Breast cancer screening under review

The value of breast cancer screening has been a source of controversy

The evidence for breast cancer screening in the UK is being reviewed amid controversy about the measure's effectiveness.

The NHS says screening saves lives, but other researchers have argued that it may cause more harm than good.
The national cancer director for England, Prof Mike Richards, announced in the British Medical Journal that he will lead a review.
He said he was taking the "current controversy very seriously".
When it comes to cancer treatment, earlier is better. Screening programmes for a range of cancers help doctors make a diagnosis sooner. But they also run the risk of false positives, diagnosing someone with cancer when they are healthy.
Life saving
Screening was introduced for breast cancer in 1988 in the UK and now offers tests to women, over the age of 50, every three years.
In 2002, the World Health Organization's International Agency for Research on Cancer estimated that screening reduced deaths from breast cancer by about 35%.
The NHS says 1,400 lives are saved through screening in England alone.

“Start Quote

The decision whether to be screened is a personal one, but that decision should be made with all of the potential harms and benefits fully explained”

End Quote Sara Hiom Cancer Research UK

However, the evidence has been questioned.

A review of clinical trials involving a total of 600,000 women concluded it was "not clear whether screening does more good than harm".
It said that for every 2,000 women screened in a 10-year period: one life would be saved, 10 healthy women would have unnecessary treatment and at least 200 women would face psychological distress for many months because of false positive results.
The authors of that research labelled the NHS Breast Screening Programme's advice "seriously misleading".
Exchange
Professor of complex obstetrics at King's College London, Susan Bewley, has turned down screening.
In a letter to Prof Richards last month, she said: "The distress of overdiagnosis and decision making when finding lesions that might, or might not, be cancer that might, or might not, require mutilating surgery is increasingly being exposed."
In response, Prof Richards said research suggested that up to two and a half lives were saved for every over-diagnosed case.
He added that he would lead a review of the evidence to settle the ongoing controversy.
"Should the independent review conclude that the balance of harms outweighs the benefits of breast screening, I will have no hesitation in referring the findings to the UK National Screening Committee and then ministers.

Mammograms can identify tumours before they would be picked up

"I am fully committed to the public being given information in a format... that enables them to make truly informed choices."
Prof Julietta Patnick, director of the NHS Cancer Screening Programmes, welcomed the review: "The NHS Breast Screening Programme has always been based on the best and latest evidence.
"Where new information has suggested them, a number of changes have been made to the Programme, for example extending the screening age range and using digital mammography."
The review will be led jointly by Prof Richards and Cancer Research UK.
The director of health information at the charity, Sara Hiom, said: "Women need more accurate, evidence-based and clear information to be able to make an informed choice about breast screening.
"The decision whether to be screened is a personal one, but that decision should be made with all of the potential harms and benefits fully explained."
Breakthrough Breast Cancer's chief executive Chris Askew said: "Breast screening is vital as it can detect breast cancer at the earliest possible stages when no other symptoms are obvious.
"The earlier breast cancer is picked up the better for the one in eight women who are diagnosed every year with this disease, as treatment options are more likely to be less aggressive and have successful outcomes."

Leafy greens protect the gut’s immune system

Leafy greens protect the gut’s immune system

13 October 2011

A chemical compound found in leafy greens plays an important part in maintaining a healthy immune system in the gut, according to new research from the Babraham Institute and the Medical Research Council (MRC).
The findings, reported in the journal Cell, could help scientists better understand the basis of intestinal disorders such as inflammatory bowel disease (IBD) and may offer new treatment opportunities.
In the new study, researchers were able to prove that leafy greens protect a certain type of immune cell known as intra-epithelial lymphocytes (IELs). IELs play a crucial role in keeping the gut lining healthy and preventing ‘bad’ bacteria from entering the gut while maintaining the balance of ‘good’ bacteria which help us to break down our food.
Researchers studied mice fed a diet containing many vitamins and minerals known to be essential for good health, but which lacked vegetables. Over three weeks the mice lost 70 to 80 per cent of IELs.
The research showed for the first time that mice fed a diet low in vegetables rapidly lose these specialised immune cells lining the intestinal tract, but not other immune cells. The team discovered that IELs depend on chemical signals from the digestive breakdown products of a substance called Indole-3-carbinol, high levels of which are found in vegetables like broccoli and cabbage.
Dr Marc Veldhoen, senior author of the paper who conducted the bulk of the research at the MRC National Institute for Medical Research before moving to the Babraham Institute, said:

“This was surprising, since the new diet contained all other known essential ingredients such as minerals and vitamins. I would have expected that cells at the surface would play some role in the interaction with the outside world, but such a clear cut interaction with the diet was unexpected.

