk and meat from cloned animals are considered "novel foods" and need to be authorised by the Food Standard Agency (FSA) before being sold.

"It is the responsibility of food business operators to ensure food that they place on the market is in compliance with the law. As the UK authority responsible for accepting Novel Food applications, the agency has not received any applications relating to cloning and no authorisations have been made," said the FSA in an e-mail to BBC News.

"The agency will, of course, investigate any reports of unauthorised novel foods entering the food chain."

Professor Robin Lovell-Badge, head of stem cell biology and developmental genetics at the National Institute for Medical Research (NIMR), said he did not understand the EU's concerns.

"There is no genetic modification. It was for this reason that the FDA has approved consumption of milk and beef from the offspring of cloned cattle - they are just normal animals, and I do not understand the EU position on this," he said.

"Obviously the FSA have their rules and need to look into what has happened, but it is more likely to be the milk of kindness than a horror story."

Are cloned animals generally normal and healthy?

It has been shown that animals conceived through an assisted reproductive technique have a higher risk of neo-natal death.

Those clones that do survive are often much bigger at birth than animals born in a natural way. They can have abnormally large organs, which can lead to a number of problems, including breathing and blood flow. This is known as "Large Offspring Syndrome" (LOS).

But Dr Curran from the school of biological and chemical sciences at Queen Mary, University of London, does not agree.

"I could see an argument for the animal welfare people being concerned, but since these procedures have to be done under very strict conditions and in a compassionate way for the animal, this also shouldn't be a problem," he said.

"After the animal has been born and grows to be an adult, it reproduces normally and does everything normally."

Herpes virus used to treat cancer

The herpes virus causes cold sores

Doctors say they have used a genetically engineered herpes virus to treat successfully patients with head and neck cancer.

A London hospital trial of 17 patients found that use of the virus alongside chemotherapy and radiotherapy helped kill the tumours in most patients.
It works by getting into cancer cells, killing them from the inside, and also boosting the patient's immune system.
Further trials are planned for later in the year.
Head and neck cancer, which includes cancer of the mouth, tongue and throat, affects up to 8,000 people every year in the UK.
Study leader Dr Kevin Harrington, who is based at the Institute of Cancer Research in London, said current treatments were effective if the cancer was picked up early but that many patients were not diagnosed until it was more advanced.
The herpes virus, which is also being tested in patients with skin cancer, is genetically manipulated so that it grows inside tumour cells but cannot infect normal healthy cells.
Once there it has a triple effect - it multiplies, killing tumour cells as it does so, it is engineered to produce a human protein that activates the immune system and it also makes a viral protein that acts as a red flag to immune cells.
'Potential weapon'
In the 17 patients injected with the virus, in addition to their standard treatment, at the Royal Marsden Hospital, 93% showed no trace of cancer after their tumour had been surgically removed.
More than two years later, 82% of patients had not succumbed to the disease.
Only two of 13 patients given the virus treatment at a high dose relapsed, the journal Clinical Cancer Research reported.
There were no safety concerns with use of the virus, the researchers said, and it is hoped the virus could one day be used to fight other types of cancer.
"Around 35 to 55% of patients given the standard chemotherapy and radiotherapy treatment typically relapse within two years, so these results compare very favourably," said Dr Harrington.
He is now planning a trial comparing the viral treatment with the standard treatment in people newly diagnosed with head and neck cancer.
Dr Alison Ross, senior science information officer at Cancer Research UK, said it would be some time before the treatment could be used in patients as it still needed to be tested directly against standard treatment.
But she added: "This small study highlights the potential of using genetically modified viruses as a weapon to fight cancer."

29 July 2010

Calcium pills 'increase' risk of heart attack

By Emma Wilkinson Health reporter, BBC News

Calcium supplements are commonly taken by older people at risk of fracture

Calcium supplements taken by many older people could be increasing their risk of a heart attack, research shows.

The study, in the British Medical Journal, said people who took supplements were 30% more likely to have a heart attack.

Data from 11 trials also suggested the medicines were not very effective at preventing bone fractures.

Almost 3m people in the UK are thought to have osteoporosis and many take calcium pills to prevent fractures.

The study recommends doctors review their use of calcium supplements for managing osteoporosis.

