.

Breast surgeons rock

2011-03-24T05:22:00.000-07:00

It takes a long time for medicine to embrace new ideas and change practice accordingly. Research, too, is painstakingly slow.

Surgery is slightly different, however. Surgeons can make small adaptations to standard operative techniques, adding their own refinements to existing procedures without absolute proof that their innovations are truly beneficial. They can merge procedures in the hope of improving outcomes for their patients.

When I was a medical student my mother was diagnosed with breast cancer. It was a fraught time as my little knowledge only served to make me feel utterly unable to guide her. She opted for a total mastectomy followed by immediate reconstruction, a major undertaking but one that was curative and the right decision for her. But that decision was not based on sound medical evidence, only her own preferences and the recommendations of her brilliant surgeons.

Now a unique audit into breast cancer surgery has produced the first national figures on how patients view the outcome of mastectomy and breast reconstruction surgery and has found that these innovations and adaptations made by the surgeons on the front line have paid off.

Eighty-eight per cent of women felt they had always been treated with respect and dignity while in hospital and 90 per cent rated the care they received as excellent or very good. More than 90 per cent were very satisfied with the competence of their consultant surgeon, and 85 per cent were very satisfied with the professionalism of the team.

More importantly, these data have finally confirmed that women prefer to undergo a breast reconstruction at the same time as they have their cancerous breast removed, so they never experience the trauma of seeing themselves without a breast and the fear of feeling less feminine. Eighteen months after reconstructive surgery, 85 per cent of women reported feeling confident in a social setting most or all of the time. Women who underwent mastectomy without reconstruction reported less positive results.

Women who chose breast reconstruction at the time of their mastectomy also reported higher levels of emotional and sexual wellbeing than those who underwent mastectomy alone.

When we are supposed to be practising only evidence-based medicine it is good to have confirmation that we are indeed getting some things right.

Losing the alcohol war

2011-03-19T04:49:00.000-07:00

There seem to be many small rebel factions working against the Government. Alcohol has inspired the latest.

Six health organisations have walked away from the Coalition's new proposals to regulate alcohol designed to reduce drink-related illness and deaths. The deal is supposed to see supermarkets, pubs and drinks manufacturers all pledging to do their bit to reduce harmful drinking, for example by labelling items with the number of alcohol units.

The Royal College of Physicians, the British Liver Trust, the British Association for the Study of the Liver, the Institute of Alcohol Studies, the British Medical Association and Alcohol Concern have all rejected the deal. In my book, those are bodies that ought to be listened to.

One of their main concerns - to me, entirely justified - is that in formulating these plans the Government has allowed the drinks industry to drive the pace and direction of the policy.

It does look like a massive PR exercise on the part of the drinks manufacturers. They can now heavily publicise their apparent concern by making a noise about any minor changes they decide to make to alcohol levels or labelling of their products and so come out with increased sales to a hoodwinked public. It won't make

the slightest difference to our health, however.

The cost to British society occasioned by alcohol is estimated at £25 billion each year. That includes both health and crime and disorder costs. When I investigated this myself for a television programme it was clear that most drinkers have no idea how many units they consume at each sitting, or even how poisonous alcohol can be at high levels. It follows that clearly labelling cans and bottles with easy-to-read information about the number of units within them, safe drinking levels and a warning message about not exceeding these levels is a must, but it is not a solution.

The World Health Organisation has stated that action on alcohol must fall into three areas: affordability, availability and promotion. I'm not sure it is that simple. Look at countries that have strict alcohol laws and expensive drinks and it can be seen that the populations binge-drink more than in the UK and have high levels of alcoholism. The only difference is that levels of alcohol-related crime and violence are lower, almost certainly because the drinking is covert.

While I know it sounds pessimistic, I rather think we irreparably screwed up when we first legalised and promoted alcohol. It is a crippling example of exactly how hypocritical and ill thought-out our stimulants laws are. Just look at our drink-driving laws where the public has basically been told that a bit is OK, a lot is not, and left to try to figure it out for themselves. They don't, and people die. Sadly I fear that now it is too late, that we can never back-pedal fast enough to reverse the damage and that there is now no satisfactory solution to this problem.

Patients struck off in NHS budget reforms

2011-03-14T13:02:00.000-07:00

The Government's reforms to the NHS are the biggest and boldest the organisation has seen since it was formed 60 years ago.

For the first time, and amid considerable controversy, the vast majority of the NHS budget will be put into the hands of family doctors.

Health unions and royal colleges have already said that they have "extreme concerns" about greater commercialisation of the NHS but I am enthused. Surely if anyone is going to know where money is most needed and best spent it is the GPs on the front line?

But some of the other proposed changes have been nothing short of ludicrous. I have written already about my mistrust of the proposal that GPs offer email consultations, and now another money-saving suggestion has been made by someone who is clearly totally out of touch with reality.

Thousands of patients face being removed from GP practice registers if they have not seen their doctor for six months. NHS managers claim that this is to ensure lists are accurate and up to date but GPs are obviously concerned that many patients will be struck off without reason and then forced to re-register when they actually need to see a doctor. The scheme is to be tested in London initially but could be rolled out elsewhere if judged a success, something I hope is unlikely.

Everybody needs to be registered with a GP, even if always seemingly fit and healthy. The age group that will suffer most from this scheme are the twenty- to thirtysomethings who are rarely ill purely because of their age. This scheme may simply panic patients into popping along twice a year to take up an appointment slot for no reason other than to ensure they remain on the books.

I don't subscribe to the argument that everyone should be going in for an annual check-up anyway - this usually throws up more issues than it solves and will take considerable time and money.

Over and above this it is men, already notoriously bad at going to doctors in the first place, who will be most likely to be removed from lists.

Women have far more reasons to see GPs because of contraception, smear tests, breast exams and pregnancies. Men have none of these issues and therefore will rarely go to GPs before the age of about 50 when the prostate starts playing up. If the current proposals go ahead I would estimate that 75 per cent of men in the UK will be without a GP after a couple of years.

Counter-arguments include the theory that GPs keep "ghost patients" on their books in order to boost their annual income; doctors receive an annual payment of up to £100 for each person registered, regardless of whether they have had any treatment. Of course, I can see that there is a need to crack down on this and tidy lists up, but having a criterion of removing those who simply haven't been for six months shows a misunderstanding about how health services are accessed by the younger generations and will only serve to further alienate a cohort of patients whom we are only just managing to win over.

GPs can't spot every disease

2011-03-03T07:17:00.001-08:00

Monday marked the fourth International Rare Disease Day, which saw patient organisations from more than 40 countries converging around the slogan "Rare but Equal" to stress the need for closer collaboration between patients and researchers and to shed light on the challenges rare disease presents to both patients and health professionals.

This clearly inspired the more depressing reports that quickly followed about how our GPs are missing one in four cancer cases, sending patients away having dismissed early warning signs as minor ailments.

It has long been reported that Britain has one of the lowest cancer survival rates in Europe.

Experts blame late diagnosis for the alarmingly high death rates.

More than half of those with the rarer cancers, which account for around half of all cases, have to see their GP repeatedly before they are finally referred to a specialist.

Rare cancers include kidney, thyroid and gall bladder cancers, and those of the blood and lymphatic system such as myeloma, leukaemia and lymphoma. They are difficult to diagnose as the symptoms are often vague or similar to many other more common conditions.

The reasons for this apparent failure are certainly multifactorial but include the simple fact that if you don't see a condition very often then you are highly likely not to think of it as a possibility. Coupled with a reluctance and dislike among doctors to have to diagnose something grim and break the news to a patient, and you can see why these results may be occurring.

These reports did initially cause me to briefly question the wisdom of what I have long considered to be the single most useful rule of thumb any doctor needs to know. First described by the 14th-century logician and Franciscan friar, William of Ockham, and known as "Occam's razor" it suggests that "entities should not be multiplied unnecessarily". A more useful interpretation for scientists is "when you have two competing theories that make exactly the same predictions, the simpler one is the better".

It means a common condition is probably more likely to be responsible for a patient's symptoms than a very rare one. This remains true for most cases that GPs see and will probably be the guidelines under which most practise, even if subconsciously.

By sticking to this adage doctors will be correct for most of their diagnoses, and only the few incidences of rarer disease may be missed.

Rare cancers can be hard to pick up, and the recent reports of patients who made multiple trips to GPs and to A&E and still failed to get diagnosed suggest that it isn't always the doctors who are at fault but the subtleties of diseases that we are still a long way from fully understanding.

Regular GP refresher courses about the more infrequently seen conditions have been suggested as a possible solution but I certainly wouldn't like to be the one who has to sell this idea to our already overstretched doctors.

Red meat - what's the beef? Dr Christian Jessen

2011-02-24T03:56:00.000-08:00

Red meat is again arousing strong - and conflicting - passions in those with opinions about what's good for us. On the one hand, the Department of Health is warning Britons to cut down on our red meat consumption because it increases our risk of developing bowel cancer.

Under its new guidelines, adults are advised to eat no more than 500g a week. On the other hand, last week the British Nutrition Foundation claimed that most adults ate "healthy amounts" of red meat and the link to cancer was "inconclusive".

Finally, nutritionists have got in on the act and declared that lean red meat such as steak is healthy and one of the best sources of iron, and that women in particular are shunning it at the risk of developing anaemia.

So what should we eat? Well, I side with the nutritionists on this one. We need red meat, we evolved to eat it, and women in particular benefit from including it in their diets. The great flaw in all the above arguments is that taking a single food group in isolation and reporting on its benefits or deficiencies is nonsensical.

Foods work together, in combination, to provide their benefits. It's why we advocate a balanced diet with plenty of variety. There is a good reason why we drink a glass of orange juice with our breakfast cereal in the morning. The vitamin C in the juice helps our guts absorb the iron in the cereals.

The truth is that some foods people have traditionally believed to be iron-rich, such as spinach, are not. Despite Popeye's claims, spinach is one of the poorest sources of iron I can think of. Not only does it start with low levels in the first place but it also contains a compound called oxalic acid, which inhibits iron absorption by the gut.

If you add the fact that high-fibre foods such as fruits and vegetables contain chemicals called phytates that can slow down iron absorption, you can see how people avoiding red meat and relying on plant sources of iron are at significant risk of becoming anaemic. In fact, iron deficiency is the commonest nutritional deficiency in Britain.

Red meat isn't perfect. The problems come from two main sources. Its fat content, particularly saturated fat, does increase the risk of heart diseases and cancers, and the chemicals produced when the outside of the meat is charred during the cooking process are indeed carcinogens.

So the solution is very simple: buy lean cuts of meat, don't burn it when cooking, and eat it in moderate amounts. It's an important and nutritionally valuable part of our diets.

Hypnosis is the new way to give birth painlessly

2011-02-16T07:26:00.001-08:00

In the middle of huge cutbacks and extensive NHS reform any newly emerging techniques that promise to save money will be welcomed with open arms.

One such proposal seems sound enough: hypnobirthing. An 18-month NHS trial study aims to teach expectant mums how to hypnotise themselves before giving birth as an alternative to painkillers. This will involve learning how to attain a trance-like state during labour in the hope that they will not need costly treatments such as epidurals. First started in the US, it uses self-hypnosis, relaxation, visualisation and breathing techniques to prepare for birth.