“After feeding otherwise healthy mice a vegetable-poor diet for two to three weeks, I was amazed to see that 70 to 80 per cent of these [protective] cells disappeared.”

“It’s already known to be a good idea to eat your greens. Our results provide a molecular basis for the importance of cruciferous vegetable-derived phyto-nutrients as part of a healthy diet.”

Dr Brigitta Stockinger, Head of Division of Molecular Immunology at the MRC’s National Institute for Medical Research added:

“The food we eat plays a crucial role in influencing our immune system and we have been looking at the intricate biology that determines how cells in our intestines maintain an intrinsic protection against microbes.

“This study in mice is an important step towards increasing our understanding of how environmental signals shape immune responses at barrier sites such as the intestine. Marc Veldhoen's continuing studies at the Babraham institute will no doubt take this onto the next step.”

Dr Marc Veldhoen added:

“We don’t yet know the implications of this research for humans, but interestingly, epidemiological studies have linked a diet low in fruit and vegetables with an increased risk of IBD. Our results provide a molecular basis for the importance of nutrients from cruciferous vegetables as part of a healthy diet."

The research was funded by MRC and BBSRC

Kill the calories ,calorie diet nonsense unmasked

Counting calories is an addictive pastime for many a dedicated slimmer. Croissant or toast? Curry or pizza? Sandwich or salad?

Food labels help millions of people decide what to buy and what to eat. So it's important that they are accurate but, according to some experts, the system on which they are based is flawed and misleading.

A calorie is the energy we get from food. Too much energy and we end up getting fat. But how is the calorie content of food calculated?

Back in the 1800s an American chemist, Wilbur Atwater, devised the system on which calorific values on our food labels are still based.

Basically, he burned food and then measured how much energy it gave off.

“Start Quote

What's important is to eat fewer calories so that the body is in negative energy balance. How you calculate it doesn't matter.”

End Quote Gaynor Bussell British Dietetic Association

He then estimated the amount of energy the body used up by calculating the amount of energy in undigested food in waste products.

That thankless task prompted Atwater to conclude that every gram of carbohydrate produced four calories, every gram of fat produced nine, and every gram of protein produced four calories.

These figures have been used as the basis for calculating the calorie content of food ever since.

Energy usage

Nutritionists have always known that these calorific values are approximate.

But recently some nutritionists, including Dr Geoffrey Livesey, are saying that the calorie content of items in our shopping baskets could be up to 25% out.

This is because the texture of the food, its fibre content, and how it is cooked can all affect the amount of energy the body is able to get from food, he says.

Even the process of chewing food uses up energy and, therefore, calories.

The more protein or fibre in a food, for example, the harder the body has to work to process it.

So when we are weighing up which ready meal to buy in the supermarket, we need to think about more than just the calories contained in food before we eat it - we need to consider how our body digests and processes it too.

Dr Livesey says: "People need to be given the right information to make the right choices, following the latest scientific understanding, because if you are not following the science, you're following something else.

"When you consider calories have been used as the only measurement for understanding foods' impact on weight loss for nearly 200 years, despite our huge advancement in nutritional science, you realise how outdated calorie counting is."

'Calorie conscious'

So is it time to overhaul the current system of food labelling?

Dr Susan Jebb, head of nutrition at the Medical Research Council, says it's right to say that some calories are more filling than others but, "in the grand scheme of things, we're talking about really small differences here."

She added: "When it comes to advising the public and getting people to eat fewer calories, I'm not sure this is going to be helpful."

"If you're trying to lose weight you have to be calorie conscious, not calorie counting all the time.

"In any case, we need to test if this is better way of advising people than the current way."

Gaynor Bussell, a dietician and spokesperson for the British Dietetic Association, agrees that overhauling the whole system on which calories are calculated doesn't make sense without backing from scientists and governments.

What matters is eating healthily and that is "not a precise art anyway", she says.

"What's important is to eat fewer calories so that the body is in negative energy balance. How you calculate it doesn't matter."

Weight Watchers is proposing a new system called ProPoints, which it says is a more accurate alternative to calorie counting.

It's based on a daily allowance which takes into account gender, age, weight and height. All fruits and most vegetables contain zero ProPoints.

The system tells you "the amount of energy that is available in a food after you've eaten it," the weight loss organisation maintains.

The UN Food and Agriculture Organization looked at the issue a few years ago and decided that changing the way calories are calculated would need huge upheaval and lots of money - all for marginal gain.

So don't fret too much over the labels at the supermarket - eating sensibly is far more important.

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• Medical Research Council
• British Dietetic Association
• British Nutrition Foundation

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Zambia's growing population

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• Seven billion and counting

You are going to hear a lot about population in the coming week. That's because on 31st October, the United Nations Population Fund will announce that the number of people on the planet has reached seven billion.

