Wednesday 17 November 2010

Why garlic is good for the heart

The smell may be a healthy sign

Researchers have cracked the mystery of why eating garlic can help keep the heart healthy.

The key is allicin, which is broken down into the foul-smelling sulphur compounds which taint breath.

These compounds react with red blood cells and produce hydrogen sulphide which relaxes the blood vessels, and keeps blood flowing easily.

The University of Alabama at Birmingham research appears in Proceedings of the National Academy of Sciences.

Our results suggest garlic in the diet is a very good thing

Dr David Kraus
University of Alabama

However, UK experts warned taking garlic supplements could lead to side effects.

Hydrogen sulphide generates a smell of rotten eggs and is used to make stink bombs.

But at low concentrations it plays a vital role in helping cells to communicate with each other.

And within the blood vessels it stimulates the cells that form the lining to relax, causing the vessels to dilate.

This, in turn, reduces blood pressure, allowing the blood to carry more oxygen to essential organs, and reducing pressure on the heart.

The Alabama team bathed rat blood vessels in a bath containing juice from crushed garlic.

Striking results

This produced striking results - with tension within the vessels reduced by 72%.

The researchers also found that red blood cells exposed to minute amounts of juice extracted from supermarket garlic immediately began emitting hydrogen sulphide.

Further experiments showed that the chemical reaction took place mainly on the surface of the blood cells.

The researchers suggest that hydrogen sulphide production in red blood cells could be used to standardise dietary garlic supplements.

Lead researcher Dr David Kraus said: "Our results suggest garlic in the diet is a very good thing.

"Certainly in areas where garlic consumption is high, such as the Mediterranean and the Far East, there is a low incidence of cardiovascular disease."

Judy O'Sullivan, a cardiac nurse at the British Heart Foundation, said: "This interesting study suggests that garlic may provide some heart health benefits.

"However, there remains insufficient evidence to support the notion of eating garlic as medicine in order to reduce the risk of developing coronary heart disease.

"Having garlic as part of a varied diet is a matter of personal choice.

"It is important to note that large amounts in supplement form may interact with blood thinning drugs and could increase the risk of bleeding.

Garlic 'remedy for hypertension'

17 November 2010 Last updated at 01:48

Garlic 'remedy for hypertension'

By Helen Briggs Health reporter, BBC News

Some experts recommend taking a clove of garlic a day

Garlic may be useful in addition to medication to treat high blood pressure, a study suggests.

Australian doctors enrolled 50 patients in a trial to see if garlic supplements could help those whose blood pressure was high, despite medication.

Those given four capsules of garlic extract a day had lower blood pressure than those on placebo, they report in a scientific journal.

A UK heart charity said more research was needed.

Garlic has long been though to be good for the heart.

Garlic supplements have previously been shown to lower cholesterol and reduce high blood pressure in those with untreated hypertension.

In the latest study, researchers from the University of Adelaide, Australia, looked at the effects of four capsules a day of a supplement known as aged garlic for 12 weeks.

They found systolic blood pressure was around 10mmHg lower in the group given garlic compared with those given a placebo.

Researcher Karin Ried said: "Garlic supplements have been associated with a blood pressure lowering effect of clinical significance in patients with untreated hypertension.

"Our trial, however, is the first to assess the effect, tolerability and acceptability of aged garlic extract as an additional treatment to existing antihypertensive medication in patients with treated, but uncontrolled, hypertension."

Experts say garlic supplements should only be used after seeking medical advice, as garlic can thin the blood or interact with some medicines.

Ellen Mason, senior cardiac nurse at the British Heart Foundation, said using garlic for medicinal purposes dates back thousands of years, but it is essential that scientific research proves that garlic can help conditions such as raised blood pressure.

She said: "This study demonstrated a slight blood pressure reduction after using aged garlic supplements but it's not significant enough or in a large enough group of people to currently recommend it instead of medication.

"It's a concern that so many people in the UK have poorly controlled blood pressure, with an increased risk of stroke and heart disease as a consequence. So enjoy garlic as part of your diet but don't stop taking your blood pressure medication."

The study is reported in the journal Maturitas.

Monday 15 November 2010

Cosmetic surgeon concerned over 'guinea pig' patients

14 November 2010 Last updated at 07:45

Cosmetic surgeon concerned over 'guinea pig' patients

By Adrian Goldberg Presenter, 5 live Investigates

surgeon working on patient with hip x-ray in background.

Some medical devices and implants used in the UK do not have to undergo independent clinical trials

A leading UK cosmetic surgeon claims patients are treated like "guinea pigs" because medical implants do not need to undergo independent clinical trials.

Nigel Mercer spoke out after complaints about problematic breast implants and hip replacements.

Speaking to BBC 5 live he described current regulation as weak, saying the regulator needed to "have teeth".

The Medicines and Healthcare Products Regulatory Agency (MHRA) said it takes its role "very seriously".

Mr Mercer, who is a former president of the British Association of Aesthetic and Plastic Surgeons, says one of the key areas of concern is a breast enhancer called a Poly Implant Prosthesis (PIP). This has been fitted to more than 50,000 women in the UK since it was introduced in 2004.

PIP implants are no longer recommended for use in Britain amid growing evidence that it is prone to rupture, leaving patients in pain and uncertain about the long-term effects.

“Start Quote

I have to live with that in my body for the rest of my life. No-one can actually tell me if that's going to be a problem in the future or not”

End Quote Catherine Kydd Breast implant patient

Catherine Kydd, from Dartford in Kent, only realised her implant had split after being sent for a mammogram and ultrasound scan when she found a lump in her breast.

Her relief at being told she did not have cancer was tempered by anger at the discovery that the silicon in her implants had leaked and spread into her lymph nodes.