Currently as many as 60 per cent of mothers have epidurals and many more use other forms of pain relief, the safety of which has often been questioned. Many mothers enter the delivery suite intending to have a "natural" birth, then understandably demand drugs when the true might of their contractions kicks in.

Hypnosis is successfully used in many other areas of healthcare, including dentistry, well known for its association with pain and fear, and fear here seems to be the key. Most mums experience anxiety and fear about the impending birth, in part due to our society's highly medicocentric approach to birthing, implying that it is a dangerous, painful and scary experience.

Hypnotherapists believe that a lot of the pain of childbirth comes from fear acting on the body to cause tension and muscle constriction. If women can relax and release muscle tension, this causes less pain, more effective contractions and often a shorter labour. It certainly sounds plausible, and the feedback from women who have used it has been consistently positive.

It's even been backed up by several relatively large-scale studies, one of which found that self-hypnosis during childbirth eased some of the pain of labour, lowered the risk of medical complications and reduced the need for surgery. Another study found that hypnotherapy shortened the first and second stages of labour. For women having their first babies, the first stage was reduced from an average of 9.3 hours to 6.4 hours, and the second stage from 50 minutes to 37 minutes on average. The differences for women having their second or later children were less dramatic, and it is here the financial benefits may be seen.

I can certainly see the downsides; this technique will not work for all women. I also worry that medical staff may attend less often seemingly self-sufficient labouring women, so putting them more at risk of complications going unnoticed.

But in general it's harmless, proven in studies, and empowers women to have more control over the birthing process, unlike other ill-thought-out proposals the NHS comes up with.

Marathons can hurt you in the long run

2011-02-10T18:15:00.000-08:00

Every year around this time several of my habitually unfit patients march in to my clinic and proudly announce that they have decided to do the London Marathon to get fit. My heart sinks. Running the marathon will not make them healthy, it will probably do quite the opposite.

People forget that the marathon is an extreme event. Even running intensely for an hour a day puts your body under so much stress that it will begin to break down. There is a very good reason why so many committed marathon runners look like they are suffering from fatal diseases.

The intensity of some training regimes, and the lack of efficiency of others, mean that the body will either be seriously damaged during training or totally annihilated by the main event. Here's an analogy: drinking water is a generally healthy thing to do, drink too much and it can kill you.

Some people are built for long-distance running and others aren't, but this is never taken into account. They may be able to push themselves by training and just about manage to finish the course, but will do their bodies no good at all in the long term.

Researchers from the Heart and Stroke Foundation will back me up. By MRI scanning hearts of runners they found that without proper long-term training marathons damaged the hearts of less fit runners. The exercise-induced injury is reversible over time, but could take up to three months.

Poorly prepared runners were also found to become more dehydrated and show greater loss of function of important areas of their hearts.

I fully expect to be bombarded with criticism for writing this, so let me just make what I'm saying absolutely clear: if you want to run a marathon, then do so, especially if you can raise some money for good causes along the way. But make sure that your training regime is suitable or you will almost certainly do yourself more harm than good.

Simon Cowell lacks the pecs factor

2011-02-04T19:04:00.000-08:00

Recent photos of Simon Cowell on the beach have been less than flattering, mainly down to the emergence of a bust many women would be proud of.

Surprisingly, given his alleged vanity, his man boobs, or moobs, don't appear to bother him but, according to new research, he is in a minority.

The latest figures show that men are queuing up to get rid of their moobs - in fact, the operation to remove them was the second most popular cosmetic procedure last year, showing a 28 per cent increase on 2009.

Only nose operations had a greater appeal among men.

Men get a drubbing in the media - not to mention down the pub - if they undergo cosmetic procedures but the fear of mockery seemingly isn't putting them off.

Clinics reported a seven per cent increase in men signing up for cosmetic operations last year, compared with five per cent in women.

And moob removals are among the most popular treatments - so what exactly are they?

There are two sorts of moobs. One sort is caused by a condition called gynaecomastia, commonly seen in teenage boys. Firm, tender glandular breast tissue grows under the nipples, under the influence of hormones, and is usually caused by rising oestrogen levels that occur during puberty.

These moobs disappear without treatment within a couple of years. In adults, however, their occurrence is not normal. They are often caused by the conversion of testosterone into oestrogen via the enzyme aromatase.

Affected men may also notice a reduction in muscle mass, a more feminine fat distribution, tiredness and loss of libido. Taking anabolic steroids, certain medicines or using cannabis can also upset hormone levels, causing gynaecomastia, and occasionally it may be due to a tumour or hormonal disease of the pituitary gland, liver or testes.

The more common type of moob is something entirely different, most frequently observed in the middle-aged male.

They are, to be blunt, just fat, caused by poor diet, lifestyle and lack of exercise. This "false gynaecomastia" does not involve any real breast gland growth, and none can be felt. The breast tissue simply feels as it looks: loose and flabby.

Moobs are the stigmata of modern working life, ushered forth by the all-too-commonly encountered combination of stress, booze, lack of exercise and poor diet, and can be tackled by a good overhaul of lifestyle.

But there is a certain degree of crossover between the two types of moobs because testosterone is converted to oestrogen primarily in the fat cells, so the fatter you are the more likely you are to
develop them.

It can all seem very amusing and if you want some alarming examples of man boobs, look at the top 10 page at manboobs.co.uk. If yours look anything like these, it really is time to do something about them.

Moobs can actually signal the impending onset of heart disease, stroke, high blood pressure and diabetes. So it's not that funny at all really.

GP patients have to be seen

2011-01-26T19:06:00.001-08:00

The NHS has been in the news a lot recently. Big changes are afoot, and about time too. While I am very aware that it is blasphemy to say so, the NHS no longer works well in many areas, and needs to change. It's a constantly evolving being and the way it is managed needs to evolve along with it. Unfortunately this hasn't happened.

I think some of the new proposals are very sensible. Surely if anyone is going to know where money is most needed and best spent it is the GPs on the front line? I hope this plan works and I welcome it.

There is another idea being touted, however, that I don't think is sensible. In fact, it makes me very concerned indeed. The Government is planning to offer patients email consultations with GPs. People will be able to directly email their GP through a new Communicator tool, part of the secure personal health organiser website originally set up to allow patients to view their records online. Remember what a disaster the NHS IT system was to set up? Doesn't bode well, does it?

It's a move the Government claims will improve access to primary care. The word to pick up on is "access". It may well be improving access but it is certainly not improving care. It may possibly work for issuing repeat prescriptions to those with chronic but well managed conditions, or getting results from home test kits such as blood sugar or BP, to update records, but beyond this? No chance.

There is a very good reason why tradition has dictated that doctors bother to see their patients in person, to talk to them, ask them salient questions and maybe even lay on a hand. It's because patients are not generally very good at telling you what is wrong with them. They need help, and it is not always what they say that gives you the answer. Being able to see them, to read their body language and hear the tone of their voice are vital parts in diagnosis. I'll give you an example: chest pain. "Dear doc, I have pain in my chest, comes and goes, maybe a bit goes to my left arm as well. Should I be worried?"

Chest pain can have many causes, heart attack being one, acid reflux another, but it could also be a simple chest infection or even depression manifesting as a pain. Never could this be worked out from an email without either much back-and-forth correspondence (taking up at least as much time as a face-to- face consultation) or a very informed, educated and impartial patient relating the exact relevant symptoms correctly. It won't happen.

I have had good personal experience of this long before any pilot schemes were tried out. Since my TV shows have aired I have been inundated on a regular basis with emails from people all over the world wanting help, advice and diagnoses. I can confidently say that few are easily or quickly answerable, and few give enough information for any sort of useful reply to be given other than "Better go and see your doctor".

Given that the public is spending £2 billion a week on the health service I think it a very sad state of affairs for medicine if a face-to-face appointment with a GP becomes not a right but a luxury.

Cash for eggs: there are so many issues

2011-01-20T18:09:00.000-08:00

Fertility and its management is always an emotive subject that polarises opinion. The views of the public are currently being sought on surrogacy - in the spotlight again following Nicole Kidman's announcement that her second daughter was carried this way - as well as the use of donor eggs and sperm to enable infertile couples to have a baby. More ethical issues are being explored, including whether close relatives should donate eggs or sperm to each other, and if it is acceptable for a baby to be born, through egg donation, to a woman who is also its grandmother.

The debate follows a high court ruling that may have opened the way for surrogate mothers to be paid, a practice which had been banned. If the public concede, then women could be set to receive thousands of pounds for donating their eggs. Currently, British clinics are banned from paying for eggs and sperm directly but can pay up to £250 in expenses - which hasn't exactly filled potential donors with a desire to go through with the process of donation.

The problem with the "cash for eggs" proposal will not be with the well-meaning majority but the unscrupulous few, who will lure in women by making egg donation seem like an easy way to earn money - without any explanation of what actually is involved. Worrying, too, is the possibility of "designer genes" being offered to couples prepared to pay exorbitant fees for the perfect combination of brains and beauty; the higher your exam marks and the better your bone structure, the more your eggs could be worth.

I'm not sure money is the main issue, however. While it's mainly the small amount of cash currently offered to donors that has been blamed for the shortage of eggs, I suspect a greater problem is the recent change in UK law which requires the identity of sperm or egg donors to be revealed to their children - the idea of a load of "surprise" children showing up years after donation undoubtedly puts off many would-be donors.

Maybe the issue is being looked at from the wrong angle, in London at least. The stats for maternal age show that in the UK London has the lowest number of births per 1,000 women aged 25 to 29, and the highest birth rate for women aged 35 to 39. This implies London women are leaving pregnancy until much later, a known risk for fertility issues and the need for donor eggs or even surrogacy. Many have argued that more should be done to cure infertility and to encourage women to have children when they are young and their eggs are still in good condition, instead of worrying about turning body parts into tradable commodities.

Flu is a threat but simple measures can keep it at bay

2011-01-20T18:03:00.000-08:00

Last year I wrote rather scathingly about the panic surrounding the predicted flu epidemic that never was. This year I'm going to be more cautious as I feel things have changed. Flu is back but this time it affects a new demographic of hitherto unaffected people, which could have profound implications on our future approach to managing flu.

The number of flu victims has been rising steadily, which isn't unusual, but these victims are mainly professional, young middle-aged and middle-class, which is. What is worrying some virologists is the newly proposed theory that these current unlikely flu victims are stricken down because last year's flu jab may have made them more vulnerable to this year's attack by the H1N1 swine flu virus.

As it has been estimated that a serious outbreak of flu could kill 65,000 people in Britain and, according to one study, could knock out nearly 40 per cent of all health professionals — doctors, nurses and paramedics — in the first 10 days then this theory, if true, is a disaster. Already swine flu is spreading faster in the UK than in Europe, and the figures are likely to climb even more steeply now that we are back at school and work and mingling with each other again.

But we have had vaccine scare stories frequently in the past and few have been legitimate. In fact many have been very damaging, like the MMR scare.

This is still very much a theory, totally unproven, so I would advise everyone, whatever age or state of health, still to have a flu jab this year, as it will help reduce the chances of a pandemic that could kill far more than the vaccine will ever adversely affect.