The National Osteoporosis Society said most people should be able to get enough calcium through their diets, rather than reaching for the medicine cabinet.

The researchers said those who had a diet naturally high in calcium were at no increased danger.

'Limited benefit'

In all 12,000 people aged over 40 took part in the trials of calcium supplements of 500mg or more a day.

Continue reading the main story

“Start Quote

It is a balance of risks - people should consider the risks involved and how they apply to their own circumstances and discuss the matter with their GP”

End Quote Dr Alison Avenell Study author

The risk of heart attack was seen across men and women, was independent of age and the type of supplement given.

A small increased risk of death was seen in the study but was not statistically significant, the researchers said.

The reason for the increased risk of heart attack is not clear but it is thought the extra calcium circulating in the blood could lead to a hardening of the arteries.

Calcium in the diet is safe and the Food Standards Agency recommends adults have 700mg of calcium a day from milk, cheese and green, leafy vegetables.

Dr Alison Avenell, from the University of Aberdeen which did the research with colleagues in New Zealand and the US, said the evidence suggests calcium supplements only have a limited benefit in preventing fractures, especially when compared to other treatments available.

"It is a balance of risks - people should consider the risks involved and how they apply to their own circumstances and discuss the matter with their GP," she said.

She added the results did not necessarily apply to younger people with conditions for which they take calcium.

Judy O'Sullivan, senior cardiac nurse at the British Heart Foundation, said the results should be interpreted with caution because the trials did not set out to look at the risk of heart attack.

"However, the research should not be completely ignored," she said.

"Any new guidelines on the prevention of fractures in those most vulnerable to them should take this type of analysis into account."

Dr Claire Bowring, of the National Osteoporosis Society, said: "We've always recommended that people should aim to get the calcium they need from their diet to help build stronger bones.

"If you get all of the calcium that you need from your diet and adequate vitamin D from exposure to sunshine, then a supplement will not be necessary."

She said there were still questions to be answered about the treatment of osteoporosis but advised people taking calcium supplements to talk to their GP, especially if they have a heart condition

Cloned cow milk claim investigated

2 August 2010

Cloned cow milk claim investigated

MEPs recently voted in favour of a ban on cloned meat and products in the European food supply

Reports that milk from a cloned cow's offspring is on sale in the UK are being investigated.

An unnamed British dairy farmer said he used milk from a cow produced from a cloned parent, the New York Times has reported.

Foodstuffs produced from cloned animals must get approval before being sold, according to the Food Standards Agency.

The FSA said it had not approved the milk, labelled a "novel food", and would investigate.

The agency, which is the UK body responsible for the assessment of so-called novel foods produced by cloned animals and their offspring, said it had not been asked to consider any such cases.

A spokeswoman said: "Since 2007 the FSA interpretation of the law has been that meat and products from clones and their offspring are considered novel foods and would therefore need to be authorised before being placed on the market.

"The agency has not received any applications relating to cloning and no authorisations have been made.

"The agency will ... investigate any reports of unauthorised novel foods entering the food chain."

Continue reading the main story

“Start Quote

Food from cloned animals may seem a tasty option for some, but it leaves a distinctly bad taste in the mouth when it comes to animal welfare”

End Quote RSPCA spokesman

The RSPCA is one of a number of organisations that opposes cloning for food production, with the charity's opposition on animal welfare and ethical grounds.

"Cloning has huge potential to cause unnecessary pain, suffering and distress which cannot be justified by purely commercial benefits," a spokesman said.

"Food from cloned animals may seem a tasty option for some, but it leaves a distinctly bad taste in the mouth when it comes to animal welfare."

He added that cloning was "inefficient" and - if it became routine - could "greatly reduce genetic diversity within livestock populations, increasing the chances of whole herds being wiped out by disease".

Dr Brendan Curran, a geneticist at Queen Mary University of London, told Sky News he had no health concerns over food from cloned animals.

"A healthy animal will give you healthier milk. I'm less convinced of the ethics of it. I can see a good argument for animal welfare people being very concerned because it has to be done under really strict conditions and in a very compassionate way for the animal," he said.

"But after the animal has been born and it has become an adult I don't see any problem - they reproduce normally, they do everything normally."

Peter Stevenson, chief policy adviser at Compassion in World Farming, said the reports were a matter of great concern.