"I'm outraged and upset," she told the BBC's 5 live Investigates programme.

"I have to live with that in my body for the rest of my life. No-one can actually tell me if that's going to be a problem in the future or not."

Ms Kidd says she raised her concerns with the MHRA in 2009 but no action was taken at the time.

'Designed for mattresses'

It was only in April this year, after France banned PIP implants, that the MHRA followed suit and advised doctors in the UK not to use them.

The Poly Implant Prosthesis breast enhancement is no longer recommended for use in Britain

Since then, it has emerged that after winning approval for the implant, the manufacturer changed the gel inside the device to one designed for mattresses.

Tests have shown that the strength of the gel-filled shells is not up to standard, increasing the chance they could rupture.

For surgeon Nigel Mercer, this highlights the regulatory confusion surrounding medical devices - a broad-ranging category which includes orthopaedic beds, artificial joints and medicine bottles.

He says unlike drugs, which have a strict testing regime, companies making medical devices have to get a European CE safety mark, which then allows their products to be sold in Britain, often without independent clinical trials.

“Start Quote

The public are being used as guinea pigs”

End Quote Nigel Mercer Leading plastic surgeon

Mr Mercer said: "A medicine has to be tested very rigorously, it has to go through different levels of testing before it goes to market and that process can sometimes take years.

"It means at every step along the way it's tested for toxicity, to see if people are allergic and it's tested for how it's delivered and how good it is.

"That process costs tens of millions of pounds and takes years to do. With a medical device you go to the two bodies in Brussels who produce CE marks.

"There are existing standards as to how any medical device is produced. As long as you follow those standards, and you have that inspected, you produce that device and sell it."

The result, he says, is that, "the public are being used as guinea pigs."

The MHRA, which is responsible for the regulation of medical devices and equipment used in healthcare, as well as the investigation of harmful incidents, responded by saying:

"The MHRA takes its role very seriously and works with other member states to ensure that only compliant devices are placed on the market."

'Rotting away'

A similar row has also erupted over the use of a new kind of artificial hip manufactured by DePuy, a French subsidiary of the respected manufacturer Johnson and Johnson.

A new artificial hip used in the UK was not required to undergo independent clinical trials before use.

The DePuy ASR hip has now been withdrawn following reports that metal shards broke off and lodged themselves in patients' bodies after being fitted.

Charlotte Bird from Suffolk was one of those who suffered as a result: "It had been rotting away and I had been rotting away around it.

"I couldn't work. It never felt right. It just held me back completely.

"It was completely depressing. Friends were worried about me - it was misery and never getting better."

DePuy has told 5 live Investigates that it was not required to carry out a clinical trial, but says that its artificial hip was subjected to numerous laboratory tests.

These included tests on the materials used, as well as the product's performance using hip simulators which looked at how well the device wore over time.

LISTEN TO THE FULL REPORT

Hear the full report on 5 live Investigates, on Sunday 13 November at 2100 GMT on BBC Radio 5 live.

Since the product was launched, DePuy says it continued to evaluate the ASR hip system.

That is little comfort to Charlotte, who condemned the lack of vigilance among the regulators.

She said she was not told it had not been subject to independent clinical trials.

"I was just told it was marvellous and it was the new way of doing it," she said.

The MHRA says it investigates all reported adverse incidents involving medical devices, where there is a risk of death or serious injury to patients, and takes action when it becomes clear that there is a need to do so. In a statement, the MHRA said:

"We encourage everyone - the public and healthcare professionals, as well as the industry - to tell us about any problems with a medicine or medical device, so that we can investigate and take any necessary action."

However, surgeon Nigel Mercer says recent evidence relating to problems with a number of medical devices suggests this is not good enough:

"The regulator needs to have teeth and be able to regulate these businesses."

You can hear the full report on 5 live Investigates on Sunday, 14 November at 2100 GMT on BBC Radio 5 live.

You can also listen again on the BBC iPlayer or by downloading the 5 live Investigates podcast.

Send your comments and stories to 5 live Investigates

People 'denied' die at home wish

14 November 2010 Last updated at 13:40

People 'denied' die at home wish

A nurse helping a terminally ill patient put on some make-up

Two in five people who die in hospital are terminally ill and could be cared for elsewhere

Too many people are dying in hospitals and care homes, and not at home the way they want to, says a report from Demos.

Of the 500,000 people who die each year in the UK, the think tank found only 18% die at home, yet 60% of people surveyed would like to.

Investing in community-based end of life care would also save the NHS money in the long term, the report says.

The Department of Health is reviewing funding for England. Services in the rest of the UK are funded locally.

The report, entitled Dying for Change predicts that by 2030 more people will die in hospital (65%) and fewer people will die at home (just one in 10 people).

In 10 years, Demos predicts that 20% of people will die in care homes, a figure currently at 17%.

Yet a poll of 2,127 people carried out as part of the report shows that two in three people would prefer to die at home, surrounded by family and friends.

“Start Quote

People are dying over a longer period, losing first their memory and then their physical capacities...”

End Quote Charles Leadbetter Demos

This equates to more than 190,000 people dying in hospital each year when they would rather be at home.

Not everyone who dies in hospital knows they are going to, but many do.

Two in five people who die in hospital do not have curable conditions and most people will be ill for six years before they die.

It is estimated that 20% of hospital beds are currently taken up with caring for people who are dying.

Funding injection

The report says that investing £500m more a year would allow more of these people to die at home or with support in the community.

Setting up new places for people to die close to home, training volunteers to support the terminally ill, a 24-hour nursing support service and an "end of life telephone help line" are all suggestions the report makes on how this money could be spent.

It also proposes setting up a national "hospice at home" service to help support people dying at home.