This year I have also seen more chest infections in my clinic, always with the same story: “It started off as a bit of a cold, then developed into something much worse, doctor.” Viral illnesses and flu can be common precursors to pneumonias so getting your flu jab will help stop this. Not smoking, a healthy diet, and getting plenty of exercise and rest will too. If you seem to be regularly affected ask your GP about pneumococcal pneumonia vaccine. It's effective in 80 per cent of healthy adults and helps high-risk groups lower their odds of getting pneumonia.

Finally, given the chances of catching flu this year seem so much greater, consider taking antiviral drugs if you do get ill. The side effects can be dreadful but they can make illness milder and last for a shorter duration.

The sound solution for breast cancer

2010-10-04T10:37:00.000-07:00

We have long known that breasts change with age. It is a perfectly natural process but one that women have been fighting for generations. Gravity always wins in the end, particularly over women with large boobs who have had several pregnancies. Joggers can suffer particularly badly. But whilst this age related sagging might not be desirable from an aesthetic point of view, it does have a very useful property from a medical one. The older you get, the less dense your boobs get and the easier it is to image them for lumps. This is the reason why we don’t offer mammograms to young women. Currently on the NHS screening is offered from the age of 47, and this is not just to do with money. It really is more effective after this age. Young boobs just don’t x-ray well. But now the results of new studies show another property of breast density, but this one is not so good. There is increasing evidence that density is a key factor in breast cancer. Women with more tissue than fat in their breasts are up to five times more at risk because they have more cells. Those involved in the research have suggested that all women should be advised of their breast density, and all should be offered ultrasound scans, to pick up tumours that mammography may have missed. The theory is that denser breasts hide their lumps from x-rays, but may reveal them to ultrasound. Of course since this information has been released the usual loud clamouring has started, demanding that the already overstretched NHS offers this extra screening test to all women.
Our current screening program is great. Mammography lowers breast cancer mortality by 15% to 20%. But if ultrasound can further improve this then surely it should be added to the program too? The problem is that it is very operator dependent, and in multiple trials comparing the accuracy of mammography plus ultrasound to that of mammography alone in women with denser breasts who were at high risk for breast cancer, the addition of ultrasound to mammography did result in detection of additional cases of cancer, but at the expense of a roughly fourfold increase in false-positives. This means that four times as many women would have to undergo an invasive biopsy procedure that they do not need if this method of screening was introduced. This would cause a level of anxiety that may be acceptable in a high-risk population, but certainly would not be in lower-risk patients. An unobtainable number of extra man-hours would also be needed to cope with the increased counselling involved.
Neither can ultrasound consistently detect certain early signs of cancer such as tiny deposits of calcium in the breast that cannot be felt but can be seen on a conventional mammogram. Nor does it have good spatial resolution like mammography, and therefore cannot provide as much detail as a mammogram image.
What is not being publicised is the fact that the combination of mammography and ultrasound still missed one out of every five cancers. So ultrasound is certainly not a silver bullet for breast cancer screening and shouldn’t be hailed as such. Perhaps rather than shouting that women are being denied ‘life saving cancer tests’ we should be a little more measured in our approach and look for ways to improve the uptake of mammography itself. Still too many women do not attend. Also, ensuring all screening programs offer digital imaging, which is more accurate still, may be a better use of time and money, and will avoid creating a cohort of worried and confused women.

Breaking the migraine barrier

2010-10-04T10:35:00.000-07:00

New research looking into the causes of migraines has produced what may be one of the most important and useful medical findings of the century. Scientists have found a gene that regulates how pain is felt in the brain, a gene that can be turned up or down. Called TRESK, the gene controls the sensitivity of pain nerves in the brain and it is thought that migraine sufferers may have a fault in their gene, causing the extreme sensitivity to light, noise and touch experienced during a migraine.

It’s an exciting discovery as it may lead to the creation of a new generation of drugs that can simply turn up the threshold at which the body feels pain making migraines a thing of the past. It not just migraines that will benefit however, as it could potentially lead to a new form of painkiller being developed as well. As the gene is susceptible to being switched on and off with drugs it means that it could be altered to increase the threshold to such an extent it eliminates the feeling of pain altogether.
Migraines cause a considerable burden to sufferers and their work. In the UK around 18 per cent of women and 8 per cent of men get migraines resulting in the loss of more than 25 million working days a year. The World Health Organisation has named migraine as a leading cause of disability worldwide and it has been estimated to be the most costly neurological disorder in Europe.

Sadly migraines are often very badly managed by the medical profession, many of whom still continue to promote ideas like its cheese, or chocolate that cause migraines. Actually the situation is more complex, and it is necessary for more than one trigger to be present, possible more than 48 hours before the onset of headache, in order to cross the threshold that leads to an attack. Contrary to popular belief migraines are not caused by food allergy either, and no specific antigen-antibody reaction has ever been identified although certain foods may be one of a complex of triggers. Actually, missing meals (resulting in a drop in blood sugar) and dehydration are far more important triggers. Changes in sleep pattern, hormonal changes, head and neck pains and stress are all other culprits. Very little time is spent explaining and helping to identify these interacting triggers and existing treatments are often not taken early enough. There is currently no cure for migraines but many different treatments are available which can be effective if used correctly. The problem is that it can require quite a bit of personal experimenting with different types and combinations of medicines before the most effective one is found. Even simple painkillers can work well, but many people only take painkillers when their headache becomes very bad. This is usually too late for any benefit to be felt.

My top 5 tips if your migraines are poorly controlled are:

1) Identify prodromal symptoms like changes in mood or behaviour to help identify as early as possible when a migraine may be imminent.
2) Keep a diary of all the details of what you were doing for the few days before an attack to help you better understand them.
3) Identify your specific triggers and gradually cut them from your life, if possible.
4) Take treatment early –by identifying the warning signs this should usually be possible.
5) Always carry treatment with you and ideally a little food and drink too.

If you feel your migraines are not under control then ask your GP for a referral to a specialist migraine clinic for further advice.

Teen Sexual Health

2010-10-04T10:33:00.000-07:00

As a sexual health doctor the recent visit of the Pope made me angry for an obvious number of reasons. In rebellion I want to announce that the 26th September this year is World Contraception Day and we should all mark it. It’s not a day I expect many to have ever heard of, and it is perhaps considered a little too Hallmark for some, but given the statistic that approximately a third of the 205 million pregnancies that occur each year worldwide are unplanned, the need for such a day can be clearly seen. To mark the event a multi-national survey looking at attitudes towards contraception has been undertaken. The results are depressing although pretty unsurprising. They highlight a significant disconnect between what young people know they should be doing for contraception, and what they are actually doing in their day to day lives. It also shows that highly unreliable contraceptive methods, such as the ‘withdrawal method’ are still being viewed as effective by almost a third of young people. Perhaps most depressing of all is the news that that the highest reported rates of STIs are found among young people aged between 15 and 24. Nearly half report that they prioritize personal hygiene, including showering, waxing and applying perfume, above contraception, and teens in the UK reported that the reason why they failed to use condoms was because they were often too drunk to remember.
Straight from the school of the bleeding obvious, this apparently earth-shattering revelation that the appalling STI and pregnancy rates amongst UK teenagers maybe linked to the significant increase in binge drinking observed over the last few years has grabbed headlines but I find it truly hard to believe that no one has made this observation before. Experts quite rightly describe the findings as alarming, but disagree over whether the solution lies in providing more contraception or better efforts to rein in binge drinking. I think improving sex education would be a better starting place, by including more focus on relationships, feelings, emotions, confidence and respect. The British media could also do a lot to help, by stopping its prudish campaign of being deliberately and mischievously resolved to undermine any sexual health/education initiative aimed at helping young people and their parents. I can but dream. I personally find the results alarming because sadly I cannot now see a truly effective solution actually being implemented. The problem is that until the government addresses its ludicrously hypocritical drug and alcohol laws things are only likely to get worse. Making legal (and, let’s be honest, frankly encouraging the use of) the one drug that causes considerable self-destructive behaviour and affects judgement in the way that alcohol does is absurd. It gives such a confused message to our young people that I weep for the future. Yes, alcohol is responsible for many a condomless encounter because that is the one property of alcohol that we most embrace –its ability to make us relax and forget. Teens are no more going to stop drinking than the Catholic Church is going to repeal some of its insane views on sex and contraception.

Losing our Doctors

2010-09-13T06:05:00.000-07:00

In my day being a junior doctor sucked. I had a miserable time, was bullied by an evil female surgeon with a chip on her shoulder and permanently felt like a zombie due to a ridiculous work rota. I’m not sure I actually learned anything for the first year or so other than the fact that this really wasn’t the working life that I wanted or hoped for. I got out and sought an alternative. Essentially we were slaves, used as 24-hour phlebotomists, secretaries, and robot-like IV cannulators by consultants who were completely disinterested in training us. We looked for any opportunity to rise as quickly as we could through the archaic feudal system or get out altogether. Unfortunately those opportunities were few and far between.
Very little attempt was made to rectify this until the EU working time directive, which was introduced into the NHS last summer, forced hands. Designed to improve the work-life balance of junior doctors it limits the working week to 48 hours. Understandably many rejoiced until the realities set in: the situation now is just as farcical as it ever was. Juniors are asked to lie about the number of hours worked to ensure trusts are compliant with the directive, or made to ‘voluntarily’ opt out of the directive when signing their contracts. Hospitals have been forced to shake up their rota systems, leaving junior doctors to work the majority of night shifts and weekends, meaning that although they were indeed working fewer hours, they were missing most of their important teaching and training sessions. Of recent medics who wanted to carry on and specialise, 22 per cent were turned down by hospitals because they lacked skills or experience –a fault of their working rotas. Junior doctors that I talk too now tell me that the only way to get work done is to sneak back into the hospital when everyone else has gone home, avoiding the managers policing the working hours. They are being made to work intense shifts doing work that should be delegated to people who are less well trained in what is a gross misuse of highly skilled staff and will lead to a dearth of properly trained specialists in the future.
So it really doesn’t come as any surprise at all that latest figures show nearly a quarter of junior doctors drop out of their NHS training in England after two years. To be fair, not all are lost from medicine as some take gap years or move to other parts of the NHS to work, but many head abroad to work in Australia, New Zealand and other parts of the world where they can enjoy a better working life. All I can say is ‘clever them.’
Hospitals are clearly struggling to cope with the introduction of the 48-hour week and are running understaffed rotas where juniors have to work on thinned-down teams with no specialist guidance. Hospitals need to look more closely at how they organise their rotas and how to reduce much of the unnecessary bureaucracy and menial work that takes up so much of the junior doctor’s time.
Until the problem is sorted doctors will continue to leave. And who can blame them?