Of course no one knows exactly how many people there are - we may have already passed seven billion - but the UN has picked the day as the best estimate.

Catherine Phiri says she wants her children to become important people without suffering

I've been to Zambia because it has one of the world's fastest growing populations.
I have been to many maternity wards around the world but never one as busy at the United Teaching Hospital (UTH) in Lusaka.
They deliver at least 50 babies a day - sometimes 70 or more. The pressure on the maternity unit is significant according to Dr Lackson Kasonga.
"The population is expanding rapidly, especially in the capital where people are moving for jobs. The demand for maternity services is rising each year but that is not matched by the increase in space or resources."
Global fertility
Women in Zambia have, on average, six children. That number has barely shifted in recent decades. Contrast that with global fertility, which has fallen from five to two and a half children since 1950.
Catherine Phiri had just given birth to a daughter when I met her and husband Robert. They have two boys at home. A fourth child died in infancy. They live in poverty, like two-thirds of Zambia's population. The Phiris want more children and, like parents the world over, they are ambitious for their future.
Catherine Phiri told me: "I want my daughter and my sons to be important people in government so as they work they can extend help to us. We grew up suffering and I want it to be different for them."
Although basic education is free, there is often pressure to get older children to begin work so that they can help with the family finances. Robert Phiri said: "We'd like five or six children but I worry if we are going to be able to send them all to school. If we have more it might mean some going to school and some not - we will have to see what happens."
Potential burden
I visited the family home outside Lusaka. It is extremely basic. There is electricity but no running water. Mr Phiri earns below the minimum wage and the couple often don't have enough money to buy clothes.
I asked Anna Sampa from Unicef why so many poor couples in Africa choose to have large families. It's something that I have found on visits to Sierra Leone, Malawi and other developing nations.
She said: "They don't see the potential burden of having more mouths to feed. Rather they look on lots of children as a means of helping them in their old age." Aid agencies do not talk about population control - they fear it smacks of eugenics. Rather, they try to encourage family spacing and getting couples to have the number of children they can support.
At UTH I watched a demonstration on contraceptive methods given to a group of pregnant women. The majority of couples in Zambia still don't use modern methods such as condoms, the pill, implants and injections.
Myths

“Start Quote

This is a vast land, so we need more people. But it is the speed which is the cause for concern - we need to match population growth with resources.”

End Quote Dr Lackson Kasonga consultant obstetrician

Even though contraception is free, many women can't afford to travel to the health centres. There is also a good deal of ignorance about the methods available according to Ruth Bweupe, family planning officer at the Ministry of Health.
"The myth surrounding the implant is that it will go to the heart or the brain and do serious harm. The implant rods are inserted in the upper arm so they feel that it will travel around the body. For the pill they feel it will cause permanent infertility and they'll never be able to have children again."
The rising workload of UTH's maternity unit is a tangible sign of Zambia's growing population. It is 13 million now and projected to triple by 2050 according to the UN Population Division. Even its most cautious projection has the population at 100 million by 2100, with its medium (or best estimate) being 140 million.
Vast land
Does that matter? After all, Zambia is a big country, three times the size of the UK. It has fertile soil and rich mining reserves, so there is huge potential.
The economy is growing and the World Bank recently re-classified it as a "middle income" country. How this works given that two-thirds of families live in poverty is a little baffling, but it is an indicator that Zambia is improving economically.
Despite the heavy workload at the maternity unit, Dr Kasonga was upbeat about the future.
"We are happy to have more babies. This is a vast land, so we need more people. But it is the speed which is the cause for concern - we need to match population growth with resources."
Half of Zambia's population is aged 16 or under and it has a relatively smaller elderly population. Contrast that with most developed countries where the problem is that fewer and fewer people are supporting a growing cohort of elderly.
The potential problem for Zambia is that the population increase is so rapid that the government may struggle to keep pace. Those under 16 need education, healthcare and homes but they are not yet contributing to the economy. Zambia can barely feed 13 million people so how will it cope in the future?
Part of the answer will depend on how Zambia manages and encourages foreign investment - China is a huge player here. It also depends on the life chances given to the young, which starts with education.
Gender equality

Future generations hope to have smaller families. Norah Zulu says she only wants two children

Unicef supports education projects in Zambia and believes empowering women is vital if couples are to be lifted out of poverty and have the number of children they can support.
At Munali High School in Lusaka, most of the teenage girls I spoke to came from large families. But all wanted careers first and motherhood second. Their attitudes seem a world away from the older generation.
Norah Zulu, who is 16, told me things were very different from her parents' day: "They never learned about family spacing. We do. And they did not have gender equality - rights for girls and boys. I want two kids, no more."
Mercy Mushindu, who is 17 and one of eight children, said she also wants two kids "to reduce the population". Things are changing in Zambia and it will be the next generation who will have to ensure that population increase is a benefit rather than a burden

24 October 2011 Last updated at 08:46

Immune system defect may cause ME

Chronic fatigue syndrome may be due to the immune system, researchers think.

