History > 2008 > UK > Health (I)

Health:

Britain lags behind

in world cancer survival,

says study

Thursday July 17, 2008
The Guardian
Sarah Boseley, health editor

Cancer survival rates in the UK lag behind much of the rest of the world, according to the first-ever global study, published today, which puts the United States, Canada, Australia, Japan and France at the top of the league.

The study, led by the leading cancer epidemiologist Professor Michel Coleman, from the London School of Hygiene and Tropical Medicine, compared data from 31 countries, including the UK's four nations. Comparative information exists on death rates and on the numbers of people getting cancer, but not on those who survive for at least five years - largely a measure of the success of the care patients get.

The results see the US take pole position in breast and prostate cancer survival and second place in colorectal cancer survival for both men and women. On the numbers alone Cuba beats the US, with the best survival rates in all but prostate cancer. But the researchers say the absence of valid data on a quarter of the Cuban deaths means its success is probably over-estimated. Bottom of the league by a long way is Algeria.

England comes 22nd in breast cancer survival rates, 19th in prostate cancer survival and 21st and 22nd respectively in women's and men's colorectal cancer survival.

Northern Ireland and Scotland do slightly better and Wales slightly worse. The Trent region had the lowest survival rate in England for all the cancers.

More than 100 scientists were involved in the study, which collected data on 1.9 million adults who were diagnosed with a first invasive cancer between 1990 and 1994 and were followed up to 1999 to establish whether or not they had survived for five years.

The UK's low position in the league table will reignite controversy over government health policy. The government says the UK is now doing much better, because of the substantial investment in health in recent years. But the most recent European data, from the Eurocare 4 study of patients diagnosed in 1995-99 and followed up to the end of 2003, showed that the UK had improved, but was still below the European mean survival rate for most common cancers.

According to Coleman, the most interesting finding from the study is how, in some countries patients appear to get good care wherever they are - which is not the case in the US, despite its apparently good performance.

"The geographical variations in Canada and Australia are very limited," he said. "The Australian and Canadian picture shows pretty uniform access and high quality care."

The survival differences between the UK and Australia have been noted before, the scientists say in their paper. "Elderly women in England had especially poor survival. More effective treatment in Australia is a plausible explanation."

The study shows substantial variations in survival across the 31 countries. It concludes that the main issue is probably differences in access to diagnostic and treatment services: how rich a country is and how much it spends on cancer care.

Health: Britain lags behind in world cancer survival, says study, G, 17.7.2008, http://www.guardian.co.uk/society/2008/jul/17/health.cancer

We have created

human-animal embryos already,

say British team

April 2, 2008
From The Times
Mark Henderson, Science Editor

Embryos containing human and animal material have been created in Britain for the first time, a month before the House of Commons votes on new laws to regulate the research.

A team at Newcastle University announced yesterday that it had successfully generated “admixed embryos” by adding human DNA to empty cow eggs in the first experiment of its kind in Britain.

The Commons is to debate the Human Fertilisation and Embryology Bill next month. MPs have been promised a free vote on clauses in the legislation that would permit admixed embryos. But their creation is already allowed, subject to the granting of a licence from the Human Fertilisation and Embryology Authority (HFEA).

The Newcastle group, led by Lyle Armstrong, was awarded one of the first two licences in January. The other went to a team at King’s College London, led by Professor Stephen Minger. The new Bill will formalise their legal status if it is passed by Parliament.

Admixed embryos are widely supported by scientists and patient groups as they provide an opportunity to produce powerful stem-cell models for investigating diseases such as Parkinson’s and diabetes, and for developing new drugs.

Their creation, however, has been opposed by some religious groups, particularly the Roman Catholic Church. Cardinal Keith O’Brien, the head of the Catholic Church in Scotland, described the work last month as “experiments of Frankenstein proportion”.

The admixed embryos created by the Newcastle group are of a kind known as cytoplasmic hybrids, or cybrids, which are made by placing the nucleus from a human cell into an animal egg that has had its nucleus removed. The genetic material in the resulting embryos is 99.9 per cent human.