"The US seems to be very much moving towards permitting this. We believe that here in the UK and the rest of Europe we need to take a different position. There's not an issue necessarily about harm to the consumer, I mean quite honestly there's just not enough necessarily known about the food safety aspect, but there's huge harm to the cows."

Last month MEPs voted in favour of a law that would ban cloned meat and other animal products in the European food supply.

The legislation faces a next stage of consideration in September before it could become EU law.

In the US, the Food and Drug Administration said in 2008 that meat and milk from cloned animals was safe for human consumption.

BBC News

BBC News


Using 'fat' may encourage people to take more personal responsibility, says Anne Milton GPs and other health professionals should tell people they are fat rather than obese, England's public health minister says.

Anne Milton told the BBC the term fat was more likely to motivate them into losing weight.

She said it was important people should take "personal responsibility" for their lifestyles.

But health experts said the word could stigmatise those who are overweight.

Ms Milton, who stressed she was speaking in a personal capacity, said: "If I look in the mirror and think I am obese I think I am less worried [than] if I think I am fat."

She said too many staff working in the NHS were worried about using the term, but suggested it could help encourage "personal responsibility".

Continue reading the main story
“
Start Quote
People don't want to be offensive. There is a lot of stigma to being a fat person”
End Quote
Professor Lindsey Davies

UK Faculty of Public Health
"At the end of the day, you cannot do it for them. People have to have the information," she added.

The minister spoke to the BBC after setting out the coalition government's vision for public health.

A white paper is expected to be published in the autumn, which she said would stress the combined role of the individual, state, business and society.

The comments come after Health Secretary Andrew Lansley last month attacked the "lecturing" of recent public health campaigns, such as the drive on school meals that followed Jamie Oliver's TV shows.

'More brutal'

Professor Steve Field, of the Royal College of GPs, said he agreed with Ms Milton and already tried to use the term fat as much as he could.

"I think the term obese medicalises the state. It makes it a third person issue. I think we need to sometimes be more brutal and honest.

"You can be popular by saying the things people want to hear and in the NHS we too often do that when we should be spelling things out clearly."

The history of the term obesity
Continue reading the main story The term obesity comes from the Latin word obesus, which roughly translated means intensive eating
Societies have long been worried about problems of excess weight with Greek philosopher Hippocrates even writing about the dangers
But it was not until the mid 1600s that obesity started being used as a medical term and then in time directly linked to other diseases
Between 1830 and 1850 a Belgian scientist invented the BMI index to measure obesity by dividing weight by height
The Journal of Chronic Diseases reported in 1972 that BMI was the best way of measuring excess fat
Over the last three decades the terms BMI and obesity have been getting more and more popular with health professionals as a result
But Professor Lindsey Davies, president of the UK Faculty of Public Health, which represents public health professionals, warned against using 'fat' when dealing with patients.

"People don't want to be offensive. There is a lot of stigma to being a fat person."

She said health professionals started using the term obesity to encourage patients to think about the condition in a different way.

"Obesity is something that happens to people rather than something they are. The language you use all depends on the relationship you have with a patient.

"I would probably be more likely to say something like 'can we talk about your weight' rather than obesity, but that is a judgement you make on a patient-by-patient basis."

Diabetes costs 'out of control

26 July 2010 Last updated at 03:06 Share this pageFacebookTwitter ShareEmail Print Diabetes costs 'out of control'By


Insulin is just one of many drugs available for diabetes control The NHS is spending too much on diabetes drugs say researchers, who found the medicines account for 7% of the UK prescribing budget.

A big rise in the number of people with type 2 diabetes in recent years does not fully explain the spiralling costs, say Cardiff University researchers.

With rates of the condition expected to rise further, the NHS needs to get the budget under control, they conclude.

But GPs said they had to look out for the best interests of their patients.

In 2008 the NHS spent £700m on drugs to control blood sugar, figures show.

Continue reading the main story
“
Start Quote
We need to do whatever it takes to get blood sugar down and some of the cheaper drugs don't do the job”
End Quote
Dr Niti Pall

GP, Diabetes UK
The researchers calculated that between 2000 and 2008 the number of prescriptions for glucose-lowering drugs had risen by 50%.

But costs, even taking into account the price of inflation, rose by 104%, they said.