More provision should be made for people to die in hospices and at home, the report says

Demos claims that making this investment would result in fewer and shorter hospital admissions, helping the NHS save money in the long term.

At present, around £20bn of NHS services is spent on end-of-life care.

This is forecast to rise to £25bn in 2030.

Charles Leadbeater, co-author of the Dying for Change report said: "It's not just that we're living longer; part of this means that people are dying over a longer period, losing first their memory and then their physical capacities in stages.

"If we put in the right kind of supports for people to cope at home, many tens of thousands of people could have a chance of achieving what they want at the end of life; to be close to their family and friends, to find a sense of meaning in death."

Care services minister Paul Burstow said the government wanted to ensure that the care people receive at the end of life is "compassionate, appropriate and gives people choices in where they die and how they are cared for".

"Identifying people approaching the end of life and advance care planning is an essential part of this," he said.

"We are consulting on extending patient choice and want to move towards a national choice offer that supports those who wish to die at home."

David Prailll, chief executive of the charity Help the Hospices, said the report would help to stimulate public debate.

"It also makes some very interesting suggestions about specific practical steps that could be taken at a national level and these merit deeper investigation."

"Seventy per cent of hospice care takes place in people's homes and a growing number of hospices - already over two-thirds - provide support to care homes to make sure residents get the palliative care they need," he said.

BBC News website readers have been sending in their reaction. Here is a selection of comments:

My husband was terminally ill with Angio Sarcoma at Guy's Hospital in August 2004. The doctor came to tell him that the cancer has spread to his other lung too. My husband said he would like to go home and yet the doctor made me feel that it would be more suitable if he stayed in the hospital. I did not understand why it would be more suitable for him to stay there. He died four days later. He was so sedated that he died without us getting a chance to say goodbye to him. I still keep worrying that I let him down by not insisting on him coming home. I still have not got over the way he died. It was so impersonal. Ranjna, London

My father died at home several years ago, which was his wish. He had been in and out of hospital and spent time in a local hospice, but it was at home where he wanted to be, and where my mother could best care for him. The GP was superb, there was a district nurse visiting regularly to help us prepare for his death, and although desperately sad for the family, it was what he and my mother wanted, and they were at peace with that. Penny, Dorset

I lost my mum and although she was totally dependant on me in the last years of her life, when it came to the end she died in hospital. I suppose because I couldn't bear to be alone when she died, not knowing if I was doing everything to make her going as painless as possible. I know in my heart that she would have forgiven me taking her in hospital but it is so hard for the loved ones to make that decision. We all, in an ideal world, would like to just go to sleep in our own bed at the end but real life isn't like that. Daisy, Reading

My mother died today in a care home. In her last few weeks she has needed continuous care and kindness to keep her clean, as she was incontinent. A hoist was needed to raise her weak body and a special bed was used to prevent bed sores and aid her in being fed. It is a nice idea that we should all die where we want to but life is not like that. My mother would also not have wanted to die in a care home but as it happens she had dementia and didn't know where she was. She had the very best of care, the bedroom was equivalent to her bedroom at home, so what is wrong with that? People would not get 24 hour care if they stayed in their own homes and the expense would be enormous if they privately hired a 24 hour a day carer. Christine, Portsmouth

I work for the NHS and it is very frustrating that patients can't die at home because of the paperwork. Sometimes it is also very dependent on your postcode. If your GP is in one PCT and you live in the next borough, you are not entitled to services as they do not receive from that borough. I speak from experience as I have recently had battles with two PCT's in getting services so that my patient could die at home. One solution given to me was that the patient changes his GP, but this is not always suitable when you have been with a particular GP and have built a relationship. As a health care professional I try very hard to give my patients the choice of dying at home. Suki, Harrow

My mum passed away only a couple of months ago and it was her wish to die in hospital. She was terrified of dying at home for many reasons. I have to say that the hospital was superb and cared for her wonderfully and I can also say she died feeling safe. Whilst many people do wish to die at home, it should be realised that many people feel safer in a medical situation, where there are nurses and doctors around to make them comfortable. Rob, Lancashire

My mother was able to die at home but only because of my persistence. She had a major stroke on 18 June and was in hospital for four days. She had signed a "Living Will" five years before and we knew her wishes, so she was not being artificially fed but just kept comfortable. When she indicated her wish to go home, the hospital made it appear an impossibility. Luckily I have friends in the NHS and was able to take their advice and through the "Fast Track for the terminally ill" was able to get her home within 24 hours. She had 36 hours in her own bedroom before dying. Jinny, Wales

putting up the price of junk food

Panorama reporter Shelley Jofre visits a chocolate factory in Denmark

By Shelley Jofre
Reporter, Panorama

In the same way as taxing cigarettes helped to reduce smoking and related illnesses, could putting up the price of junk food - as Denmark has done - cut obesity rates in the UK?

The first thing that struck me on the taxi journey into Copenhagen was how slim everyone looked.

I really had trouble spotting anyone fat.

And the second thing that became obvious the moment I stepped out of the cab and was almost run over by a cyclist, was that the Danes are clearly no strangers to exercise.

So why on earth has their government become the first in the world to introduce a tax on junk food?

The answer is depressingly simple. They may be among the slimmest in Europe but the Danes do not want to end up as fat as the British.

The UK is the fattest nation in Europe; one third of children and two-thirds of adults are overweight or obese.

When cigarettes were taxed... there was an immediate decline in the number that were bought

Professor Peter Kopelman
Obesity expert

At this rate, by 2050 obesity will be costing the state £32bn a year.

In Denmark there are signs that obesity among younger children is actually falling for the first time in 60 years.

But adult obesity is still on the increase and the government is anxious to reverse that trend.

"We've been relying on and emphasising self-responsibility for the last 50 years and it doesn't work," Charlotte Kira Kimby, of the Danish Heart Foundation told me.