The BBC reported that the Newcastle cybrids lived for three days, and that the largest grew to contain 32 cells. The ultimate aim is to grow these for six days, and then to extract embryonic stem cells for use in research.

Once the technique has been tested, scientists hope to create cybrids from the DNA of patients with genetic diseases. The resulting stem cells could then be used as models of those diseases to provide insights into their progress and to test new treatments.

It is already illegal to culture human-animal embryos for more than 14 days, or to implant them in the womb of a woman or animal, and these prohibitions will remain in the new legislation.

Using cow eggs reflects a short supply of human eggs. There are also ethical difficulties involved in collecting human eggs for research, as the donation process carries a small risk to women.

Professor John Burn, a member of the Newcastle team, told the BBC: “This is licensed work which has been carefully evaluated. This is a process in a dish, and we are dealing with a clump of cells which would never go on to develop. It’s a laboratory process and these embryos would never be implanted into anyone.

“We now have preliminary data which looks promising but this is very much work in progress and the next step is to get the embryos to survive to around six days, when we can hope-fully derive stem cells from them.”

The Newcastle team’s decision to announce its success on television, before its results have been published in a peer-reviewed journal, will also trigger criticism from scientists.

Medical researchers said last night that the experiments were important, but that they wanted to see published details before passing judgment on their merits.

We have created human-animal embryos already, say British team, Ts, 2.4.2008, http://www.timesonline.co.uk/tol/life_and_style/health/article3663033.ece

Antidepressant drugs don't work

– official study

Tuesday, 26 February 2008
The Independent
By Jeremy Laurance, Health Editor


They are among the biggest-selling drugs of all time, the "happiness pills" that supposedly lift the moods of those who suffer depression and are taken by millions of people in the UK every year.

But one of the largest studies of modern antidepressant drugs has found that they have no clinically significant effect. In other words, they don't work.

The finding will send shock waves through the medical profession and patients and raises serious questions about the regulation of the multinational pharmaceutical industry, which was accused yesterday of withholding data on the drugs.

It also came as Alan Johnson, the Health Secretary, announced that 3,600 therapists are to be trained during the next three years to provide nationwide access through the GP service to "talking treatments" for depression, instead of drugs, in a £170m scheme. The popularity of the new generation of antidepressants, which include the best known brands Prozac and Seroxat, soared after they were launched in the late 1980s, heavily promoted by drug companies as safer and leading to fewer side-effects than the older tricyclic antidepressants.

The publication in 1994 of Listening to Prozac by Peter Kramer, in which he suggested anyone with too little "joy juice" might give themselves a dose of the "mood brightener" Prozac , lifted sales into the stratosphere.

In the UK, an estimated 3.5 million people take the drugs, collectively known as selective serotonin reuptake inhibitors (SSRIs), in any one year and 29 million prescriptions were issued in 2004. Prozac, the best known of the SSRIs made by Eli Lilly, was the world's fastest-selling drug until it was overtaken by Viagra.

In the study, researchers conducted a meta-analysis of all 47 clinical trials, published and unpublished, submitted to the Food and Drug Administration in the US, made in support of licensing applications for six of the best known antidepressant drugs, including Prozac, Seroxat – which is made by GlaxoSmithKline – and Efexor made by Wyeth. The results showed the drugs were effective only in a very small group of the most extremely depressed.

Two drugs were excluded from the study because of incomplete data. A third drug, chemical name nafazodone, has been withdrawn from the market because of side-effects.

Professor Irving Kirsch of the University of Hull, who led the study published in the online journal Public Library of Science (PLoS) Medicine , said the data submitted to the FDA would also have been submitted to the licensing authorities in Britain and Europe. It showed the drugs produced a "very small" improvement compared with placebo of two points on the 51-point Hamilton depression scale.

That was sufficient to grant the drugs a licence but did not meet the minimum three-point difference required by the National Institute for Clinical Excellence (Nice) to establish "clinical" significance. Yet Nice approved the drugs for use on the NHS in the UK because it only had access to the published trials, which showed a larger effect.