Writing in the journal Diabetic Medicine, they said figures for England specifically show an increase from £290m to £591m over the study period.

Researchers pointed to marked increases in use of the most expensive therapies.

Newer drugs, like rosiglitazone, as well as increasing use of insulin - the hormone that controls blood sugar levels in the body - have contributed to the increased costs, they said.

Lifestyle

Dr Chris Currie said the findings suggested that national guidelines are not being followed.

The National Institute for Health and Clinical Excellence recommends lifestyle changes as a first-step in controlling type 2 diabetes, before drug treatment is started.

Related stories
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GPs should then start people on the basic treatments before looking at other options if they do not work.

The researchers said in recent years the new expensive treatments had been aggressively marketed by drugs companies.

However, the figures also showed a dramatic rise in use of metformin - a cheap generic drug recommended as first line treatment - which the researchers said was reassuring.

It is thought that 2.6m people in the UK have diabetes - 90% of those type 2 diabetes - and a further one million have the condition but have not yet been diagnosed.

"The drugs bill is extremely high," said Dr Currie.

"Somebody has got to take a lead in managing the way we treat people with diabetes and making sure doctors adhere to the recommendations.

"This is going to continue to rise and part of the issue is people don't realise how big the problem is."

But Dr Niti Pall, a GP in Birmingham and spokesperson for Diabetes UK said she did not agree with the authors' conclusions.

She said the job of GPs was to get blood sugar levels as low as possible by whatever means possible to prevent complications in their patients.

"They have not looked at the health economics, we are saving the NHS money in the long run.

"We need to do whatever it takes to get blood sugar down and some of the cheaper drugs don't do the job."

'Toxic trio' triggers gut disease

'Toxic trio' triggers gut disease




Foods like cake are off-limit to coeliacs The precise cause of the immune reaction that leads to coeliac disease has been discovered.

Three key substances in the gluten found in wheat, rye and barley trigger the digestive condition, UK and Australian researchers say.

This gives a potential new target for developing treatments and even a vaccine, they believe.

Coeliac disease is caused by an intolerance to gluten found in foods like bread, pasta and biscuits.

It is thought to affect around 1 in every 100 people in the UK, particularly women.

Related stories
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The link between gluten and coeliac disease was first established 60 years ago but scientists have struggled to pinpoint the precise component in gluten that triggers it.

The research, published in the journal, Science Translational Medicine, studied 200 patients with coeliac disease attending clinics in Oxford and Melbourne.

The volunteers were asked to eat bread, rye muffins or boiled barley. Six days later they had blood samples taken to measure their immune response to thousands of different gluten fragments, or peptides.

Continue reading the main story
“
Start Quote
It's an important piece of the jigsaw but a lot of further work remains so nobody should be expecting a practical solution in their surgery within the next 10 years."”
End Quote
Sarah Sleet

Coeliac UK
The tests identified 90 peptides that caused some level of immune reaction, but three were found to be particularly toxic.

Professor Bob Anderson, head of the Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia, said: "These three components account for the majority of the immune response to gluten that is observed in people with coeliac disease."

Coeliac disease can be managed with a gluten-free diet but this is often a challenge for patients. Nearly half still have damage to their intestines five years after starting a gluten-free diet.

Professor Anderson said one potential new therapy is already being developed, using immunotherapy to expose people with coeliac disease to tiny amounts of the three toxic peptides.

Early results of the trial are expected in the next few months.

COELIAC DISEASE
Continue reading the main story Coeliac disease is an autoimmune disease
Gluten found in wheat, barley and rye triggers an immune reaction in people with coeliac disease
This damages the lining of the small intestine
Other parts of the body may be affected
Source: Coeliac UK
Sarah Sleet, Chief Executive of the charity Coeliac UK, said the new finding could potentially help lead to a vaccine against coeliac disease but far more research was needed.

She said: "It's an important piece of the jigsaw but a lot of further work remains so nobody should be expecting a practical solution in their surgery within the next 10 years."

The symptoms of coeliac disease vary from person to person and can range from very mild to severe.

Possible symptoms include diarrhoea, nausea and vomiting, recurrent stomach pain, tiredness, headaches, weight loss and mouth ulcers.