"We know that sugar and fat are really what causes obesity to increase. So to target taxes makes sense and should have an impact on health."

'Ruin ourselves'

Think of all your favourite indulgences - chocolate, ice cream, crisps, sweets, cola… and imagine they all cost you significantly more than at present.

That is what is happening in Denmark. If it hit you in the pocket, would it make you change your behaviour? Or would you simply be furious about the food police telling you what to eat?

I met one Danish couple who are raising three young children on a modest income in what is already the most highly-taxed nation in Europe.

FIND OUT MORE

Panorama: Tax the fat is on BBC One on Monday 15 November at 2030GMT

Or watch it later via the BBC iPlayer

Join the debate on the Panorama blog

But they do not resent the government adding further to their grocery bills; far from it.

Lars Moerck and Karina Kirkefeldt have both struggled with obesity in the past.

At his heaviest Lars jokes that he had the belly of "an English hooligan".

Having both lost substantial amounts of weight, neither of them wants their children to have the same problems.

"We ruin ourselves and somebody has to take action. So if we can't do it, then the government should make health for the people," said Karina.

And Charlotte Kira Kimby denies that the new taxes amount to government nannying.

"We still have the same free choice to buy the things we would like to buy in the shops.

"What is happening with this kind of tax is that we actually just see the state going in and balancing price because it is cheap to produce food with a high content of sugar, fat and salt."

Calorie cuts

Not everyone has welcomed the changes though.

Jesper Moller believes consumers are already demanding healthier options

As chief executive of leading chocolate company Toms, Jesper Moller is Copenhagen's very own Willy Wonka.

He says firms like his are already reducing the calorie content of their products in response to customer demand.

He thinks the new taxes are an unnecessary burden.

"It just makes it very complicated to be a confectionary producer in Denmark. We already have some of the highest labour costs in the world," he said.

Obesity expert Professor Peter Kopelman of the Royal College of Physicians argues that the UK could learn a lesson from the lean Danes.

He believes that there is a clear parallel with the taxation of cigarettes.

Nudges are very important... tax is not a nudge, tax is a shove

Andrew Lansley, Health Secretary

Prof Kopelman said: "When cigarettes were taxed, you found that there was an immediate decline in the number that were bought.

"We also saw that there was a decline in the diseases that complicate cigarette smoking. I think there are lessons to learn for unhealthy food."

The Health Secretary Andrew Lansley is due to publish a white paper on public health for England shortly. In it, he will lay out his strategy for tackling obesity.

But it seems any idea of a junk food tax is already off the table.

"Nudges are very important. Tax is not a nudge, tax is a shove," he said.

"If you start down the route of taxation, quite often you get quite a lot of push back against that. The public don't think it's our job to be trying to tell people what to do."

Read his lips. No new taxes.

It is too early to tell whether the Danish experiment will be successful but at least they have time on their side.

In the UK, the clock is ticking.

Public health experts fear that if we do not take steps to improve our diet in the UK, by 2050 we could expect a 20% rise in heart disease and a staggering 70% rise in Type 2 diabetes.

No-one would argue there is anything sweet about those statistics.

Panorama: Tax the Fat is on BBC One on Monday 15 November at 2030 GMT. Or watch it later via the BBC iPlayer. Join the debate on the Panorama blog.

Sunday 14 November 2010

NHS 'must improve care of elderly surgery patients'

11 November 2010 Last updated at 00:39

NHS 'must improve care of elderly surgery patients'

By Nick Triggle Health reporter, BBC News

The elderly population is set to double in 25 years

Hospitals must improve their care of elderly patients undergoing surgery, an independent review has concluded.

Pain management, nutrition and delays were all highlighted as problems by experts from the National Confidential Enquiry into Patient Outcome and Death.

Overall, just over a third of patients were judged to have had good treatment.

The review body analysed the care given to 820 people aged over 80 who died within 30 days of having surgery in England, Wales and Northern Ireland.

Many of these were patients admitted as emergencies following fractures or internal bleeding.

'Wake-up call'

Researchers used case notes and surveys of doctors to assess the quality of the treatment.

They concluded the care given to 38% of patients could be classed as good. More than half got care which had "room for improvement", while 6% received treatment that was less than satisfactory.

Click to play

Mike Weston says his mother Florence suffered "appalling care" when she fractured her hip

One of the major problems was a lack of access to expert elderly care doctors - over two thirds of patients were not reviewed by such specialists.

A fifth of patients also experienced significant delays between admission and their operation, while pain management was lacking in many cases.

Report author Dr Kathy Wilkinson said: "I hope our report is a wake-up call."

There are about 1.25m people over the age of 85 in the UK - a figure which is set to double over the next 25 years.

Kieran Mullan from the Patients Association described the problem as a "national disgrace".

"We continue to be extremely concerned about the care of elderly patients in hospital. As a society, not just a health service, we should all look after our must vulnerable."

Michelle Mitchell, of the Age UK charity, said: "This report is a stark reminder that far too often older people in the UK receive second or even third rate care in hospital, condemning many of them to an early death."

Jo Webber, of the NHS Confederation, which represents hospitals, said the care of elderly surgery patients was often "complex".

But she added: "There is absolutely no excuse for poor care, regardless of the age of the person involved. "

Saturday 13 November 2010

Painkillers, pregnancy and male reproductive problems

Fergus Walsh | 15:35 UK time, Monday, 8 November 2010

The use of painkillers such as ibuprofen, aspirin and paracetamol during pregnancy could be linked to male reproductive disorders according to new research. A study in the journal Human Reproduction (opens pdf) found that women who took more than one painkiller at the same time during pregnancy, or who took the drugs during the second trimester, were at increased risk of giving birth to boys with undescended testicles.