Egg Donors should volunteer for the right reasons

2010-09-13T06:04:00.000-07:00

The government's fertility regulator has announced that it is considering lifting the UK ban on selling eggs and sperm to try to ease the shortage that they say is driving thousands of couples to go to foreign fertility clinics. It claims it’s decision is based on allegations that clinics in countries like Hungary, the Czech Republic and Slovenia, popular with couples unable to conceive naturally, routinely ignore safety guidelines. Women attending there have multiple embryos implanted into the womb to increase the chance of a pregnancy occurring, but unfortunately this also increases the likelihood of multiple births, and so to the health risks to both mother and baby.
Currently, British clinics are banned from paying for eggs and sperm directly, but can pay up to £250 in expenses which hasn’t exactly filled potential donors with an enthusiastic desire to go through with the complicated process of donation. Several different alternative options are now being explored from simply doubling this sum, to copying the system in Spain, where women are paid €900 for each cycle of eggs. The regulatory body is also examining an alternative option: to allow women to be paid many thousands of pounds, enticing them with considerable lump sums, as happens in the USA.
All this makes me rather uncomfortable. There is something intrinsically wrong with a ‘cash for body parts’ situation. Families of organ donors do not benefit financially from their deceased relative’s decision to donate, and blood donors don’t get paid either. I feel that so too should egg and sperm donations be done for altruistic (or egotistic) reasons and not for large wads of cash. I am well aware of the counter arguments; egg donation is far more invasive than giving blood and so deserves some sort of compensation for the time and risks involved. Women need to have their cycles synchronised with the matched recipient and then undergo a two-week course of hormone injections, daily blood tests and ultrasounds until they have produced several ripe follicles. Harvesting those follicles then involves a minor operative procedure, time off work is inevitable and complications can occur. But look at the situation in the USA, where cutting-edge reproductive technologies and infertile couples are providing young women with thousands of dollars for their eggs. Tempting adverts can be seen in college newspapers making donating eggs seem like an easy way to earn money and help meet the demands of rising costs, without any explanation of what actually is involved. More worryingly are the reports that the excess of young women wanting to exchange their eggs for cash is creating a cohort of doctors who are exploiting the desperation of childless couples by offering a ‘designer genes’ service for couples prepared to pay exorbitant fees for the perfect combination of brains and beauty. The higher your exam marks and the better your bone structure, the more your eggs are worth. This terrifies me as it is nothing more than a sordid form of eugenics, selecting those characteristics deemed desirable by society and selecting out those, like homosexuality and being ginger, that aren’t. A genetic underclass will be created of those whose attributes do not meet the high expectations of the prospective parents.
Getting pregnant and having a baby is not an absolute right, as so many women seem to think. Nor is choosing the type of child that you have. Donating your eggs to help others should be a noble, selfless and altruistic act, having total control over the phenotype of your baby is certainly not. It’s selfish and a gross violation of the laws of nature.

Same sex wards can work

2010-09-13T06:02:00.000-07:00

Our great leaders are about to announce their rather ambitious plan to put an end to mixed sex wards in hospitals. It’s certainly not the first time this desire has been voiced. Tony Blair called for their abolition in 1996, when Labour was still in opposition, saying it should not be beyond "the collective wit" of ministers to achieve. 14 years on and it clearly was. Its successful implementation has been a goal that has eluded ministers for years.
As with many of the government’s ideas this one seems rather attractive on paper, but as soon as the practicalities of achieving it across the board are considered, it shows itself to be an unrealistic aspiration. Many of our hospitals are old Victorian buildings that would require extensive renovations in order for them to comply. These are unlikely to occur since we are living in a time of massive public service cutbacks and a pre-existing shortfall of hospital beds. I do understand the feelings of anxiety, exposure and vulnerability that mixed sex wards may create, to say nothing of those dreadful ‘backless’ hospital gowns that leave little to the imagination. If it is indeed the case that patients are left uncovered in front of patients of the opposite sex then it seems to me that a simpler and more urgently needed solution would be to improve the training and discipline of nurses and doctors on such wards, perhaps by bringing back the concept of ‘Matron’. These dragons may have been feared by all, and certainly struck terror into the heart of every junior doctor who crossed them, but boy did they get things done properly.
Rather bizarrely the government makes much of the apparent indignity of the sexes having to share bathrooms. I’m not really sure why this should be such a problem -surely there are bigger and more pressing health issue that need tackling than whether Mrs Jones prefers to find the loo seat left down when she pays a visit? As is so often the case it’s not only the idea that is questionable, but also the way in which ministers attempt to enforce their ideas. NHS trusts will be warned that they will face fines if they do not get rid of their remaining mixed sex wards by the end of the year. Just what an already cash strapped trust needs when trying to implement a change that will require a considerable increase in spending to achieve.
Just how necessary are these proposed changes? In a recent survey of 150 patients admitted to a variety of different wards 24 per cent said that they had no preference as to the type of ward they went on, and 57 per cent actually preferred mixed sex wards; their reasons being that they felt it created a more normal atmosphere and better reflected the outside world. The concept of segregating the sexes stemmed in part from the data that in the community young men commit most violent crime, and women were said to report feeling vulnerable on mixed wards. But in an institutional or hospital setting research has found a very different picture. There, women have equal rates of episodes of violence, there was considerable spread in age range, and that age and gender failed to predict assaultiveness. I cant help feeling that all this is a bit of a sly distracter however; same-sex wards may be nice to have, but must come secondary to safe clinical care and good medical outcomes. Assessing your hospitals worth by how comfortable you stay was, as you would a hotel, is most definitely flawed. Patient satisfaction and consumer choice are all very well politically, but isn’t therapeutic benefit the one main issue on which health care planners should focus? What effect will same-sex wards have on therapeutic outcome? I’m not sure anyone actually knows the answer. Yet.

Time to stop milking it?

2010-09-13T06:00:00.000-07:00

As the government desperately scans through it’s extensive list of expenditures looking for areas in which it can make cuts, the spotlight fell on the ‘free milk for kids’ scheme. Scrapping it could save around £60m per year, and yet almost as soon as it was suggested publicly, No 10 hastily released a statement saying the scheme would remain. But the damage has already been done and the usual militants are stepping in, shrieking with outrage that such a proposal could even have crossed anyone’s mind.
Yet if you suppress the initial knee jerk reaction and look at the science behind it one can see that it’s actually a perfectly sensible, even advisable idea. The scheme is the only remaining part of what was known as the Welfare Food Scheme, first introduced in 1940 to protect pregnant women and young children against wartime food shortages, but now, in this time of gross nutritional excess, is an outdated and unnecessary idea. Indeed scientific evidence is amassing that suggests regular consumption of milk may be bad for you, by not only by causing some diseases but also by failing to prevent others for which it has traditionally been seen as a panacea.
Experts now say that after the first year of life children require no milk of any type. The former director of paediatrics at Johns Hopkins School of Medicine estimated that half of all iron deficiency in US infants results from cows' milk-induced intestinal bleeding. He proposed that infants drink so much milk (which is very low in iron) that they have little appetite left for foods containing iron; at the same time, by inducing gastrointestinal bleeding, milk causes iron loss. The same certainly applies to British infants too.
Cow's milk is simply just that: for cows. Man is the only animal that drinks milk into adulthood. It’s higher in sugar than humans need, and although high in calcium, only around 30% of it is available for use by the body, as compared to 60-70% for fruits, grains, legumes, nuts, roots, seeds, and vegetables.
There is also a theory that a protein found in milk mimics closely a protein found on the insulin producing cells of the body. If the body develops an allergic reaction to this milk protein then it is also stimulated to destroy the insulin cells through an autoimmune attack, a possible cause of diabetes.
The pro-milk lobby will scream ‘osteoporosis’ in their defence. But whilst milk is often sited as being key in the development and maintenance of strong bones, even this has now been questioned. When looked at globally it can be seen that the countries with the highest rates of osteoporosis, also have the highest consumption rates of milk and dairy products –it does make you think. Milk proteins contain phosphorous and sulphur compounds that acidify the blood. In order to correct this acidity, the body actually draws calcium from the bones, weakening them.
Instead of recommending multiple servings of dairy to ward off the dreaded osteoporosis, we would probably do better to advise women, and especially teenage girls, to take more exercise. A 15-year study published in the BMJ found that exercise may be the best protection against hip fractures, and that a reduced intake of dietary calcium does not seem to be a risk factor.
So perhaps it really is time to re-evaluate this dinosaur of a tradition and ask ourselves the question: is providing our kids with free milk actually doing more harm that good? Current evidence suggests that it might be.

Steer clear of the Botox cowboys

2010-02-17T16:24:00.000-08:00

On Friday, the Department of Health will be issuing new guidelines on the use of Botox and fillers. But what they are going to propose has left many of the more conscientious within the industry feeling that the DoH has bottled out of imposing any regulations at all. The guidelines will ask the industry to take the lead on improving safety and regulate itself. It is understood they will be proposing a voluntary system whereby clinics join a register run by the Independent Healthcare Advisory Services. No legislation, and no penalties for bad practice.
The British Association of Aesthetic and Plastic Surgeons (BAAPS) is not at all happy with this, saying it will not protect the public from cowboy clinics. They want a system of fines or the register to be compulsory. Currently Botox can be carried out anywhere by anyone with training in giving injections. Podiatrists, physiotherapists and veterinary surgeons have all enquired about injecting the toxin for cosmetic reasons and in fact anyone could set up shop offering Botox jabs. The temptation to do so must be huge, with the anti-wrinkle treatment becoming increasingly popular, especially in London. Over 100,000 Britons a year use Botox and take up has gone up 2,500% in three years, making it the fastest-growing treatment in the cosmetics industry. It’s big business.
The medical profession is usually pretty strict about what can and cant be done by people with various levels of qualification, but Botox and fillers seem to have been overlooked. They are invasive procedures and Botox is a prescription-only medicine. Patient safety should be paramount. When things go wrong, and they do, (think Leslie Ash) patients can be left physically or psychologically scarred for life.
Botox blocks the nerve signals to muscle in the area it is injected, so that the muscles relax, smoothing and softening wrinkled areas. Its effect wears off after four to six months. It is generally safe and well tolerated but it isn’t always harmless. Cliff Richard and Lynne Franks both suffered drooping brows after treatment, and other users have had headaches, double vision or sagging facial muscles. In rare cases, it can cause an allergic reaction that can kill.
It is also sold to patients in some very unethical and irresponsible ways. Alcohol fuelled Botox parties. Two for One, time limited offers and non-refundable deposits all put pressure on patients to undergo procedures they may well later regret. This is immoral in any branch of medicine. The GMC states that the patient must have a two-week cooling off period to think it over before deciding to have work done.
In France and Denmark there are laws that limit who can do what, to whom and where, and the same is likely to happen in Mexico and Spain, yet still the British government is avoiding improving regulation to safeguard patients. I’m not at all sure why.
If you are considering any sort of cosmetic procedures I would urge you to check your surgeon's qualifications first. They should be on the Specialist Register of the GMC, and preferably registered with BAAPS, but remember that the UK government insanely refuses to recognize cosmetic surgery as a specialty. If a surgeon is not listed on the Specialist Register, they have not received a full surgical training in the UK.
The cosmetic surgery industry was born in the 80s but the law has failed to keep pace with regulation and training. But as many will argue self-regulation is better than no regulation at all, as is currently the case.