Some symptoms may be mistaken as irritable bowel syndrome or wheat intolerance.

'Cut down on meat to lose weight'

People in Denmark, Germany, Spain, Sweden and the Netherlands ate the most meat Eating less meat may be the key to keeping a healthy weight, say researchers.
A European study of almost 400,000 adults found that eating meat was linked with weight gain, even in people taking in the same number of calories.

The strongest association was found with processed meat, such as sausages and ham, the Imperial College London team reported.


It suggests that high-protein diets may not help slimmers in the long run.


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Sausage a day 'raises heart risk'
Death link to too much red meat
The findings, published in the American Journal of Clinical Nutrition, also support public health messages advocating cutting down on the amount of meat we eat, the researchers said.
The study looked at data from adults taking part in a large project looking at the link between diet and cancer.
Participants from 10 European countries, including the UK, were weighed and measured at the start and then asked to report their weight five years later.
They also filled in a detailed food questionnaire.
Weight gain
Overall, the researchers found that meat consumption was associated with weight gain in both men and women.
More detailed analyses showed that the link was still significant after taking into account overall calorie intake, physical activity and other factors which may have skewed the results.
The team calculated that in people who ate the same number of calories, an extra 250g of meat a day - equal to a small steak - led to an additional weight gain of 2kg (5lbs) over five years.


Although it is not clear why meat would lead to weight gain in people eating the same number of calories, one theory is that energy-dense foods like meat alter how the body regulates appetite control.
But there could also be another lifestyle or dietary explanation for the link that was not accounted for by the study.
Study leader Dr Anne-Claire Vergnaud said: "I would recommend to people to control their consumption of meat to maintain a healthy weight and good health in general during life."
But she added: "Decreasing the amount of meat alone would not be an adequate weight loss strategy."
Sian Porter, a dietician and spokeswoman for the British Dietetic Association, said there were caveats in the study, including the fact that at the end-weight was self-reported.


But she said it was an interesting finding.
"We eat more meat than we need.
"What I say to my patients is to think about variety - so have an egg for breakfast instead of bacon, cheese for lunch instead of ham and fish for the evening meal.
She advised people to eat lots of lentils and pulse, wholegrains, fruit and veg and oily fish as well as meat.
"Portion size is the other thing - a portion of meat should be about the size of a deck of cards."

Archaeologists have discovered a second henge

The new "henge" is about 900m (2,950ft) from the giant stones
Archaeologists have discovered a second henge at Stonehenge, described as the most exciting find there in 50 years.

The circular ditch surrounding a smaller circle of deep pits about a metre (3ft) wide has been unearthed at the world-famous site in Wiltshire.

Archaeologists conducting a multi-million pound study believe timber posts were in the pits.

Project leader Professor Vince Gaffney, from the University of Birmingham, said the discovery was "exceptional".

The new "henge" - which means a circular monument dating to Neolithic and Bronze Ages - is situated about 900m (2,950ft) from the giant stones on Salisbury Plain.

Continue reading the main story
“
Start Quote
It's a timber equivalent to Stonehenge”
End Quote
Professor Vince Gaffney

University of Birmingham
Images show it has two entrances on the north-east and south-west sides and inside the circle is a burial mound on top which appeared much later, Professor Gaffney said.

"You seem to have a large-ditched feature, but it seems to be made of individual scoops rather than just a straight trench," he said.

"When we looked a bit more closely, we then realised there was a ring of pits about a metre wide going all the way around the edge.

"When you see that as an archaeologist, you just looked at it and thought, 'that's a henge monument' - it's a timber equivalent to Stonehenge.

"From the general shape, we would guess it dates backs to about the time when Stonehenge was emerging at its most complex.

"This is probably the first major ceremonial monument that has been found in the past 50 years or so.

Continue reading the main story
Archaeologists say the find is "exceptional"

Discovering the henge
"This is really quite interesting and exceptional, it starts to give us a different perspective of the landscape."

Other wooden structures have been found in the area, one of these being Durrington Walls about 3km (1.86m) to the north east of the stones.

Data from the site is being collected as part of a virtual excavation to see what the area looked like when Stonehenge was built.

Speculation as to why the 4,500-year-old landmark was built will continue for years to come, but various experts believe it was a cemetery for 500 years, from the point of its inception.