Professor Kirsch said: "Given these results, there seems to be little reason to prescribe antidepressant medication to any but the most severely depressed patients, unless alternative treatments have failed to provide a benefit. This study raises serious issues that need to be addressed surrounding drug licensing and how drug trial data is reported."

Five years ago, there were allegations that antidepressant drugs were addictive and could trigger suicides. All but Prozac were banned for children, although a major investigation on the safety of medicines cleared them of causing suicide in adults.

Alternative treatments for depression, such as counselling or physical exercise , should be tried first, Professor Kirsch said. The pharmaceutical companies had withheld data that was available to the licensing authorities so that doctors and patients did not understand the true efficacy, or lack of it, of the drugs.

"This has been the frustration. It has made it very difficult to answer the question of whether the drugs work. The pharmaceutical companies should be obliged when they get a drug licensed to make all the data available to the public. When you analyse all the trials of these SSRIs, both published and unpublished, it leads you to more sober conclusions," he said.

Tim Kendall, deputy director of the Royal College of Psychiatrists' research unit, said the findings, if proved true, would not be surprising. As head of the National Collaborating Centre for Nice guidelines on mental health, he said it had proved impossible to get access to unpublished trials in the past.

"The companies have this data but they will not release it. When we were drawing up the guidelines on prescribing antidepressants to children [in 2004] we wrote to all the companies asking for it but they said no. The Government pledged in its manifesto to compel the drug companies to give access to their data but that commitment has not been met."

The new finding would make doctors "much more cautious about prescribing the drugs," Mr Kendall added.

GlaxoSmithKline, makers of Seroxat, said the authors of the study had "failed to acknowledge" the very positive benefits of SSRIs and their conclusions were "at odds with the very positive benefits seen in actual clinical practice." A spokesperson added: "This one study should not be used to cause unnecessary alarm for patients.

Lilly said in a statement: "Extensive scientific and medical experience has demonstrated that fluoxetine [Prozac] is an effective antidepressant.

Wyeth said: "We recognise the need for both pharmacological and non-pharmacological treatments for depression."

On the new training for therapists, Mr Johnson said the programme signalled a decisive shift away from drugs in favour of non-drug treatments for depression. "We are not taking the decision away from clinicians," he said.

"For many, medication is successful. But talking therapies can have dramatic effects. We have put a lot of emphasis on medication in the past and it is about time we redressed the balance and put more emphasis on talking treatments."

The treatments that do work

* Exercise: Helps some people with depression. Douglas Adams, author of The Hitchhiker's Guide to the Galaxy, said running helped him cope with depression.

* Friends: Talking through your feelings can help in mild depression with a friend or relative or in a self-help group.

* Cognitive behavioural therapy: Teaches you to challenge negative thoughts and feelings of hopelessness.

* Interpersonal therapy: Focuses on relationships and problems such as difficulties with communication.

* Counselling: Helps you think about the problems in your life and find new ways of dealing with them.

* Antidepressants: Increasingly seen as a second-line treatment, if exercise or talking treatments do not work.

Antidepressant drugs don't work – official study, I, 26.2.2008, http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/antidepressant-drugs-udontu-work-ndash-official-study-787264.html

Alcohol-related deaths

have doubled in 15 years,

report says

Saturday January 26, 2008
Guardian
John Carvel, social affairs editor


A sharp increase in the number of middle-aged people drinking themselves to death was revealed yesterday.
The Office for National Statistics (ONS) said alcohol-related fatalities among all adult age groups in Britain more than doubled from 4,144 in 1991 to 8,758 in 2006.

But the steepest increase was among men aged 35 to 54, who were falling victim to cirrhosis of the liver and other alcohol-induced diseases at a younger age than before. The alcohol-related death rate for this group rose by 132% from 13.4 deaths per 100,000 in 1991 to 31.1 in 2006.

Among middle-aged women, the rate increased from 7.2 to 14.8 deaths per 100,000 - a larger increase than for women in other age groups.

Frank Soodeen, of the charity Alcohol Concern, said: "The link between alcohol misuse and ill-health is well established. However, these figures reveal some disturbing trends.