The perils of heels

2010-02-17T16:23:00.000-08:00

The years of ignored warnings have finally become a reality for Victoria Beckham as she caves in to pain, discomfort and deformity and elects to have surgery to correct her impressively large bunions. Wearing six-inch heels constantly, even to do daily activities, has predictably taken its toll. At only 34 one would think that Posh is really rather young to be having this sort of surgery, but the allure of heels now means that orthopaedic surgeons are busier than ever correcting the damage that tottering around on spikes causes.
I have seen some truly horrific injuries to the ankles of teenage or twenty-something year old girls that occurred due to a combination of alcohol and unsuitable footwear. Ankle fractures sustained by ‘going over’ on a heel can be extremely messy, with no single clean break, and often require complex pinning operations that never fully restore normal use of the ankle, and inevitably cause osteoarthritis of the joint in later life.
The body comes with a wide array of early warning and damage protection mechanisms, pain being the most obvious one. If something hurts, then it is probably causing damage and should be stopped. This is common sense. Yet surveys have shown that 42% of women will happily endure pain in order to wear a pair of killer heels.
What I found more worrying were the images of 3-year-old Suri Cruise being proudly showed off by her mother whilst wearing high heels. If you want to cripple a child before she reaches her teens then stick her in heels.
Heels cause many stresses on the foot: in addition to restricting, they also massively increasing the weight pressing down on the restricted areas, pushing the toes with enormous force into a small wedge shape. The best-known foot problem is probably the bunion, known medically as hallux valgus. It occurs because the big toe becomes excessively angled towards the second toe – and a bunion is a symptom of this deformity. Once the big toe starts leaning like this then the problem tends to get progressively worse. The jury is still out on whether high heels actually cause bunions; we know there is a genetic component involved, but heels certainly exacerbate them. Bunions do occur in societies that don’t wear heels at all however.
Whilst I fully appreciate that telling women not to wear heels will be about as effective as telling kids not to eat sweets I thought I would give you my top tips on how to minimise the damage as much as possible.

1. Make sure your heels are properly fitted. Most are not. If your feet slide to the front, leaving a gap behind your heel then they don’t fit. Look for narrow heels with a snug but not tight fit.

2. Try to avoid very thin, heels and opt for a thicker one, to increase stability. They should give you better balance and may help relieve some pressure by distributing the weight on your foot more evenly.

3. Invest in some silicone metatarsal pads, which act as excellent shock absorbers and help reduce pain and damage to the ball of your foot.

4. Avoid heels with a straight drop down from the heel to the toe. These can be very hard on your arches: go for a gentler slope.

5. Wear open-toe high heels to relieve pressure on corns and calluses. Closed-toe heels cramp and deform the toe joints more.

6. Try these exercises to strengthen the muscles and tendons around your big toe: put your feet side by side, and try to move your big toes towards each other. Do this three or four times a day, 10 reps each time.

Carbon Monoxide leaks are a hazard in the home

2010-02-17T16:19:00.000-08:00

Towards the end of last year I saw a young girl in clinic with rather strange and non-specific symptoms. As well as dizziness, nausea and shortness of breath, which would have hinted at some sort of respiratory infection, she had one very worrying sign: she was pale, but had bright cherry red lips. She had been staying with her mother in a rather swish houseboat moored on the Thames at Chelsea.
Because of certain suspicions I sent her to the nearest hospital to have her blood gas composition analysed and it showed carbon monoxide levels in her blood of 22%. Normal levels are around 0.1 to 2%.
She was given oxygen therapy under pressure and thankfully made a full recovery. Investigation revealed a faulty exhaust system on the boat that had causes levels of gasses to build up at the end of the boat where the girl slept.
Carbon monoxide is a colourless and odourless gas that accumulates rapidly in the lungs and blood. It can bind to haemoglobin and does so about 240 times more tightly than oxygen, forming a compound called carboxyhaemoglobin. This means that if both carbon monoxide and oxygen are inhaled, carbon monoxide will preferentially bind to haemoglobin. This reduces the amount of haemoglobin available to bind to oxygen, so the body and tissues become starved of oxygen. Carboxyhaemoglobin also has direct effects on the blood vessels of the body - causing them to become 'leaky'. This is seen especially in the brain, causing the brain to swell, leading to unconsciousness and neurological damage.
Symptoms of toxicity are rather non-specific including headache, nausea, dizziness, confusion, vomiting, and lethargy and are often misdiagnosed. Long-term neurological complications of CO toxicity occur in 14% to 40% of patients and include cerebral oedema, cardiac ischemia, rhabdomyolysis, and thrombosis.

I hate to admit it but I suspect that in private practice CO poisoning is rarely ever considered as a possible diagnosis for a simple reason: we usually think of those at risk of CO poisoning as staying in crummy bed sits and run down hostels: not the type likely to be accessing private healthcare, and certainly not well-heeled Chelsea types. But doctors should never make assumptions about class and background in this way, for obvious reasons: if we misjudge, it could kill.
As if on cue a new national campaign called Carbon Monoxide – Be Alarmed! has just been launched to try to reduce the number of deaths and injuries caused by carbon monoxide poisoning. It’s also lobbying for legislative change to make putting alarms in new builds and rented properties law. According to their research this subject is particularly relevant to us Londoners. We are half as likely as the national average to have an audible carbon monoxide alarm in their home and significantly less likely to understand the risks and characteristics of carbon monoxide.
I had never really thought this much of an issue before. But this recent case of mine was an eye opener. 93% of homes have smoke alarms, but only 15% have carbon monoxide alarms. And as it is the most common cause of fatal poisoning in Britain today, again a fact that I did not know and would never have guessed, this is clearly something we all need to address.

It’s not just politics - families do need fathers

2010-01-20T06:05:00.000-08:00

The role of the father is one that has been more stereotyped than any other. We have two main characters: the bumbling, useless, out-of-his-depth father and the househusband, the super-dad who does it all — and there's very little in between.
But set against these clichés, new research has identified two fresh trends in fatherhood today: men who spend more time with their children than ever before and fathers who are completely absent.
Two hundred years ago, the father was the focal point of the family — the paterfamilias — and acted as moral mentor and teacher. But the Industrial Revolution took many men away from home to work, leaving mothers to raise the children single-handedly.
Now, as more mothers return to the workforce, the set-up is similar to that of a couple of centuries ago, with the domestic workload, including the raising of the children, more evenly distributed between both parents. When surveyed, 75 per cent of fathers said they would trade career advancement for more time with their children, and the number of dads present at their children's births has risen from 27 per cent in 1974 to nearly 90 per cent today.
Inevitably, fatherhood has now become a political issue too. The Tories have called for fathers to be more involved with their children and have attacked “deadbeat dads” who abandon their responsibilities, while Labour wants to counter criticism that it has been too focused on mothers' rights by putting fatherhood at the centre of its social policy.
Health minister Andy Burnham will announce tomorrow that prospective fathers will receive lessons on breastfeeding and supporting their partner through childbirth. Meanwhile, a families green paper will propose measures to get fathers more involved in their child's upbringing from before birth and beyond, including forcing single mothers to name the biological father on the birth certificate and encouraging hospitals to allow fathers to stay overnight after the birth of a child.
But it's not all just a desperate vote-winning strategy. Research has, to an extent, confirmed the importance of dads: children benefit greatly from having increased interaction with their fathers and show better cognitive abilities when their fathers are highly involved during their development. Fathers offer greater tactile stimulation and are more likely to physically interact when they play, whereas mothers are more verbal and toy-mediated in their interaction.
Studies have shown that the young rely more on their fathers for factual information and look to their mothers for day-to-day care and emotional support: children are twice as likely to receive As in school when their fathers are involved in their education. And the benefits start early; babies are twice as likely to be breastfed if their fathers have received instruction about the benefits before birth, and further studies reveal that fathers who are around at the birth are far less likely to flee.
So while these initiatives certainly won't guarantee Labour safely through the next election, they may well help improve family life for future generations.

I am exploding the myths about health and winter

2010-01-13T03:40:00.000-08:00

How is it that I can travel to a tiny Austrian village in the Alps to ski each year with minimal hassle yet can't go five stops on the Bakerloo line in winter to get to my Harley Street clinic?It seems we Londoners are out of touch with our seasons and how to cope with them. But in a way you can't blame us because so much nonsense is written about health and winter. The best-known myth is that going out in cold weather increases your chances of catching a cold. There is no evidence that you can get a cold from exposure to cold or wet weather: viruses cause colds. There are more colds at this time of year simply because people are cooped up indoors in sustained contact with others who might be contagious. However, cold weather may make the lining of your nose drier and more vulnerable to viral infection.
Another popular myth is that we lose most of our body heat through our heads: again, untrue. Head heat loss is usually less than 20-30 per cent of total heat loss. As one scientist who researched this put it: “If we lost 45 per cent of body heat through our heads, going out without a hat would feel like going out with no trousers.”
The complementary medicine brigade is responsible for more rubbish: echinacea, a herbal supplement which people use to treat colds, has been shown not to help prevent colds in adults and is useless in the treatment of children aged two to 11. In a similar vein, many swear that vitamin C wards off colds. But large-scale, controlled studies have produced no conclusive data as to its effectiveness. It's big money for manufacturers, however.
What is true is that a 5C drop in temperature has been associated with a 12 per cent increase in admissions for heart attacks and that 53 per cent more heart attacks take place in the winter than summer. The cold can cause arteries to constrict, reducing blood flow and therefore oxygen supply to the heart, leading to a heart attack. Research has also shown that very cold weather may increase the risk of blood clots via its effect on platelets in the blood. So we do need to be better prepared for our winters and if you're starting a new fitness regime, take the cold weather into account.
Always start gently — it won't then be such a shock to your system. Your cardiovascular system can adapt to slow, progressive changes but it has more difficulty adapting to sudden ones. You'll feel less sick and dizzy at the end of your workout and may actually keep it up beyond January.
Look on this month as a warm-up, a time for getting into the habit of exercise and healthy eating, rather than expecting unrealistic results. And whatever you do, try to do it indoors and avoid sudden exertion outside — it's this that can precipitate heart attacks and strokes.

Help for those who aren't waving but drowning

2010-01-06T17:29:00.000-08:00

January is traditionally grim. The come-down after Christmas and New Year's celebrations hits us, we still haven't begun our tax returns, and the threat of an unbroken year of work stretches before us. So it's not surprising that January is when doctors are overrun with patients seeking advice for anxiety and depression.
Depression, stress and anxiety are certainly increasing: as life becomes more complex and demanding, we as a species have yet to evolve coping techniques and so are suffering as a result. The phrase “not waving but drowning” comes to mind.
Traditionally the medical profession has stuck those unable to cope on antidepressants. But the times they are a-changin'. It's now known that a combination of talk therapies and drugs works best. Research has shown that cognitive-based therapy, when conducted well, works as quickly and thoroughly as the drugs. When a person continues using the skills they learn with CBT, relapses are prevented — something the drugs don't do.
This is all great news but there is a problem: accessibility is limited.
As more people are diagnosed with depressive-type disorders, the national charity the Mental Health Foundation is quite rightly calling for more talk-based therapies to be made available, including meditation and yoga in the form of Mindfulness Based Cognitive Therapy. The National Institute for Clinical Excellence has approved MBCT, a treatment based on meditation techniques, as a suitable treatment which can cut relapse rates for depression by half.
The report claims that Mindfulness meditation can affect the workings of the brain and even its structure, and that people undertaking Mindfulness training showed increased activity in the pre-frontal cortex — the area of the brain which is less active in people who are depressed.
A large majority of GPs think this treatment would help their patients but only one in five has access to the therapy. What is most concerning is that three-quarters of GPs have prescribed medication to people with long-term depression, believing another form of treatment would actually have been better for them. That really goes against all the training and ethical guidelines that we medics should follow.
And here lies the problem. The best treatments may well be the talk therapies but they are simply not available to most.
I have another slight reservation: MBCT usually consists of an eight-week course in Mindfulness meditation, with elements of CBT and yoga, which sounds wonderfully holistic but I feel this is a wildly impractical aim in an already overburdened NHS. Also, every doctor knows that it's hard enough to get patients to finish a course of antibiotics, so I'm certainly not convinced a depressed, demotivated patient will bother attending meditation and yoga classes.
We clearly need to find a middle ground that provides good patient care with long-term lasting results which is accessible to all who need it. But then, isn't that the great challenge in all areas of the NHS, and one that may now be an impossible pipe dream without a radical overhaul of the way our health service is run and funded?