In 2008, the first excavation in nearly half a century was carried out at the iconic site on Salisbury Plain.

This latest project is being funded by the Ludwig Boltzmann Institute for Archaeological Prospection and Virtual Archaeology, in Vienna, and the University of Birmingham, and is assisted by the National Trust and English Heritage.

Professor Gaffney said he was "certain" they would make further discoveries as 90% of the landscape around the giant stones was "terra incognita" - an unexplored region.

"The presumption was this was just an empty field - now you've got a major ceremonial monument looking at Stonehenge," he said.

standards in the NHS

The new framework will eventually cover most NHS work A consultation has begun on how standards in the NHS in England should be measured.

The government says it wants to move from national targets to a "set of national outcome goals".

So far it has taken a cautious response to dismantling the targets put in place by Labour.

Experts say gains made in cutting waiting times should not be lost in any changes.

In future, it has proposed the health service should be judged by measures which include how well it prevents people dying prematurely, how they recover and patients' experience of care.

Related stories
Commons clash over NHS shake-up
The first set of new standards is to be developed by April 2011. Under the planned shake up of the health service the new NHS commissioning board would use them to hold GP groups to account. Family doctors are due to take over NHS budgets for their local community by 2013.

The Health Secretary Andrew Lansley said: "I want to free doctors and nurses to focus on what really matters - better results for their patients - instead of them being stifled by top down targets."

So far the only target introduced by Labour to be removed outright is the obligation for GPs to offer an appointment within 48 hours to all patients.

Continue reading the main story
“
Start Quote
Much of what is proposed is already part of the performance management system for the NHS ”
End Quote
Kings Fund

Catherine Foot
Accident and Emergency departments have had the target to see patients within four hours relaxed slightly, but not removed. The promise of hospital treatment within 18 weeks of referral from a family doctor is no longer being monitored nationally but the health service has been told that long waits are not acceptable.

After angry exchanges in the Commons last week the government confirmed it would also be keeping the maximum two week wait for an appointment with a cancer specialist for urgent suspected cases.

The new outcome measures will include, wherever possible, information that can be compared internationally with standards in other major economies. This may help more accurate comparisons to be made. Andrew Lansley has said he wants to close the gap in cancer survival between the UK and other European countries.

Death rates from diseases which are treatable are one way of giving a rough idea of how well health systems are looking after their patients. Survival rates might also be important, as they take account of the number of patients suffering from any particular condition.

Performance management

The clinical watchdog for England, the National Institute for Health and Clinical Excellence (NICE), is being asked to develop 150 new outline standards for different areas of healthcare to support the new framework.

They are expected to be similar to the work it has already done in setting out what constitutes best care for groups of patients such as those suffering strokes, or dementia.

One common criticism of the targets developed by Labour was that they often had unintended consequences. Managers would focus all their efforts on improving areas where there were targets, sometimes at the cost of paying less attention to types of care which had few or no targets.

The Department of Health says the new outcomes framework should eventually cover most of the work of the health service.

Catherine Foot, senior policy fellow at the Kings Fund, said the ambition to develop such a comprehensive set of standards was welcome. But she added

"Much of what is proposed is already part of the performance management system for the NHS and it is positive to see this document building on what has been established before rather than reinventing things."

The independent health think tank says in order for the new outcomes to make a difference the NHS at a local level will probably still need to measure staffing levels and waiting times.

The beautifully-preserved remains

Cave yields marsupial fossil haul
Nimbadon may have travelled in herds, say the scientists
Fossil hunters in Australia have discovered a cave filled with the 15-million-year-old remains of prehistoric marsupials.

The rare haul of fossils includes 26 skulls from an extinct, sheep-sized marsupial with giant claws.

The finds come from the Riversleigh World Heritage fossil field in north-west Queensland.

Continue reading the main story
“
Start Quote
To find a complete specimen like that and so many from an age range is quite unique”
End Quote
Liz Reed

Flinders University
The beautifully-preserved remains have been described in the Journal of Vertebrate Paleontology.

"It's extraordinarily exciting for us," said University of New South Wales palaeontologist Mike Archer, co-author of the research.

"It's given us a window into the past of Australia that we simply didn't even have a pigeonhole into before.

"It's an extra insight into some of the strangest animals you could possibly imagine."