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Researchers in Norway believe Chronic Fatigue Syndrome (CFS), also known as ME, may be caused by a wayward immune system attacking the body.

The illness, the cause of which is uncertain and has no known cure, has attracted significant controversy.

A small study, reported in PLoS One, showed a cancer drug, which inhibited the immune system, relieved symptoms in some patients.

The ME Association said the findings were "very encouraging news".

Doctors in Norway stumbled across their first clue in 2004 when treating a patient with both Hodgkin's lymphoma, a cancer of the white blood cells, and CFS.

When she received cancer treatment, her fatigue symptoms improved for five months.

'Dramatic'

The latest study, carried out at the Haukeland University Hospital in Bergen, built on the previous discovery by testing 30 patients with CFS.

“Start Quote

Their life was turned completely around very dramatically”

End Quote Øystein Fluge Consultant oncologist

Half were given two doses of Rituximab, a cancer drug which eliminates a type of white blood cell, while the other half were given a fake treatment.

In those patients receiving the drug, 67% reported an improvement in a score of their fatigue levels. Just 13% showed any improvement in the sham group.

Øystein Fluge, an oncology consultant at the hospital, told the BBC: "There was a varied response: none, moderate, dramatic relief of all symptoms.

"Two had no recurrence [of their symptoms], their life was turned completely around very dramatically."

Their theory is that a type of white blood cell, B lymphocytes, are producing an antibody which attacks the body.

The drug wipes out the lymphocytes which in some cases may "reset the immune system", however, in other patients the fatigue symptoms would return when more B lymphocytes were made.

Caution

Chronic Fatigue Syndrome

• The disease is thought to affect some 250,000 people in the UK
• Symptoms include extreme tiredness, problems with memory and concentration, sleep disturbances and mood swings
• There is currently no accepted cure and no universally effective treatment
• The cause is not clear either, with many doctors thinking the term CFS/ME is being used for several different diseases.
• Some patients have sent death threats to researchers after disagreements over a cause or cure

• What causes Chronic Fatigue Syndrome?

Mr Fluge said: "I think the fact that patients responded to treatment, improved cognitive function, fatigue and pain makes us believe we're touching one of the central mechanisms.

"But we're scratching at the surface, I would not characterise this as a major breakthrough."

The researchers are now investigating the effect of giving more doses over a longer period of time.

If their hunch is right it will throw up more questions, such as what is the immune system actually attacking and whether or not an actual test for CFS/ME be developed.

Dr Charles Shepherd, the UK ME Association's medical adviser, said: "The results of this clinical trial are very encouraging news for people with ME.

"Firstly, they help to confirm that there is a significant abnormality in immune system function in this disease.

"Secondly, they indicate that altering the immune system response in ME could be an effective form of treatment for at least a subset of patients.

"We now need further clinical trials of such anti-cancer agents to see if other research groups can replicate these findings."

More on This Story

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• What causes Chronic Fatigue Syndrome? 24 SEPTEMBER 2011, HEALTH
• Questions over virus link to ME 22 SEPTEMBER 2011, HEALTH
• Brain, body training 'treats ME' 18 FEBRUARY 2011, HEALTH

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• PLoS One
• Haukeland University Hospital
• ME Association

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• BBC Health: CFS

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can industrialised farming make Africa feed the world?

British-owned Chayton Atlas manages a 25,000 acre farm in Mkushi

The vision unfolding across the Mkushi plain in Zambia is at odds with the doleful imagery of modern Africa to which we have become accustomed.
Three hours from the capital Lusaka the wheat crop glows under the tropical sun. A combine harvester moves methodically across one portion of a vast field. Nearby a giant sprinkler irrigates the soya bean crop.
One might as easily be standing on the plains of the American Mid-West or among the grain fields of the Ukraine.
These are fields of plenty, a productive Africa that challenges the narrative of conflict and hunger that so dominates our idea of the continent.
"If we just increased the yields to 80% of world averages, Africa would become a net exporter of food. We believe that Africa can feed itself and the rest of the world too," Dabney Tonelli of Chayton Atlas, the British-owned company that manages the 25,000 acre farm at Mkushi, says.