The condition, known as cryptorchidism, affects about one in 20 boys in the UK. It is known to be a risk factor for male fertility problems later in life and an increased risk of testicular cancer.

1,463 pregnant women in Finland completed written questionnaires and 834 women in Denmark did the same or took part in a telephone interview. The researchers found that women significantly under-reported the use of painkillers in the written questionnaire because they did not consider mild painkillers to be "medication".

The study showed that women who used more than one painkiller simultaneously (such as paracetamol and ibuprofen) had a seven-fold increased risk of giving birth to sons with some form of undescended testes compared to women who did not take the drugs.

The second trimester appeared to be a particularly sensitive time. Any analgesic use at this point more than doubled the risk of the condition. Simultaneous use of more than one painkiller during this time appeared to increase the risk 16-fold.

The scientists behind the research believe painkillers may be part of the reason for the increase in male reproductive disorders in recent decades, possible by interfering with the role of the male hormone testosterone. Research carried out on rats in Denmark and France found that painkillers disrupted androgen production, leading to insufficient supplies of testosterone during the crucial early period of gestation when the male organs were forming. The effects of the painkillers on the rats was comparable to that caused by similar doses of known endocrine (hormone) disrupters such as phthalates - a family of chemical compounds used in the manufacture of plastics such as PVC.

Dr Henrik Leffers, senior scientist at Righospitalet in Copenhagen, who led the research, said: "If exposure to endocrine disruptors is the mechanisms behind the increasing reproductive problems among young men in the Western World, this research suggests that particular attention should be paid to the use of mild analgesics during pregnancy, as this could be a major reason for the problems".

But the study is not without limitations. The researchers could not find a statistically significant effect among the Finnish women, which was the larger group, but did find significant effects among the Danish women.

Dr Leffers said: "We do not quite understand why the Finnish cohort does not show the same associations as the Danish cohort." However, he said the telephone interviews used in Denmark gave the "most reliable information" and this may explain some of the differences. He added: "The prevalence of cryptorchidism is much lower in Finland (2.4%) compared to Denmark (9.3%) and, therefore, this would require a larger cohort to find the same number of cases."

Pregnant women in the UK are already advised to avoid taking ibuprofen or aspirin, unless they are advised to do so by their doctor.

Instead they are told they can take paracetamol. The NHS Choices website puts it like this:

Paracetamol has been used routinely through all stages of pregnancy to reduce a high temperature (fever) and relieve pain. There is no clear evidence that paracetamol has any harmful effects on the baby.

As with any medicine that is used during pregnancy, paracetamol should be taken at the lowest effective dose for the shortest possible time.

This raises a further concern with the research. Of the individual painkillers, ibuprofen and aspirin approximately quadrupled the risk of cryptorchidism. Paracetamol doubled the risk, but this was not statistically significant. This suggests that a link between paracetamol use alone in pregnancy and male fertility problems is not clear-cut.

Dr Leffers said: "Although we should be cautious about any over-extrapolation or over-statement, the use of mild analgesics constitutes by far the largest exposure to endocrine disruptors among pregnant women."

Prof Richard Sharpe of the Medical Research Council's Human Reproductive Sciences Unit at the University of Edinburgh, said:

"The studies are top quality from groups with considerable expertise. The association between painkiller (paracetamol) use in early pregnancy and increased risk of cryptorchidism in sons has been independently confirmed in another study from Denmark (MS Jensen et al. November 2010, Epidemiology). Painkillers/paracetamol are likely to be one of several factors that cause cryptorchidism - some environmental chemicals are also implicated - it is probably the sum of all such exposures that determines the outcome.

Pregnant women who are alarmed by these studies should note the following:

It is only prolonged use that has an effect - taking occasional painkiller for a headache will have no adverse effect (and the stress, worry and sickness from not taking something for a bad headache may be worse for the mother and baby).

Most women in this study who used paracetamol did not have a baby boy with cryptorchidism.

Prolonged use of painkillers in pregnancy should not be contemplated without medical approval. For certain, taking paracetamol as a 'feel good' factor should be avoided (by all of us!).

It is sound common sense to minimize your exposure (and therefore your baby's exposure) to all drugs, environmental (pesticides, paints, household chemical exposures) and lifestyle (smoking, alcohol, cosmetics usage) chemicals during pregnancy wherever possible."

Update at 17:00

Basky Thilaganathan, Spokesperson for the Royal College of Obstetricians and Gynaecologists, said:

"The findings need to be interpreted with caution. Firstly, the study shows an association rather than causation; it is entirely possible that mothers took these analgesics for an ailment (for example, a viral infection) in pregnancy that may have been the real cause for the noted problems. Secondly, the dose-dependent effect was seen in one study cohort but not another, raising the possibility that this preliminary study may be prone to inadvertent bias of patient recruitment and ascertainment. Furthermore, the definition of cryptorchidism is broad and clinical, rather than specific and the overall number of cases is so small that a small change in affected numbers would have nullified the findings.

"Given these limitations, the findings of the study should be interpreted with caution and it would be inappropriate to spread alarm to pregnant women on this basis."