The giant-clawed, wombat-sized marsupial is named Nimbadon lavarackorum; researchers discovered the first of the Nimbadon skulls in 1993.

The palaeontologists have been stunned at how well preserved the fossils were - and by how many were found.

Discovering such a large assemblage suggests the animals may have travelled in herds - like modern-day kangaroos, said palaeontologist Karen Black, who led the research team.


The specimens offer an extra insight into the life of an extinct creature But how the animals all ended up in the cave remains a mystery. One theory is that they accidentally plunged into it through an opening obscured by vegetation and either died from the fall, or became trapped and later perished.

The Nimbadon skulls include those of babies still in their mothers' pouches, allowing the researchers to study how the animals developed.

The skulls reveal that bones at the front of the face developed quite quickly, which would have allowed the baby to suckle from its mother at an extremely young age.

Those findings suggest that Nimbadon newborns developed very similarly to modern kangaroos - likely being born after a month's gestation and crawling into their mother's pouch for the rest of their development, Black said.

Nimbadon also may have something in common with another marsupial. The fossils revealed the creatures had large claws, which may have been used to climb trees - as koalas do, Dr Black explained.

"To find a complete specimen like that and so many from an age range is quite unique," said Dr Liz Reed of Flinders University in South Australia, who was not affiliated with the study.

"It allows us to say something about behaviour and growth and a whole bunch of things that we wouldn't normally be able to do."

diagnosis of autism is based on a range of behavioural features, not just language development.

mengele-westof
Voice technology 'could help detect autism'

Children with autism have a very different vocal development pattern Young children with autism can be identified by listening to the noises they make, say US scientists.


Research suggests the babbling of infants with autism differs from that of children without it. The differences were spotted with 86% accuracy using automated vocal analysis technology.


Vocal characteristics are not currently used for diagnosing autism, even though the link has been suggested before.


The study is in the journal Proceedings of the National Academy of Sciences.


Autism is the name given to a group, or "spectrum", of lifelong developmental conditions characterised by an inability to communicate with or relate to others, a lack of social skills, obsessional traits, and repetitive behaviour.


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An estimated 500,000 people in the UK are believed to be affected by autism.


'Child utterances'


The US scientists analysed nearly 1,500 day-long vocal soundtracks from battery-powered recorders attached to the clothing of 232 children aged between 10 months and 4 years.


In total more than three million individual child utterances were used in the research, the study notes.


The study focused on 12 specific sound parameters associated with vocal development.


Continue reading the main story
“
Start Quote
The diagnosis of autism is based on a range of behavioural features, not just language development. The social aspects of communication must also be considered”
End Quote
Dr Gina Gomez de la Cuesta


The National Autistic Society
The most important were those involving "syllabification" - the ability of children to produce well-formed syllables with rapid movements of the jaw and tongue.


Experts believe these sounds form the foundation of words.


In autistic children up to four years old, there was a mismatch between the expected parameter values and age.


Professor Steven Warren, an expert in autism spectrum disorders at the University of Kansas, US, who took part in the study, said: "This technology could help paediatricians screen children for ASD (autism spectrum disorder) to determine if a referral to a specialist for a full diagnosis is required and get those children into earlier and more effective treatments."


The new system, called Lena (Language Environment Analysis) could make a big difference to the screening, assessment and treatment of autism, say researchers.


Speech patterns


They point out that since the analysis is based on sound patterns rather than words, it could be used to screen speakers of any language for signs of autism.


"The physics of human speech are the same in all people as far as we know," said Prof Warren.


Dr Gina Gomez de la Cuesta, action research leader at The National Autistic Society, said: "Any tools which could help to identify speech and language difficulties at a younger age have the potential to help families, when used with professional guidance.


"However, they are no substitute for proper assessment by experienced and well-trained professionals."


Dr de la Cuesta added: "The diagnosis of autism is based on a range of behavioural features, not just language development.


"The social aspects of communication must also be considered, and it should be remembered that every child is different and develops at their own pace."

malicious GP risk

Shipman's Hyde colleague warns of malicious GP risk
By Peter Marshall



Shipman killed at least 215 patients, an inquiry found A doctor who worked alongside serial killer Harold Shipman has told the BBC there is still scope for wrongdoing within the medical profession.