Dabney Tonelli says Africa can become a net exporter of food

Chayton acquired a 14-year lease on the land from the Zambian government with the promise of hugely increasing yields, providing jobs for locals and passing on skills to the small farmers who live on subsistence plots nearby.
After years of misrule and corruption Zambia, which recently elected a new government, is seen as a beacon of stability on the continent.
"The political environment is stable, excellent conditions for agriculture in terms of climate and the quality of soil. For the agricultural investor Zambia is where you want to be," says Ms Tonelli.
Zimbabwean expertise
White farmers who were driven off their land in Zimbabwe have been hired to run the Chayton operation, bringing with them the intensive farming skills they have honed over decades.
The farm manager at Mkushi, Stuart Kearns, became a full-time farmer as a teenager after his father was killed in the Bush War in what was then Rhodesia. Despite his experiences in Zimbabwe he is optimistic about the future of farming in Zambia:
"There is huge potential here and I think the thing with Africa is that you have to keep trying again and again. That is something you learn when you grow up here."
Chayton promises to "create jobs, introduce sustainable farming methods… provide support and training to small-scale farmers".

Zambia's vice-president Dr Guy Scott voiced concern about job losses

But there are considerable obstacles - poor infrastructure and bureaucracy stand in the way of Zambia becoming a major exporter of food to the continent. At the moment Chayton is only producing for the local market.
And in an interview with Newsnight, the country's new vice-president, Dr Guy Scott, a farmer himself, was sceptical of some of the claims made by the company:
"I am very sceptical because I've been around a lot and I know what proposals look like and what justifications look like in the investment game and I would say that 90% of what is promised turns out not to be true… not necessarily because of any venality or any deliberate fraud.
"I mean people hope for the best. They hope it is going to work. And the government hopes it is going to work. And we all get each others hopes up. And then you find 'oh dear we didn't actually succeed in having the social impact or economic impact we'd hoped for'."
Displacement fears
Dr Scott worries about the social impact of job losses due to more intensive farming where machines take the place of people:

Local small-scale farmers complain about problems securing capital

"I think the main problem is that the population for Zambia is that the population is about four times too big for the economy. And I think that is the danger with large scale intensive farming; it tends to be capital intensive, it tends not to create jobs and at the same time tends to displace people who are unemployed from their fallback position which is to be subsistence farmers."
Chayton acknowledge that their modernised farming methods have already led to job losses, but insist that as the business grows it will create employment in spin-off businesses:
"Yes, over time some of the less skilled work goes as a result of mechanisation, but we are building a large scale business so over time we are creating other jobs," Ms Tonelli says.
"What we are able to do is train people to do highly skilled jobs which they can continue to use in a career in agriculture of transfer to other sectors as well."
Local feeling
The local subsistence farmers I meet say they welcome the principle of commercial farming, but have yet to see it bring any benefit to them.
Chayton has only been operating in the area for a year but Brighton Marcokatebe, a farmer in the nearby village of Asa, says other commercial farmers have failed to help their smaller neighbours.

Most of Zambia's farmers are small-scale subsistence farmers

"If they come with help then I will accept it, but so far they don't help," he says.
The villagers also complain that they cannot access capital. Most land in Zambia is owned by the state and administered by village chiefs. Without any legal title to the land small farmers cannot get bank loans to buy machinery and expand their production.
But according to Dr Guy Scott, Zambia's small farmers can look forward to a better deal:
"We're elected by Zambians and their interests have to come first. If their interests can be made to coincide with those of the international markets or whatever then great, but at the end of the day we are responsible for their protection, their social protection."
Matching that commitment with the agreements already made with foreign investors will require considerable political skill.

Henry David Thoreau

"Christianity, on the other hand, is humane, practical, and, in a large sense, radical. So many years and ages of the gods those Eastern sages sat contemplating Brahm, uttering in silence the mystic "Om," being absorbed into the essence of the Supreme Being, never going out of themselves, but subsiding farther and deeper within; so infinitely wise, yet infinitely stagnant; until, at last, in that same Asia, but in the western part of it, appeared a youth, wholly unforetold by them,—not being absorbed into Brahm, but bringing Brahm down to earth and to mankind; in whom Brahm had awakened from his long sleep, and exerted himself, and the day began,—a new avatar. The Brahman had never thought to be a brother of mankind as well as a child of God."

-Henry David Thoreau

Dutch court convicts five for Tamil Tiger fundraising

Tamil Tiger rebels fought for a separate homeland in Sri Lanka for decades

Sri Lanka After War

• UN panel report: Main allegations
• War in pictures
• Q&A: Post-war Sri Lanka
• Profile: Mahinda Rajapaksa

A Dutch court has convicted five Dutch ethnic Tamil men for raising funds for the banned Tamil Tiger rebels.