The Central African Republic is a country obsessed with black magic

The Central African Republic is a country obsessed with black magic, where nearly half the prison population are convicted witches.
In villages and the capital witchcraft is used to explain every misfortune and it is such a powerful weapon that it is a feature of almost every family quarrel or village dispute. And, as Unreported World reveals, it's often the most vulnerable who are singled out.
Reporter Seyi Rhodes and director Julie Noon's journey begins at a ceremony performed by a traditional healer. She claims to have the power to expose black magic by looking into a fire and seeing the names and images of witches. During the ceremony she pulls a small boy from the crowd and announcing that he turns into a horse at night and eats people.
Healers like Marceline wield huge influence across the country and their authority is rarely questioned. She tells Rhodes her most recent case involved exposing a local man as a witch and that he was subsequently arrested and imprisoned.
Since independence from France in 1960 it's been illegal to use charlatanism and sorcery to harm others. Those found guilty can be jailed for up to ten years or even sentenced to death. Rhodes and Noon travel to Mbaiki prison. The Governor says he chains up all new suspected witches for the first seven days, but despite this one prisoner managed to escape; the governor claims he turned into a rat or snake and tunneled out.
Rhodes finds one prisoner, Francois, awaiting trial. He claims that although he was labeled a witch by his neighbours he is innocent. Francois says he was tied up, beaten by fellow villagers and dragged to the police station where he confessed.
Even though it is against the law there is no explanation in the penal code to what actually constitutes witchcraft. Rhodes speaks to the police to find out how they go about tackling a phenomenon that isn't even defined. A senior police captain says eyewitness testimony is enough for him to prosecute.
The team attends Francois's trial. His case, like others, seems to be based on rumour, hearsay and forced confessions. In court there's a big turnout. The judge begins by reading the charges and Francois's lawyer submits his plea of not guilty. A traditional healer is brought in and testifies he saw Francois turn into a dog and bite a man. Much to everyone's astonishment Francois pleads guilty. After the trial he tells Rhodes he was too scared to deny it.
Travelling north to Sibut, the team visits the local prison where more than half the prisoners are accused or convicted of witchcraft. The inmates protest their innocence and most of them seem to be a victim of quarrels with relatives or neighbours, which had all resulted in accusations of witchcraft being made. They all appear to be vulnerable, from the elderly to people who were living on their own.
Back in the capital, one of the country's most senior prosecuting judges - Arnaud Djoubaye - admits there is a problem with the law. He says there is no legal definition of the concept of witchcraft, which can be confusing and vague. However he's convinced witchcraft is a real and present threat to the population and believes the laws should remain to allow the judiciary to take action.
Watch now on 4oD

Clips from Episode 17

Friday 12 November 2010

Increase in rickets

12 November 2010 Last updated at 14:07

Increase in rickets in Southampton astonishes doctors

Coloured X-Ray of the legs of a child with rickets

More than 20% of children tested showed signs of the bone disease rickets, Southampton University Hospitals NHS Trust said.

Consultant orthopaedic surgeon Prof Nicholas Clarke checked more than 200 of the city's children for bone problems caused by a lack of vitamin D.

He was astonished by the results, which, he said, were "very reminiscent of 17th Century England".

Prof Clarke works for Southampton General Hospital.

He said vitamin D supplements should be more widely adopted to halt the rise in cases.

The crippling bone disease can lead to deformities like bowed legs as well stunted growth and general ill-health.

A lack of vitamin D can be caused by poor diets and insufficient exposure to sunlight, which helps the body synthesise the vitamin.

Prof Clarke said: "A lot of the children we have seen have got low vitamin D and require treatment.

'Middle class and leafy'

"In my 22 years at Southampton General Hospital, this is a completely new occurrence in the south that has evolved over the last 12 to 24 months and we are seeing cases across the board, from areas of deprivation up to the middle classes.

Prof Clarke said vitamin D supplements should be more widely adopted to halt the rise in cases

"There is a real need to get national attention focused on the dangers this presents."

He added that the "modern lifestyle, which involves a lack of exposure to sunlight, but also covering up in sunshine" had contributed to the problem.

"The return of rickets in northern parts of the UK came as a surprise, despite the colder climate and lower levels of sunshine in the north, but what has developed in Southampton is quite astonishing," said Prof Clarke.

"We are facing the daunting prospect of an area like Southampton, where it is high income, middle class and leafy in its surroundings, seeing increasing numbers of children with rickets, which would have been inconceivable only a year or so ago."

Wednesday 10 November 2010

high use of locums could affect patient care.

10 November 2010 Last updated at 00:01

NHS locum spending 'nearly doubles in two years'

westof home page

Surgeons scrubbing up before performing an operation in an NHS hospital

The working time directive was introduced in the NHS last year

Spending on locum doctors by hospitals in England has nearly doubled in the past two years, figures suggest.

The Royal College of Surgeons said temporary doctors were now "propping up" the system and linked the rise to EU laws restricting working hours.

The RCS estimated that spending on locums topped £750m last year, after gathering evidence from 96 trusts.

Health Secretary Andrew Lansley agreed it was a problem, as high use of locums could affect patient care.

There have been reports that the European Working Time Directive, which limits the working week to 48 hours and was introduced into the NHS last year, has been harming the health service.

'Unacceptable'

Unions have complained it has damaged the amount of training junior doctors get, while some hospitals have reported difficulties filling rotas.

The RCS believes the rise in spending on locums is a consequence of the rules.

The college asked for data from 164 trusts under the Freedom of Information Act, getting results from 96.

“Start Quote

The scale of increase in the cost of agency staff in the NHS is unacceptable. There is also a practical concern about continuity of care for patients”

End Quote Andrew Lansley Health Secretary

These figures were then extrapolated to give figures for the whole of England. These suggested spending rose from £384m in 2007-8 to £758m last year.

A third of the £758m figure related to surgical posts.

RCS president John Black said: "It seems ridiculous that at a time of economic crisis, with wide-ranging cuts to services across the board, we are seeing astronomical sums of money being thrown at locum doctors in order to prop up services that are only falling apart because of an ill-conceived European law."

Health Secretary Andrew Lansley added: "The scale of increase in the cost of agency staff in the NHS is unacceptable. There is also a practical concern about continuity of care for patients.

"It is clear that the the European Working Time Directive is having an impact on the number of locum doctors."