Dr Raj Patel, who still works in Hyde, believes that a malicious doctor could still exploit weaknesses in GP systems - 10 years after Shipman was jailed.

Dame Janet Smith, who chaired the Shipman inquiry, also said more still needed to be done to protect patients.

Shipman was jailed in January 2000 for murdering 15 of his patients.

A subsequent inquiry decided he had killed at least 215 people over a period of more than 20 years, making him the UK's most prolific serial killer.

Shipman exploited weaknesses in death certification and other systems used by GPs to avoid detection.

Ten years on from his imprisonment, Shipman's Market Street surgery in the Greater Manchester town is now a thriving business. Dr Patel works over the road in the Brooke Surgery.

Continue reading the main story
“
Start Quote
I certainly note that there could be potential for some wrongdoing by a healthcare professional or even a carer”
End Quote
Dr Raj Patel

Hyde GP

Shipman 'thought he was a god'
Are patients safer after Shipman?
Shipman response 'lacks progress'
As a young GP he occasionally stood in for Shipman as a locum and counter-signed many of his cremation forms - Shipman lied on those forms to avoid alerting the authorities to his crimes.

When the Shipman Inquiry highlighted weaknesses in that system, doctors at the Brooke Surgery say they tightened procedures almost overnight.

Anyone counter-signing a form would always speak to a relative or carer of the deceased and always examine medical records.

"We decided that we did not have to wait for the authorities to write legislation," said Dr Patel.

"We determined, as a group of doctors, if we decided we would behave differently around particularly cremation then we could effect that change very quickly."

But it was not until January 2009 that the government introduced a more stringent cremation form nationally. But new tighter checks before a body is cremated do not apply to burials.


Dr Raj Patel said his colleagues did not wait for legislation changes "The fact that the body is retrievable is an important factor for the process for burial to be more simple," Dr Patel added.

"However, I certainly note that there could be potential for some wrongdoing by a healthcare professional or even a carer."

It is a fear echoed by Dame Janet Smith, the senior judge who chaired the Shipman Inquiry.

In an exclusive BBC interview, she said the inquiry, which concluded its reports in 2005, had still not achieved as much as she had hoped.

"We haven't moved at all on basic death certification. It's exactly the same. There hasn't been any further work done since I moved off it in 2003," said Dame Janet.

Wholesale reform

For more than 20 years, Shipman used the drug diamorphine to kill patients both in their homes and at his surgery. He was jailed for life in January 2000 and committed suicide in prison in 2004.

In 2003, her inquiry recommended wholesale reform of death certification to make it less dependent on the honesty of a single doctor.

A single system covering burials and cremations, recommended by the inquiry, is yet to be implemented, although cremation forms have been made more stringent.

The government has said its new Coroners' and Justice Act, which includes plans for medical examiners to scrutinise death certificates, will help prevent a repeat of Shipman's killings.


Dame Janet Smith said Shipman's weapon was his syringe
"The act cannot function until secondary legislation in the form of rules have been prepared and brought into force," said Dame Janet.

"And that hasn't happened yet. That will take another year or two at least."

The Department of Health has insisted that the majority of recommendations from the Shipman Inquiry have been implemented with the aim of improving the quality and safety of patient care.

"Reforming the process of death certification requires changes to primary and secondary legislation - this takes time." said a spokesman.

"We've already made changes to primary legislation and decisions on priorities for this area will be made in the coming weeks."

Revalidation of doctors

The Shipman Inquiry was also highly critical of the General Medical Council's (GMC) approach to managing dangerous and incompetent doctors.

Dame Janet said the GMC's initial plans for revalidation - a process of assessing and re-licensing doctors - amounted to a "rubber stamp".

However, despite her recommendation for a robust evaluation of a doctor's fitness to practice, this has still not happened.

GMC chief executive Niall Dickson admitted that convincing the profession had been a slow process.

"I certainly think some older doctors found it a threatening process," he said.

"I know there will inevitably be frustration with how slowly the system moves and I can understand that. I think people who've seen system failure leading to the loss of a relative have genuine anger at how slowly things operate.

"The only assurance I can give sitting where I am now is that our commitment to drive through a regular checking system for doctors is absolute and I will do everything I can both to see the system launched and delivered."