The men got sentences of up to six years for their activities on behalf of rebels who fought for an independent homeland for Tamils in Sri Lanka.
Prosecutors said the men extorted millions of euros from the Tamil diaspora through blackmail and threats.
But the defence counsel for the five men argued that they were freedom fighters.
In a complex ruling, the judge said the men were not convicted of supporting terror but that he found them guilty of involvement in a criminal organisation.
The Liberation Tigers of Tamil Eelam [LTTE] was outlawed by the European Union in 2006.
They fought a decades-long and bloody war against Sri Lankan authorities for a separate Tamil homeland in the north and east of the country, but were defeated by the Sri Lankan army in 2009.
Prosecutors also accused the men of "brainwashing" children by teaching them to make pictures of bombs and grenades.
This case is one of a number of prosecutions concerning both sides of the Sri Lankan conflict that are currently being considered in foreign courts.

More on This Story

Sri Lanka After War

• UN panel report: Main allegations

• War in pictures

• Q&A: Post-war Sri Lanka

• Profile: Mahinda Rajapaksa

• After the Tigers

• Election a family affair

• Child soldiers' second chance

Background

• Leaderless opposition

• Profile: Gen Sarath Fonseka

Watch/Listen

• History of the war in Sri Lanka Watch

• Sri Lanka displaced leaving camps Watch

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• Swiss Attorney General Office
• Sri Lankan government
• TamilNet

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UN finds polio among Madagascar's children

Vaccination programmes have to reach 80-90% of the population to be effective

Continue reading the main story

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An outbreak of polio in three children from the south of Madagascar has raised concerns over a possible resurgence of this crippling disease.

The UN children's fund (Unicef) has called for urgent action to prevent its spread.

Unicef spokesman Daniel Timme says three cases of polio without symptoms have been identified.

The disease was discovered during Unicef's Mother and Child Health week following tests and urine samples.

Mr Timme said that the symptoms could emerge in these children at any time.

Polio vaccination programmes must reach at least 80 to 90% of the population of the region to be effective.

Otherwise there is a risk that non-vaccinated children could produce a mutation of the polio disease.

Vaccination campaigns disrupted

Unicef experts believe this may be the case in Madagascar, as has been seen elsewhere in Africa, including Nigeria.

The political crisis in Madagascar since 2009 has interrupted vaccination programmes across the country.

Shortages of fuel for refrigerators to store the vaccines, and the closure of 250 clinics, have reduced vaccination rates to less than 40% in the south.

Two further vaccination campaigns are now required to ensure 90% of the 700,000 children are vaccinated to curb a potential epidemic.

More on This Story

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• Africa in bid to wipe out polio 06 MARCH 2010, AFRICA

Related Internet links

• UNICEF - UNICEF Home

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• BBC - Health Polio

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NHS reforms: Audit areas to be extended

NHS reforms: Audit areas to be extended, Lansley says

Andrew Lansley said offering patients more choice did not amount to privatisation

Monitoring of NHS healthcare is to be extended to 11 extra areas of medicine, the health secretary has announced.

Andrew Lansley told GPs in Liverpool that auditing would be extended to areas including HIV and breast cancer.

He said publishing better data would allow patients to make more informed choices and specialists to "compare themselves with the best".

Mr Lansley also defended plans to give GPs more commissioning responsibility under the government's NHS reforms.

In his speech to the Royal College of GPs' conference, Mr Lansley said the government's Health and Social Care Bill would encourage competition and that GPs wanted more say in the running of the service.

"For years, GPs have been telling me, 'if only they would listen to us, we could do it so much better'," he said.

"Well as I say, I am now 'they'. I am listening to you. And I do want you to do it better.

"At the heart, then and now, of doing it better for patients is for clinicians to be at the heart of commissioning."

Speaking to BBC News before Saturday's conference, Mr Lansley said that offering more choice for patients did not mean privatisation.

"We're not looking to turn the NHS into some kind of private industry, far from it.

"It's a public service and it has to be integrated around the needs of patients.

"But there is a role, a big role, for patients in being able to exercise choice and therefore by extension where patients exercise choice, you have to have a choice amongst providers."

Mr Lansley told the conference outcomes for patients in areas of medicine including breast cancer, prostate cancer and chronic obstructive pulmonary disease would be "audited, monitored and regularly published in the future".

"From December we will pilot the publication of clinical audit data to detail the performance of clinical teams. This will then be rolled out across England from April next year," he said.

"Better data means better quality in the NHS - for patients, for their specialist clinicians, and crucially for you - both as their GPs and as the future commissioners of those services," he said.

Controversy over policy

The NHS reforms in the Health and Social Care Bill would increase competition and put GP-led groups in control of buying care in their areas.

Ministers say the changes are vital to help the NHS cope with the demands of an ageing population, the costs of new drugs and treatments and the impact of lifestyle factors, such as obesity.

The reforms have been one of the most controversial areas of government policy over the past year and had to be put on hold in the spring amid mounting criticisms from the medical profession, academics and MPs.

It led to ministers making a number of concessions, including giving health professionals other than GPs more power over how NHS funds are spent as well as watering down the role of competition.