Christmas means coping with the hangover from hell

2009-12-22T05:07:00.000-08:00

Nagging about diet and exercise is all well and good but I do sometimes feel we doctors could give a little more useful advice from time to time. At this time of year an obvious theme jumps out at me: how to avoid hangovers.I hear so many myths circulating on this subject and most are complete nonsense. So whilst I cannot possibly condone heavy drinking, even to celebrate so auspicious an event as the arrival of the baby Jesus, I can at least advise you on how to get through your Christmas parties with the minimal of damage and pain afterwards.The first mistakes people make occur before they have even left the house. Number one error is not eating before a night on the booze. Drinking on an empty stomach can lead to a rate of absorption of alcohol that is similar to being given it via an IV drip. This leads to disaster very quickly, and while the liver is in overdrive dealing with the booze it is not able to metabolise glucose very well. This causes blood sugar levels to drop, causing shakes and sweats. The heart pumps harder as well, causing blood pressure to rise, thought to be the reason why some drinkers suffer heart attacks the next morning. Wolfing down a dodgy kebab on your way home is too little too late, and will probably only make your hangover nausea worse. The reason some people get completely sloshed very quickly and others take much longer is partly to do with food, but it’s also partly due to genetics. The quantity of stomach enzymes that break alcohol down differs: women get drunk more quickly than men because they have more fat, less muscle and fewer enzymes. The good news for women is that as they get older women almost catch up with men. Brains shrink a little with age too, making them less prone to headaches the morning after.Whilst out, be aware of the need to avoid dehydration. The kidneys will produce more urine than normal, in response to the diuretic properties of alcohol, and this will dehydrate and deplete the blood's levels of sodium, potassium, calcium and magnesium. Although your brain may seem to tell you otherwise the next morning, alcohol doesn’t actually dehydrate the brain; it causes it to swell, creating pressures on the surrounding membranes and causing the infamous headache. Avoid this by alternating one alcoholic drink with one soft drink, to keep up your hydration levels, and the advice of drinking a pint of water before you go to bed is sound, provided you are not so pissed that you pee yourself in the night.
Despite what you have heard, all alcohol is the same, whether you are drinking the finest champagne or the roughest of alcopops. All drinks contain ethanol which your liver and brain deal with it in exactly the same way whatever the source. It's a myth that mixing your drinks makes a hangover worse. Beer before wine, or wine before beer, both will make you feel rough if you drink enough of them. What does make a big difference is what is mixed with the alcohol. Different drinks will affect you in different ways, and at different times, so choosing what you drink will help you the next day. Generally speaking the browner the drink, the worse the hangover it causes. Rum, whiskey, brandy and port can all be cruel. Vodka is least likely to give you a hangover as it is repeatedly filtered to remove as many impurities as possible. Beer is probably the least dangerous to drink but it's the most calorie rich - one pint contains between 170 and 200 calories.Lastly, I should warn you that knocking back painkillers can be dangerous. Aspirin is popular but can irritate the stomach, and even causing bleeding with alcohol. Paracetamol, too, is not ideal as it can promote further liver damage when combined with alcohol –this makes it a popular although slow acting suicide choice. Taking some before you go to sleep will not help –their effects will have worn off in about 4 hours and probably long before you wake up.And for our herbal and ‘complementary’ friends researchers have reviewed all the available studies on hangover pills, such as yeast and artichoke extract and concluded that there is no compelling evidence of any effective treatment. The only proven cure is time, and getting it right the night before.

Warnings about iPods may fall on deaf ears

2009-12-21T03:45:00.000-08:00

I come from a relatively small family but still find choosing Christmas presents one of the great headaches of the year.
Some small short-circuit occurs in my brain that prevents any form of sensible thought occurring any time I plan who should get what.
I thought I had it cracked this year, however. MP3 players are, according to consumer research, top of the list of most popular Christmas gifts. For Londoners, they provide some much-needed escape from the stress of Christmas shopping and the commute to work each day, so I thought I had my solution: iPods all round.
I'm sure even my mother would find some use for one, downloading Intermediate Spanish to practise on the bus, or listening to Eileen Atkins reading the latest Alan Bennett. But I've had to backtrack.
Increasingly shrill warnings are being issued by the various hearing protection organisations about how these gadgets, played at excessive volume, are setting us up for a future of hearing problems and deafness. Perhaps not the best present for a doctor to give after all —back to the drawing board.
Actually, come to think of it, I can't think of anything more irritating than sitting next to someone listening to their MP3 player too loudly. The tinny frenetic beat of their always utterly-unsuitable-for-the-time-of-day music is impossible to shut out.
It's the modern-day equivalent of the Chinese water torture. I have started asking people to turn theirs down.
But experts would say that I am doing these headbangers a favour. London commuters face the greatest risk of all as the noise on the Underground means that the devices have to be played at potentially damaging volume levels to be heard.
Hearing specialists are warning that for young people this is a huge problem and that prolonged listening could lead to permanent damage.
It's not an exaggeration. I have certainly seen an increase in young people coming to see me in clinic with ear problems, mainly tinnitus or dullness to their hearing, and on questioning they nearly all use MP3 players and go to concerts regularly.
Tinnitus can be an early sign of hearing damage due to noise, and occurs when the sensory hair cells in the cochlea are damaged by loud sounds. Some ear, nose and throat specialists explain the damaging effect of the noise exposure on the inner ear as being similar to the effect of a storm on a field of corn, flattening and damaging the stalks.
Proposals have been made to limit the maximum volume of a player to 100dB. As a rough guide to decibels, if you are listening to sound at 70dB it's possible to hold a conversation at normal volume; at 90dB one needs to talk loudly; at 100dB loud shouting is necessary, and from 105dB upwards it is no longer possible to hear speech at all.
Most MP3 players have a maximum volume of 125dB (equivalent to the sound of an aeroplane engine a few metres away, and more than 40dB more than generally permitted noise levels for a working environment), and according to a British study, 39 per cent of 18-24-year-olds listen to music for at least an hour a day at close to this upper volume limit.
This creates a serious danger of becoming deaf within about five years — and herein lies the problem. The damage can take a long time to show up and therefore is of no real concern to young people now.
One audiologist has even predicted that at current rates one third of young people using MP3 players today will need a hearing aid by the time they hit 50.

Sex and booze and the festive"spirit"

2009-12-10T05:24:00.000-08:00

An advantage of the Virgin Birth was that it neatly bypassed the risk of catching STIs. Before you accuse me of blasphemy there were significant numbers of STIs around, even in Jesus’ day. Indeed his persecutor Herod was thought to have died of syphilis, a common disease of the time, his death following internal pains and burning sensations, swelling of the feet, convulsions, an ulcerated colon, putrefied and worm-eaten genitals, and very, very bad breath. Many biblical stories and particularly the list of rules offered in parts of the Old Testament merely give practical medical advice on how to stay fit and healthy during those times. Most is utterly outdated today of course but it’s interesting to read how circumcision, mandatory in biblical times, has now been shown to reduce infection rates of herpes, HPV and to a lesser extent HIV. As the world turns full circle and another Christmas approaches the threat of syphilis and other STIs remains ever present, but unfortunately for our STI and teen pregnancy stats virgin births seem few and far between. The NHS is launching a campaign warning Londoners about ‘Christmas Chlamydia’ as the party season approaches. This is inspired by research showing that a quarter of under 25 year olds admitted having unprotected sex during last year’s festive season, of which 60% were left unsure whether they had caught the sexually transmitted infection or not. The main culprit, of course, is alcohol. Sex and alcohol is a powerful combination that frequently leaves you with more than you bargained for. Alcohol based stats show that more than one in ten 18 – 34 year olds in London have had sex with someone they just met due to the influence of alcohol at a party over the festive season, more than one third admitted to having sex under the influence of alcohol that they wouldn’t have had if sober, nearly two in five have had sex that they regretted the morning after it happened and the majority have drunk to the point where they would describe themselves as ‘out of it’. Women are also more at risk of an unplanned pregnancy during Christmas and New Year than at any other time. Marie Stopes International is so aware of the problem that they have advised women to stock up on emergency contraception to cover this season. They have also put together festive family planning pack (containing two condoms, two luminous spikeys [to stop people spiking your drink], the Emergency Contraception pill Levonelle 1500, a pocket sized Christmas sexual health guide and even a festive chocolate) priced at £15 in an effort to reduce the incidence of unwanted pregnancies and infections. The excess of alcohol and the general over-excited atmosphere of the dreaded office party lead to fewer inhibitions and more casual hook ups, again upheld by the stats which reveal that almost one third of those surveyed claimed to have had sex with a colleague either during or after an office party. This then makes less surprising the news that in January and February of 2007, more women than ever before in MSI’s thirty year history, attended its nine UK centers for abortion services and official statistics show that the first quarter of every year always produces the highest numbers of women having abortions.But there is a darker side. Along with the increased alcohol and reduced inhibitions comes increased vulnerability. Sexual consent can be a confusing subject at the best of times. Add in buckets of alcohol and the pent up frustration of the past year spent flirting at the photocopier and things can get badly out of hand. But to the police there are no grey areas with regards to sex without consent: if there is doubt, it’s treated as rape.
If you have had unprotected sex over the festive period, a test for sexually transmitted infections is advisable, even if you don’t have symptoms, and if you are a woman and don’t want to be pregnant, visit your local pharmacy, doctor’s surgery or sexual health clinic for emergency contraception as soon after the unprotected sex as possible. All this can be avoided, however, by making sure you carry condoms with you; in AD2009 this is no longer seen as meretricious.