He said ministers would seek changes to the way it had been implemented in the health service in future negotiations.

Tuesday 9 November 2010

Failing care homes may 'slip net'

Care homes in England will no longer be inspected on an annual basis

A new way of checking up on care homes for the elderly in England will put vulnerable residents at greater risk, says a union representing inspectors.

Unison claims the system, which relies more on written self-assessments, will mean thousands of homes will avoid inspections if they look good on paper.
But the Care Quality Commission, which introduced the system, said it would let inspectors focus on failing homes.
It also released figures it said showed adult care had improved significantly.
Whistleblowers
The new system replaces yearly automatic inspections for all homes.
It came into force in October and now means that homes which provide a good written self-assessment may not be inspected again, unless there is a serious complaint made about them to the commission (CQC).
Unison, which says it represents about 700 inspectors, claims that the workforce numbers have halved since 2004.
Its officer for the CQC, Helga Pile, is concerned about the changes, and said the new inspections would take just a couple of hours, instead of a whole day.
She said: "Our members are really concerned about the lack of ability to really go into homes, spend enough time on site, really talking to people finding out about what is going on."
The carer who blew the whistle on a care home scandal in Somerset in 2007 is also warning the new system would have meant her own care home could have avoided inspections for years on end.
It was because Sarah Barnett raised her concerns over several deaths at Parkfields Care home in Butleigh in Somerset, that its nurse manager was found guilty of killing a 97-year-old resident and stealing drugs to feed her own addiction.

“Start Quote

We just don't know what's going on in care homes”

End Quote A senior inspector for the CQC in England

Rachel Baker was sentenced to 10 years in prison earlier this year for the manslaughter of Lucy Cox.

Ms Barnett said: "My personal experience is that people will not blow the whistle, even if they have clear knowledge of what's been happening.
"And as for relying on relatives or people in the community, then you are relying on people who have no medical knowledge and are assuming they will raise concerns."
But the CQC has defended the new arrangements, which it says will allow time to concentrate on homes that are failing.
CQC director for the South West Ian Biggs said: "I can see that a move away from a one-size-fits-all regulatory regime of inspecting every six months, or every year… to a system that is more flexible that acts swiftly when we get information, is a new system.
"And everybody needs to get confident about how that system can work.
"I think we can rely on whistleblowers. We need to encourage them and we need to show them that if they report and whistleblow to us then we will act quickly and responsibly."
'Poor practice'
But a senior inspector for the CQC in England, who wants to remain anonymous, told the BBC: "Larger private providers could be good at filling out forms that can hide a multitude of sins.
"Therefore there will be no need for us to go out and check. As long as the assessments are done, we look like we have done our job.
"It is only when there are gaps in paperwork that we need to seek more information from a provider. We just don't know what's going on in care homes."
The CQC has published its final assessment of care provision under the old system.
It said 83% of care homes, home care services, nursing agencies and shared lives schemes were rated good or excellent, compared with 69% in 2008.
People were increasingly being supported to live in their own homes, rather in residential facilities, it said, and overall the quality of social care commissioned by councils was improving.
But CQC chief executive Cynthia Bower said "pockets of poor practice" remained.
The regulator also warned that further growth in provision would be needed to meet future needs.

Monday 8 November 2010

A public inquiry into the scandal-hit Stafford Hospital has begun, years after campaigners first demanded an open hearing.

8 November 2010 Last updated at 12:57

Frank and Janet Robinson's son John died after being mis-diagnosed and discharged

A public inquiry into the scandal-hit Stafford Hospital has begun, years after campaigners first demanded an open hearing.

A 2009 report condemned conditions at the hospital, said to have caused hundreds of avoidable deaths.

The last government ordered a private investigation, but refused a wider public inquiry.

But in June the coalition government said the families of those who died deserved to know what went wrong.

Campaigners praised

The start of the inquiry was delayed after one of the relatives objected because family members and the media were in a different room from the inquiry chairman, Robert Francis QC, and his panel.

The Mid Staffordshire NHS Foundation Trust Public Inquiry is being held at the offices of Stafford Borough Council.

It is the fifth inquiry into the higher than expected deaths at Stafford Hospital between 2005 and 2008.

“Start Quote

If they (the regulators) had done something about it when we first reported concerns, it would have saved many, many lives within this community”

End Quote Julie Bailey, Cure the NHS

Patients 'left sobbing'

Mr Francis also chaired the fourth inquiry, which he criticised for its narrow remit.

In setting out the framework on Monday, Mr Francis said he would not revisit the harrowing cases of deceased patients brought to light in the fourth inquiry, which was held in private.

Instead he said he wanted to look at the structure of the NHS and the actions and inactions of management to see how the failings had come about and why they had remained undetected for so long.

He also paid tribute to the relatives and campaigners from groups such as Cure the NHS, which was set up to highlight problems at Stafford Hospital. He said without their tenacity in calling for a full investigation, many of the findings would never have seen the light of day.

Hoping for answers

Julie Bailey who set up Cure the NHS said: "This will get to the truth. We really believe this will be a full examination of what went wrong, not just at the hospital but with the regulatory bodies."

Analysis

Michele Paduano BBC Midlands health correspondent

The public inquiry will look beyond the walls of Stafford Hospital at the way the NHS is managed.

Amongst the million pages of documents there are submissions from doctors, staff and patients from other parts of the country recording similar experiences.

Key to the inquiry will be the role of the statutory regulators.

Monitor gave the hospital a clean bill of health and made it a foundation trust a month before the Healthcare Commission began its first investigation.

Were The public inquiry will look beyond the walls of Stafford Hospital at the way the NHS is managed.

Amongst the million pages of documents there are submissions from doctors, staff and patients from other parts of the country recording similar experiences.