Earlier this month, the House of Lords rejected a proposed amendment that would have referred parts of the bill to a special select committee.

It will now proceed to a normal committee stage in the Lords.

However, Labour's shadow health secretary Andy Burnham has said his party will continue to fight for "substantial and drastic changes" to the bill.

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NHS shake-up

Analysis and comment

• Q&A: The NHS shake-up

  The Health and Social Care Bill paves the way for a major shake-up of the NHS. How will the health service be changing?

  ---

• NHS shake-up: The sticking points

• Is the NHS set for an autumn of discontent?

• Analysis: Why the NHS wants to move on

• How the NHS works in rest of UK

News

• Delays 'could kill off NHS bill'

• Fears as GPs offer private option

• Critics renew NHS revamp attacks

• More competition planned for NHS

• PM agrees major NHS concessions

• GPs want 'more NHS concessions'

• Cameron unveils NHS rethink

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• Q&A: The NHS shake-up 06 OCTOBER 2011, HEALTH

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Saturday, 22 October 2011

When did potatoes become

When did potatoes become unpopular?

US senators easily approved a measure to forbid restrictions on potatoes served at school

Potatoes have gone from nation-building superfoods to national pariahs. Why?

This week, the US Congress foiled plans to limit the amount of potatoes served in school lunches. Rules proposed by the United States Department of Agriculture (USDA) stated that potatoes, along with other starchy vegetables like corn, peas, and lima beans, could be served in school cafeterias only twice a week.
A Senate amendment passed on Tuesday, however, forbade the USDA from imposing such restrictions.
It was a small victory in an era when the potato is often under attack.
"Carbohydrate-rich foods in general have been vilified unfairly, and potatoes are the latest target," says dietician Elisa Zied, author of Nutrition at Your Fingertips.
In 2007, Americans ate 20% fewer potatoes than they did in 1997, according to a report from the United States Potato Board. In the UK, potato consumption decreased by 7.8% between 2005 and 2008.
It was not always this way. The potato used to be considered something of a wonder food. Grown originally in South America, its introduction to Europe literally transformed agriculture.
Fertile food
Before the introduction of the potato, those in Ireland, England and continental Europe lived mostly off grain, which grew inconsistently in regions with a wet, cold climate or rocky soil. Potatoes grew in some conditions where grain could not, and the effect on the population was overwhelming.
"In Switzerland, for instance, the potato arrived in the early 18th Century and you can see over and over again as people started growing potatoes, the population grew," says John Reader, author of The Potato: A History of the Propitious Esculent.
"Birth rates rose, infant mortality improved, women became more fecund and all of that can be absolutely attributed to the potato."
For decades, potatoes were one of the most reliable sources of energy. They grew when other grains and vegetables could not, they required little processing once grown, and they packed a healthy dose of nutrients.
"For a 5.3-ounce, medium baked potato, you're looking at over 100 calories, very little fat, and one of the richest sources of potassium of any single food in the entire food chain," says nutritionist David Grotto, author of 101 Optimal Life foods. It is also a good source of vitamin C and fibre.
Defamed by diets
Recently, potatoes have suffered from poor PR. Diets like Atkins and South Beach forbid potatoes because of their carbohydrate content. Starchy, carb-heavy food became synonymous with empty calories and low nutritional value, and the battle against potatoes became another front in America's relentless war on fat.

The amazing potato

• Potatoes were the first food to be grown in space
• There are more than 10,000 different kinds of potatoes, 5,000 of which are regularly grown and eaten
• Potato crystals were used to develop the first colour photography
• Biodegradable plastics can be created from potato starch
• Like humans, potatoes are 80% water

Source: Meredith Hughes, managing director of the Potato Museum

The facts do not bear that out, says Mr Grotto. "Our potato consumption has been on a decline, and I'd love to say that our obesity rate has declined as well, but that's not the case," he says.