Doctors must stop refusing to confront Aids

2009-12-02T03:27:00.000-08:00

Yesterday was World Aids Day. It's a hugely important event given that there are more than 33 million people living with HIV worldwide and it is the number one killer of women aged 15-44. It matters.
New research offers some hope that the number of new Aids cases is decreasing but fear and misunderstanding of HIV are still, even in 2009, hindering the introduction and implementation of more improvements.
HIV prevention programmes are having an impact but as in so many areas of sexual medicine shame, embarrassment and ignorance are our greatest opponents. And then comes stigma and taboo, which are still rampant.
As long as discrimination exists, people will be much less willing to get tested. My faith in human nature is sorely tested when I hear, even today, people stating that HIV and Aids is revenge from God for promiscuity.
Continental Europe is streets ahead of us, promoting greater openness and understanding in dealing with sexuality, including teen sexuality.
This has created wider and easier access to sexual health information and services for people of all ages.
Most important for me is that in Europe political and religious interest groups have little influence on public health policy.
This means that the stigma of sexually transmitted infections (STIs) is just not there - going for a check-up is seen as being cool and responsible.
How have they achieved all this? For a start, doctors make STI screening and HIV testing part of normal GP practice.
Ours, in many cases, do not. Ignorance and stigma apply not just to the public's attitude but also, I'm ashamed to say, to my colleagues too.
Many UK doctors still view HIV/Aids as a specialist subject and one that they do not feel confident or willing to get involved with.
HIV is now so prevalent, especially in a large city such as London, that it must now been seen as part of normal, everyday general medicine.
While I agree that the management of HIV-positive patients does indeed require expert care, basic advice and, in particular testing, does not. Any doctor should be able to do it.
There are still far too many GPs who refuse to do HIV tests and send their patients to GUM (genito-urinary medicine) clinics instead.
This sort of insensitive handling only adds to the stigma, and decreases the public's willingness to be tested.
It can take a lot of courage for some people to seek help and one callous comment - even if unintentional - from a stressed doctor can do untold damage.
GPs do an incredible job (for little thanks and many complaints) and are probably in the best possible position to make a difference.
All too often many of us allow personal prejudice, religious beliefs or even academic ambitions to affect the way we practice.
This must stop if doctors are ever going to improve medicine and come crawling from the 20th century into the 21st.
We alienate ourselves at the expense of our patient's health and I am sorry to say that I suspect we may compound the problem of worsening STI and HIV figures in many cases, instead of helping to lower them.

A green planet is a healthier world

2009-11-26T04:30:00.000-08:00

We doctors were always taught about the various diseases as if they were separate, individual afflictions, with little interaction.
The fact that a multitude of other factors, including environmental ones, also strongly influence disease was rarely discussed.
If we have been a bit slow on the uptake, those heading the campaign on climate change certainly haven't.
Frustrated by the slow response from many of us to their pleas to make "green" changes to our lifestyles, they have sought new ways to bribe us into submission - and come up with the impact that climate change could have on our health as a topic that hopefully will get us listening.
Health Secretary Andy Burnham has declared that health should now be at the centre of our fight against climate change and has called upon ministers and professionals across the world to recognise the danger that climate change poses to public health.
Wherever we live in the world the climate has powerful impacts on human life. We are brilliantly designed to live in many environments but there are limits.
Extremes of heat and cold can cause potentially fatal illnesses and research has shown that they can increase death rates from heart and respiratory diseases.
It's already happening. Heatwaves across Europe cause thousands of deaths and the recent flooding in Cumbria disrupted many lives, significantly increasing the risk of disease.
The majority of people rely on safe drinking water, sufficient food, secure shelter and good social conditions to ensure their health.
A changing climate is likely to adversely affect all of these conditions.
It's clear to see how changing ecological systems may affect the prevalence and range of infectious diseases.
Vector-borne diseases such as malaria, dengue fever, yellow fever and encephalitis are currently among the largest global killers.
It has been predicted that the global population at risk from malaria will increase by between 220 million and 400 million in the next century.
While it is unlikely that climate change would cause malaria to become re-established in somewhere like London, the overall effects of a rapidly changing climate on health are likely to be overwhelmingly negative, particularly in the poorest communities - which ironically have contributed least to greenhouse gas emissions.
One reason we in the West have done so little about it is that most of these climate-related disasters occur in developing countries.
Perhaps if we started to suffer from them saving the environment would become more of a priority.
There are added benefits to getting greener. Cutting down on red meat consumption means livestock numbers can be reduced, lowering methane emissions but also improving our diets, particularly our saturated fat intake.
As is so often the case it's the elderly, the very young, the homeless and the poor who are especially vulnerable to increase risk of disease.
Darwin would certainly have something to say on this but only the fittest being able to survive is no longer acceptable.

Stress has many causes and symptoms

2009-11-20T05:50:00.000-08:00

We all need a certain amount of pressure in our lives to make our work satisfying and help us meet our deadlines.
But too much pressure without having the chance to let off steam causes stress. Of course, what is stressful for one person may not be stressful for another. Some thrive on it while others crumble.
If you feel that you are always rushing about, trying to be in too many places at once, missing meal breaks, for ever taking work home with you, and never seem to have enough time for exercise, relaxation or spending time with your family, then you may well be at risk of developing stress-related problems.
Stress is caused by a wide variety of different situations, and so can also have a wide range of symptoms. I tend to divide these into physiological, psychological and behavioural symptoms.
Physiological symptoms caused by stress include headaches, migraines, stomach disorders, raised blood pressure, changing sleep patterns, muscle spasms, back/shoulder/neck pain, general malaise and an unwillingness to work.
Psychological symptoms can cause you to grow resentful towards your work, making it a place of anxiety, tension and the cause of irritability, low self-esteem and forgetfulness. It can even lower your sex drive.
Finally, behavioural symptoms can cause sufferers to becoming irritable, aggressive and withdrawn, and to stop communicating.
An affected person may show signs of changes in eating and sleeping patterns; they may drink and smoke more, and even start excessively self-medicating.
Of course, these will also affect home life, making them more “difficult” outside work, less able to cope with their family and maybe even neglecting their hygiene and personal appearance.
There is rarely any one single cause of work-related stress.
While sudden, unexpected pressures can trigger it, it is often the result of a range of stressful factors that build up over time. If they are left undetected and untreated, they can reach boiling point and cause a full mental breakdown.

Why sport is a vital goal for women

2009-11-13T06:50:00.000-08:00

A local school in Lambeth, near to where I walk my dog, is the venue Sport England has chosen to announce the launch today of its new £10 million campaign targeted at getting women from disadvantaged communities to play more sport.
Even Gordon Brown is urging a cultural change that allows girls to see sport and physical activity as aspirational - something that is most definitely not the case now.
Many girls enjoy games such as netball and hockey at school but as soon as they leave often all sporting activities stop. This is a shame.
The statistics show that campaigns of this sort really are needed.
There has been almost no change in the level of women's physical activity in the UK for the past 20 years, with 80 per cent of women doing too little exercise to benefit their health.
Twice as many men play competitive sports as women and six out of 10 women prefer exercising alone to team sports. Is this because sporty athletic girls are seen as unfeminine and female team sports a little too sweaty and "butch"?
I suspect that early experiences at school (don't we all have memories of terrifyingly masculine PE teachers hurling medicine balls at us?) have a greater impact on how girls perceive sport, and this is backed up by some evidence.
Research has shown that nearly a quarter of women say that PE at school put them off sport, two in five girls felt selfconscious about their bodies in PE lessons and a quarter of women hate the way they look when exercising or playing sport.
I remember having to play in "skins" (meaning top off) as one team colour as opposed to "shirts" (top on) and absolutely hating it, feeling terribly self-conscious, but I suspect getting small boys to run around with their tops off is forbidden now. I did go to a public school, after all.
This has got me thinking about the way we doctors sell the idea of exercise to our patients. I tend to say "join a gym" as an automatic response when discussing weight loss, as this is the London thing to do.
Talking to my colleagues has confirmed that this seems to be the standard advice that most of them give. But is the gym quite the same, and does it have the same benefits as a team sport? I favour the mindless gym as my own choice of training.
I work out admittedly a little excessively and go about five times a week, which means I like to think I am pretty fit. But I suspect my speed, agility, balance and endurance are actually very poor.
I lift weights in the main which will make me strong but that's about it.
Playing sport would certainly redress this imbalance. So this idea has struck me as rather a good one, and perhaps something we should be suggesting more - and gym membership a little less.
The benefits of sport go far beyond simple weight loss.
We know that women who play sports do better academically; they have improved learning, memory, and concentration, giving active women an advantage.
Sport teaches teamwork and goal-setting skills; important in business where teaming up with others to meet goals can be the key to success.
Some benefits of sports are immediately obvious - such as improving fitness and maintaining a healthy weight, but women who play sports are less likely to smoke and have reduced chances of getting breast cancer and osteoporosis later in life.
We also know that women involved in athletics feel better about themselves, both physically and socially, and playing sports can help deal with stress and fight depression. I don't know why I didn't think of it before.

Stop being so selfish and get the swine flu vaccine

2009-10-15T06:03:00.000-07:00

The swine flu vaccine has finally been developed and approved and is about to be rolled out across the UK amid a flurry of controversy.Should pregnant women get it? Do I really need it if I'm young, fit and healthy? Should I get the seasonal flu vaccine, too?
The anti-vaccine lobby suggest we are using claims of an impending emergency to rush medical products through the usually tight controls to the detriment of their safety.
They state that the swine flu jab hasn't been properly tested or put through the normal process of long-term safety testing that the public expects.
They also argue that because the fatality rate from swine flu is remarkably low, in fact no higher than seasonal flu, there is no real need for a vaccine at all.
Most other non-live vaccines and previous flu vaccines are safe for pregnant women to be given, and as they are more likely to be hospitalised if they catch the flu it seems sensible they are vaccinated.
The European Medicines Agency has given a clear recommendation that the GlaxoSmithKline vaccine can be given safely to pregnant women and side-effects will be monitored closely during the initial campaign.
The Department of Health has issued a dramatic statement claiming that the risk of swine flu is so great that patients' health will be put at risk and the NHS left understaffed through illness if the majority of its workers are not vaccinated.
Many NHS nurses see the jab as unnecessary and potentially unsafe.
To add to the mêlée, some very up-to-date reports of Canadian research suggest the possibility that having the seasonal flu jab could double your risk of developing swine flu.
No wonder NHS Direct is already swamped with calls.
This is an unfortunate example of the medical establishment's attempts at reassurance and calls for calm backfiring on them.
The repeated reminders of the benign nature of swine flu, and the recent claim that the UK is "tantalisingly close" to beating the virus, is making many believe that vaccination is neither important nor necessary.
My view is that frontline staff should strongly consider the vaccine, especially those working with very ill patients.
As was proved in round one of the swine flu attack, most of us who got it were relatively mildly ill for a short time but it did kill those with pre-existing conditions.
I will be getting vaccinated because, as a London doctor, I am almost certainly going to be exposed to the virus by my patients.
I often see the elderly and the frail and those with serious immune diseases so I need to be sure that I will not be passing this potentially life-threatening virus on to them.
Flu can kill the vulnerable. Nor do I want to give it to my grandmother on a Christmas visit.
Perhaps we need to start thinking about this issue a little more altruistically?

Dr Christian wears Hawes & Curtis

2009-10-13T15:09:00.000-07:00

Traditional shirtmakers from Jermyn Street have been coordinating my outfits for Embarassing Bodies & Supersize vs Superskinny. The vibrant colours combined with elegant, subtle tailoring paired with an impressive array of bold stripes and checks have been my choice since series one.

After so many enquiries about the shirts I wear on TV I have decided to write in here where I get them from.

I often wear Hawes & Curtis off screen too in clinic as they are always very smart and definitely not boring.