Key to the inquiry will be the role they talking to each other?

Huge reputations are at stake; David Nicholson, now head of the entire NHS, was in charge in this region in 2005.

The current chief executive of the Care Quality Commission, Cynthia Bower, took over as head of West Midlands Strategic Health Authority, with responsibility for measuring quality and safety, from 2006 until 2008.

Ultimately the inquiry's recommendations should change the way safety in our hospitals is monitored.

She said the inquiry should find out how much the 50 or so health regulators had known about the problems at Stafford Hospital.

"We believe that if they had done something about it when we first reported concerns, it would have saved many, many lives within this community."

Problems at Stafford Hospital, run by the Mid Staffordshire NHS Trust, were first exposed by an NHS regulator in March 2009.

The Healthcare Commission said there had been hundreds more deaths than there should have been between 2005 and 2008.

It listed a catalogue of failings, including cases where untrained accident and emergency receptionists had assessed emergency cases.

The Labour government then started several investigations.

Catalogue of failings

These included an independent inquiry led by Mr Francis, but it was held in private and did not have the power to compel witnesses to give evidence.

When it reported in February it said the trust had been driven by targets and cost-cutting.

Managers had been focused on winning elite foundation trust status during the problem years.

But campaigners said the failings went far wider than the hospital itself, and the broader NHS and regulators should have realised there were problems and stepped in.

They demanded a full public inquiry with stronger legal powers.

In June, Health Secretary Andrew Lansley announced Mr Francis would continue the work he had already done on investigating the hospital by leading an inquiry.

The inquiry will consider more than a million pages of evidence and will hear from dozens of witnesses.

Campaigners are hoping they will now get some of the answers they have been seeking for years.

They want to hear from the chief executive who was in charge at the time, as well as senior managers from the NHS in Staffordshire and Whitehall and former health ministers.

Stafford Hospital management have said they have been working hard to improve patient care over the past 18 months.

The new chief executive, Anthony Sumara, said they had taken on 140 more nurses, improved training, and changed procedures in the areas which had problems.

"It's desperately important for the NHS in general that we get some answers," he said.

He said he worried the impending reorganisation of the NHS and a tougher financial climate could provide the ingredients for similar problems to be repeated.

"We need to make sure we don't take our eye off the ball again," he warned.

Have you been affected by the issues raised in this story? You can send us your stories using the form below

Saturday 6 November 2010

Some trainee doctors 'without adequate supervision'

4 November 2010 Last updated at 18:04

Some trainee doctors 'without adequate supervision'

By Jane Dreaper Health correspondent, BBC News

Concerns are being raised about supervision of trainee doctors

A review team says it is alarmed that some trainee doctors do not have adequate supervision.

The inquiry into how young doctors spend their first two years in the NHS said the issue must be urgently addressed.

The review team, who spoke to junior doctors across England, heard about a trainee being left in charge of 100 patients overnight and at weekends.

Health Secretary Andrew Lansley has asked for quick action on the report.

Doctors' training has been a controversial area since changes to the application system caused uproar in 2007.

This review was ordered to look at trainees' roles in the two-year foundation programme in England, and how they are regulated.

The team of 14 experts spoke to junior doctors in big cities around England and looked at evidence from a range of other sources.

Patients 'at risk'

Chairman Professor John Collins said: "Many exciting things have been done to help these young people integrate into clinical practice.

"But we also found worrying features - particularly newly qualified doctors employed outside their level of competence and without appropriate supervision.

“Start Quote

Over and over again we heard the message about being asked to attend to patients beyond their level of competence.”

End Quote Professor John Collins Review chair

"We were given alarming evidence of unacceptable practise.

"One example was a young doctor who told us she had recently qualified. She was left to look after 100 very sick patients at nights and weekends without appropriate cover.

"That is completely unacceptable. It puts patients at risk and gives these young post-graduates the wrong message that sub-optimal care is condoned.

"It is difficult to gauge how common it is, but over and over again we heard this message about being asked to fill rosters or attend to patients beyond their level of competence.

"Even if it is a small number, we must address this."

Prof Collins said in some cases trainees were being failed by hospital systems, but in other instances they weren't getting adequate supervision from consultants.

'Incredibly stressful'

The report also recommends that the curriculum for junior doctors has an increased emphasis on managing chronic illness.

Dr Tom Dolphin, co-chairman of the British Medical Association's junior doctors committee, said: "It is incredibly stressful for doctors to be put in this position and it will inevitably threaten patient safety.

"Our medical education system produces highly skilled graduates, but they must be properly supported once they begin direct patient care.

"We also need to urgently investigate problems with the selection of doctors into the programme, the length of work placements and the excessive levels of assessment."

Mr Lansley praised the report as "thorough".

He said: "I have asked Medical Education England to work with the profession, the service and medical royal colleges to take forward the recommendations as swiftly as possible.

"This will fit with Medical Education England's ongoing work to improve the quality of training, ensuring that trainees have appropriate supervision and are not undertaking tasks for which they are not yet competent."

Wednesday 17 November 2010

Garlic 'remedy for hypertension'

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Monday 15 November 2010

Cosmetic surgeon concerned over 'guinea pig' patients

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People 'denied' die at home wish

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Sunday 14 November 2010

NHS 'must improve care of elderly surgery patients'

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Saturday 13 November 2010

Painkillers, pregnancy and male reproductive problems

Clips from Episode 17

Friday 12 November 2010

Increase in rickets in Southampton astonishes doctors

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Wednesday 10 November 2010

NHS locum spending 'nearly doubles in two years'

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Tuesday 9 November 2010

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Monday 8 November 2010

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Analysis

Saturday 6 November 2010

Some trainee doctors 'without adequate supervision'

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