One of the latest trends in nutrition, the Glycemic Index, has not been kind to the potato, either.
The index measures how foods affect blood sugar (glucose) levels, and is used to help people with diabetes control their blood sugar levels. Recent diet books have also proposed the GI as a good way to prevent weight gain and monitor health.
Carbs rank high on GI, and potatoes are a main source of carbs. But fears about their effect on health and weight are unfounded, says Mr Grotto, because potatoes are not eaten in isolation.
"We don't eat carbs, we eat food," he says. "The effect of protein and fibre with potatoes, how the potatoes are cooked, whether they are served as a reheated leftover can all have an effect on the glycemic index."
Deep-fried dilemma
When it comes to its maligned reputation, a bigger problem is that the potato has started spending too much time with the wrong crowd.
"It's been demonised for its association with the deep fat fryer," says Grotto.
Not without reason. According to the Institute of Medicine (IOM) children eat less than half the vegetables they should - and of the vegetables they do eat, over 20% come in the form of potato chips, or crisps as they are known in the UK.
The regulations supported by the USDA - based of recommendations from the IOM - were in part to help promote different types of vegetables instead of the starchy standbys so often served with added fat and salt.
For Ms Zied, there needs to be a better approach. "The message to consumers should not be avoidance of foods that are naturally nutrient-rich, low in fat and relatively low in calories," she says. "The message should include finding ways to have potatoes and other healthful foods," prepared without an excess of sugar, solid fats, or calories.
But the truth of the matter is that school children love their chips. That is why Meredith Hughes, managing director of the Potato Museum, is not worried about pockets of anti-potato sentiment. "I don't agree that the potato is vilified," she says. "I think the potato is just taking off."
Ms Hughes and her family have built up the largest private collection of potato artefacts, currently located in New Mexico, but in search a permanent home. Both she and the museum are unaffiliated with the potato industry.
"The potato is an incredibly influential food," she says. "It has changed the course of history, it has influenced popular culture. It has saved people from starvation."
And at least for now, potatoes will continue to be plentiful in school lunches.

An ancient bone with a projectile point lodged within it appears to up-end - once and for all - a long-held idea of how the Americas were first popula

Old American theory is 'speared'

It would have taken a lot of force to drive the point into the mastodon bone

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An ancient bone with a projectile point lodged within it appears to up-end - once and for all - a long-held idea of how the Americas were first populated.

The rib, from a tusked beast known as a mastodon, has been dated precisely to 13,800 years ago.
This places it before the so-called Clovis hunters, who many academics had argued were the North American continent's original inhabitants.
News of the dating results is reported in Science magazine.
In truth, the "Clovis first" model, which holds to the idea that America's original human population swept across a land-bridge from Siberia some 13,000 years ago, has looked untenable for some time.
A succession of archaeological finds right across the United States and northern Mexico have indicated there was human activity much earlier than this - perhaps as early as 15-16,000 years ago.
The mastodon rib, however, really leaves the once cherished model with nowhere to go.
The specimen has actually been known about for more than 30 years. It is plainly from an old male animal that had been attacked with some kind of weaponry.
It was found in the late 1970s at the Manis site near Sequim, north-west of Seattle, in Washington State.
Although scientists at the time correctly identified the specimen's antiquity, adherents to the Clovis-first model questioned the dating and interpretation of the site.
To try to settle any lingering uncertainty, Prof Michael Waters of Texas A&M University and colleagues called upon a range of up-to-date analytical tools and revisited the specimen.
These investigations included new radio carbon tests using atomic accelerators.
"The beauty of atomic accelerators is that you can date very small samples and also very chemically pure samples," Prof Waters told BBC News.
"We extracted specific amino acids from the collagen in the bone and dated those, and yielded dates 13,800 years ago, plus or minus 20 years. That's very precise." It is 800 years or so before Clovis evidence is seen in the historical record.
Computed tomography, which creates exquisite 3D X-ray images of objects, was used to study the embedded point. The visualisation reveals how the projectile end had been deliberately sharpened to give a needle-like quality. And it also enabled the scientists to estimate the projectile end's likely original size - at least 27cm long, they believe.
"The other thing that's really interesting is that as it went in, the very tip broke and rotated off to the side," said the Texas A&M researcher.

The CT imagery reveals the extent of the wound and the shape of the buried point's end

"That's a very common breakage pattern when any kind of projectile hits bone. You see it even in stone projectiles that are embedded in, say, bison bones."
DNA investigation also threw up a remarkable irony - the point itself was made from mastodon bone, proving that the people who fashioned it were systematically hunting or scavenging animal bones to make their tools.
The timing of humanity's presence in North America is important because it plays into the debate over why so many great beasts from the end of the last Ice Age in that quarter of the globe went extinct.
Not just mastodons, but woolly mammoths, sabre-toothed cats, giant sloths, camels, and teratorns (predatory birds with a nearly four-metre wingspan) - all disappeared in short order a little over 12,700 years ago.
A rapidly changing climate in North America is assumed to have played a key role - as is the sophisticated stone-tool weaponry used by the Clovis hunters. But the fact that there are also humans with effective bone and antler killing technologies present in North America deeper in time suggests the hunting pressure on these animals may have been even greater than previously thought.
"Humans clearly had a role in these extinctions and by the time the Clovis technology turns up at 13,000 years ago - that's the end. They finished them off," said Prof Waters.
"You know, the Clovis-first model has been dying for some time," he finished. "But there's nothing harder to change than a paradigm, than long-standing thinking. When Clovis-First was first proposed, it was a very elegant model but it's time to move on, and most of the archaeological community is doing just that."

Now extinct, the mastodon was a large elephant-like animal