Jacko's Death Highlights abuse of prescription drugs

2009-07-10T12:33:00.000-07:00

Another death and so another issue becomes ‘hot’ this week. This time it’s misuse or abuse of prescription drugs following the death of Michael Jackson. I’m not sure the issues are quite the same in the UK. Patients here don’t have doctors at their beck and call in quite the same way as they do in, say, the US. There, the very nature of the way doctors are paid means that they have a greater need to keep their patients happy and coming back to them, which dare, I say it, means providing them more readily with the prescriptions they ask for (I now ready myself for indignant letters from American medics...) It is now claimed that the abuse and trafficking of prescription drugs, including painkillers and stimulants, has overtaken the use of nearly all illegal drugs.
If you think about it from the addicts point of view this shouldn’t really be that surprising: medications containing narcotic drugs or psychotropic substances can provide a high comparable to practically every illicitly manufactured drug when taken in appropriate (or perhaps that should be inappropriate) quantities, but without the risk of them being ‘cut’ with various noxious substances by the dealer. Fentanyl, a painkilling drug is thought to be around 80 times more potent than heroin and is pure. Why would you ever go back to heroin?
The two most commonly abused drug groups are opioids and benzodiazepines. They are usually prescribed for short-term use but they may also be prescribed for chronic pain or generalized anxiety and this is where the problem starts.
The body becomes tolerant to their effects and so larger doses of the drugs are needed to achieve the same effect. Doses get gradually higher until patients are taking huge quantities and become completely dependent.
Addiction is different. Addicts tend to be reliant on the regular use of a drug to satisfy physical, emotional, and psychological needs so that the drug begins to take over their lives and becomes more important than anything else. There are many housewives who are unidentified addicts. Started on antidepressants during a bad patch a year or so ago they become convinced that they now cannot function without their tablets. They depend on them emotionally and getting them off them will be a Herculean task.The elderly are particularly at risk. It’s estimated that as many as 17% of adults 60 and over abuse prescription drugs.
This is because there is less likelihood that an elderly person will comply with directions. We docs give advice like ‘always take with food’, ‘don’t drink alcohol with these pills’, ‘finish the course’, or even, in the case of addictive drugs, ‘only take for a short time and don’t sell your pills to dodgy looking blokes down the pub’, but this advice is rarely stuck to. Doctors are also much more likely to prescribe addictive medications to elderly patients than to younger ones.
But possibly a more acute problem in the UK is the effect that the pressures of looking good seem to be having on our fitness fanatics. A survey of male and female gym users last year found that 10 % used diuretics, 10% had used thyroxine, 14% insulin, 22% tamoxifen, 24% growth hormone and 44% had used ephedrine to boost their fitness.
And the issue of body dysmorphia is increasing in young men so that steroids remain the most abused drug, and even 7% of women admit to taking them. This is still abuse of medications, even if it’s not the addictive ones. I’m not sure that as a nation we are all hooked on painkillers, but we clearly have plenty of demons to fight.

It's not the doctor's fault that recession breeds depression

2009-07-10T12:07:00.000-07:00

The powers that be, or in this case the powers that want to be; the Lib Dems, have reported that we docs are prescribing too many antidepressants. Their new report claims an increase of 2.1 million scripts for the drugs in 2008. Apparently we need to tackle this issue and reduce our prescribing. But are they really all completely unnecessary prescriptions, or are there simply more depressed people around? Or is there an absence of other treatment options easily available for doctors to access?

It’s considered very bad management to have a patient commit suicide on you, especially if he has been in the week before to make clear his unhappy mind, and so doctors naturally feel some sort of positive intervention must be made quickly.

A 10 minute appointment is really only long enough to write out a prescription.I have found myself asking why we are even setting targets to reduce the growth in prescribing of anti-depressants. Why are they seen as a bad thing? They are an evidence-based treatment that is appropriate to the particular malady and they allow patients who previously would have been disabled by their mental health condition to return to a normal life and give them the confidence to tackle their once insurmountable problems.

We should really be asking why there are so many depressed people around.The truth is that the recession (and I know this has now become the excuse for everything) is doubtlessly affecting the mental health of the nation. GPs are offering drug treatments because most do not have many other options. Access to therapists, psychiatrists and counsellors is limited and waiting lists are long. Mrs Creak with her achy hip can safely wait a few months to see an orthopaedic surgeon, Mr Gloom with his black mood and suicidal ideation cannot. Antidepressants may not remove the cause of the problem it is true. Popping pills wont resolve a failing business or an impending redundancy, but they at least help the patient to better ride out the storm.

Norman Lamb, the Liberal Democrats' health spokesman says "The increase in the number of people being prescribed antidepressants is deeply disturbing.” Yes Mr Lamb, it is. It implies the nation is not coping, not that GPs are overzealously handing out happy pills. We do need more alternative therapies to help counter the increasing reliance on antidepressants, but they are just not available. The government has already committed millions to plug gaps in mental health provision and has promised to train thousands more therapists and hundreds more specialist nurses. But that is for the future.

They are not here now. I think an effective solution would be to recommend good financial and debt management advisors to those caving in under the economic uncertainties. They would be able to come up with far more useful advice, and they will have longer than 10 minutes to do it in.

Men’s Health Week

2009-07-02T05:58:00.000-07:00

Men’s Health Week has just come and gone. I know it’s confusing given we already have prostate week, erectile dysfunction week, testicular cancer week, male menopause week, testosterone week and many others. What bits could be left to cover?

Looking at the statistics of GP attendances in the UK for last year and also at the top 10 causes of death that’s easy to answer: men actually taking any notice of their general health whatsoever would be a good start. Can I just point out here that grunting away on a pec dec at it’s heaviest setting once a week and occasionally slapping on some high-tech-packaged moisturiser doesn’t count as health care. It’s vanitiy.

It may well help us to find a mate which could in time allow us to pass on our genes, arguably our primary role in life, but it’s not ging to do much to make us healthy. Men are notoriously bad at going to their GPs when they are ill, and alarmingly good at ignoring problems. In fact research shows that women are 100% more likely than men to seek preventative health care. It’s a male pride thing you see, a machismo deeply ingrained by evolution. Illness is weakness, and it would never do to admit to being weak.

It’s also to do with background access to healthcare in general. Women realise from a young age that it’s ok to talk about their bodies; their periods start and they talk about that. Then come family planning issues, with an ensuing visit to the GP’s in many cases, then babies, smear tests, mammograms, more babies and finally menopause and HRT. She is often at the GP or having some sort of medical consultation.

For man it’s a different story with most presenting to their GP’s for the first time when they hit 50 because the prostate is starting to play up. And having to talk to another bloke about his undercarriage is a mortifying new experience for which life so far has left him totally unprepared. It’s unfortunate for men that so often the bits that seem to go wrong first are the really embarrassing ones: testicles and lumps thereon, prostates with their sexual and urinary sequelae, erection probs, man boobs. Our smugness at not having to go through the hell of ‘women’s problems’ is now making us look foolish as we now die at higher rates than women from the top 10 causes of death.

We also die six years earlier than women on average. In the current economic climate men are experiencing high levels of stress, longer working hours and for many a less secure home life. This will inevitably lead to increased anxiety, depression, hypertension and heart disease. They are all treatable, as are many cases of male cancers, but only if we catch them early enough. To do that men need to start taking an interest in their long-term health, recognise and respond to health warnings and seek help when they need it.

They need to get more in touch with their feminine side when it comes to their health and take as much pride in going for a check up at their GP’s as they do in their grooming and appearance.

Acupuncture helps, but so does a back rub.

2009-06-23T03:29:00.000-07:00

New guidelines tell GPs that they should now offer acupuncture to their patients with chronic back pain. This is the first time an alternative therapy has been backed in this way and smacks of desperation. What worries me most is their reasoning. The guidance says anyone whose pain persists for more than six weeks should be given a choice of several treatments, because the evidence about which works best is so uncertain. Translated for you into plain English it says ‘we have no idea so might as well try them all and hope one works.’ And this is supposed to have come from the National Institute of Clinical Excellence. Makes you think.

Results showing the ineffectiveness of most alternative remedies continue to pour out and so, in what I have to admit is a quite brilliant move, the peddlers of this snake oil have had a change of semantics. Instead of ‘alternative’ the treatments are now known as ‘complimentary’ i.e. they are now supposed to be used alongside traditional medical treatments. If that doesn’t sound like an admission of their uselessness I don’t know what is. (If I sound a little closed to other ways of treating illness then forgive me. I am not. What I am utterly opposed to is the dressing up of unsubstantiated mumbo jumbo witchery as science, coupled with a very selective reading of the ‘evidence’.

The truth is that back pain is difficult to treat and rarely has an easily identifiable cause. It one on a list of many heart-sink complaints that GPs dread hearing, like ‘I’m tired all the time, doctor’ or ‘I don’t feel right in myself.’ For many doctors this decision will come as mana from heaven -finally something to help get the patients out of the consulting room door on time AND they feel like we have actually been helpful. Doctor happy, patient happy, but commonsense, logic and 200 years of medical science have just been shat upon. Trials looking at the efficacy of acupuncture have shown that it helps a bit, for some people, but so does sham acupuncture (sticking needles anywhere) and so does jabbing the skin with toothpicks. And come to think of it so does a cup of green tea, a good chat with a friendly looking therapist and a back rub. And perhaps that is the key: time and a sympathetic ear, certainly lacking from many GP consultations today. If time and money were spent on improving access to GPs and the amount of time they can spend with their patients I’m certain that many chronic conditions would improve, without the need to fool and insult patients with sham quackery.

Welcome to my very first post

2009-06-16T18:42:00.000-07:00

In here I would like to write about things I am so often asked but for some reason have not yet found the time or space to answer.

Thank you all for the lovely emails to my website and messages on my Facebook profile, they really made me realize how keen you are to find out more about getting fully fit, healthy eating, wellbeing and other such stuff. I'm also going to write in general about things that interest me, and hopefully they might interest you too.

This week has been very very busy, filming in Southend on Sea today for my new Channel Four show about cosmetic surgery -The Ugly Face of Beauty. It's going to be a cracking show and I hope will make people realise the crying need for more regulation and control over the cosmetic surgery industry. And we filmed some amazing surgeries too.

Londoners need a trendy sex clinic

Despite decades of pleading from doctors to take the nation's sexual health more seriously, the Government is only just getting round to addressing the issue.
Its answer, as is so often the case, is to throw money at the problem, and so bring on a shiny new walk-in centre in Soho, complete with designer wallpaper and wi-fi access.

The glossy brochure looks like an advert for a new Grouchoesque members' club and its pages boast that "the colours, finishes and quality of materials and furnishings have created an inviting, comfortable, reassuring and stylish environment".

My gut reaction was to groan at the vast sums of taxpayers' money wasted on hardwood flooring and Cole & Son's wallpaper instead of medical supplies but the great difference between sexual medicine and most other specialities is that its success relies on getting people through the door and screened, not on expensive drugs or high-tech equipment.

Many STIs do not cause any symptoms and so people need to volunteer themselves for regular screening if we are to get on top of the problem.

Most NHS clinics I've worked in were around the back of the main hospital building, seedy, dirty, badly lit and certainly not places you wanted to be seen coming out of. Even the discipline itself, ungraciously called veneriology, was part of the dermatologist's remit. It's now a glorious speciality in its own right.
This new clinic offers exactly the same services as most other GUM clinics but the big difference is that it is trendy and welcoming, even, dare I say it, "cool".

Here's hoping that the bright young things agree with me and don't mind being seen coming out, for then our battle is half won.