"It appears that for certain younger people who've been drinking heavily for most of their lives, the consequences are beginning to show themselves at ever earlier stages. It is vital that the government finally starts investing more in alcohol treatment to help problem drinkers address these issues before the situation becomes irretrievable."

The ONS said among adults of all ages, the alcohol-related death rate increased from 12.9 per 100,000 in 2005 to 13.4 in 2006. Men continued to account for about two-thirds of the deaths.

Dawn Primarolo, the public health minister, said the government was launching a £10m campaign to raise awareness of the dangers of too much alcohol and reviewing alcohol pricing and promotion.

"We know we're not going to change people's attitudes to alcohol overnight - it's going to take time - but it's reassuring to see that figures published earlier this week suggest alcohol consumption is no longer on the rise," she said.

Professor Ian Gilmore, president of the Royal College of Physicians, said: "My colleagues and I are seeing more women with serious liver damage than ever before in our clinics."

Alcohol-related deaths have doubled in 15 years, report says, G, 26.1.2008, http://www.guardian.co.uk/uk_news/story/0,,2247165,00.html

Leading article:

Welfare reform comes at a cost

Published: 07 January 2008
The Independent

The Conservatives are rolling out a programme of benefit proposals that owes much to the "tough love" approach of recent welfare reforms in the United States and some European countries. Yesterday David Cameron spoke of introducing more rigorous checks for recipients of incapacity benefit. Today we report his plan to limit the number of job offers a benefit recipient may turn down before forfeiting the job seeker's allowance. Mr Cameron will present the whole package tomorrow.

We note, merely in passing, the succession of announcements about one and the same policy that was once the presentational hallmark of New Labour. Here it is rather the substance that concerns us. Thanks in part to Iain Duncan Smith's analysis of "Breakdown Britain", Mr Cameron is developing a neat line in "compassionate conservatism" that balances promises of help for the deserving with threats of punitive action against abusers. Thus he sets out to banish the image of the "nasty party", while also reassuring those who see in every benefit recipient a "scrounger". So far, a mostly benign public has allowed him to have the argument both ways.

Few can doubt that there are benefit recipients who play the system and job-seekers who do not actively seek jobs. And the number of young people judged unfit to work is a scandal – not because anyone is defrauding anyone else, but because so many are thus written out of the social mainstream. The Government is complicit here: high rates of invalidity keep official unemployment figures low.

There are problems here that cry out to be tackled – and the Government, to its credit, has tried, though arguably not hard enough, to get those capable of work into employment. Mr Cameron wants much more active measures, coupled with tougher sanctions, and promises a reduction in incapacity benefit claimants of 200,000 as a start.

At 7 per cent of the current total, this target is, in fact, not particularly ambitious – which might suggest one of the limits to the policy. The unspoken element, however, which applies to any serious measures to curb the benefits bill, is that they will be expensive.

If those currently on benefits are to be helped into work, they need more training, medical treatment or counselling than they now get. While efforts have been made to ensure that no one is better off out of work than in, the system is complex and the margins may be too slender to provide an incentive. Employers also have to be persuaded to recruit individuals with perhaps a chequered work or health history. The truth is that, in the first instance at least, reducing the numbers on benefits will probably cost more than it will raise.

    Leading article: Welfare reform comes at a cost, I, 7.1.2008, http://comment.independent.co.uk/leading_articles/article3315051.ece

10.30am GMT

Vomiting virus closes hospital wards

Friday January 4 2008
 Guardian Unlimited
David Batty and agencies

Dozens of hospital wards across the UK have been forced to close due to outbreaks of a winter vomiting virus.

The ward closures come amid the worst outbreak of the bug, which causes vomiting and diarrhoea, in five years.

More than two million people across the UK have contracted the norovirus this winter with around 100,000 people a week catching the bug, according to doctors.

Infections are predicted to peak this month, with the Royal College of GPs predicting up to 200,000 new cases per week as children return to school and pass on the bug to their parents.

Cases among hospital staff and patients have led to wards being closed across the NHS.

Worcestershire Acute Hospitals NHS Trust said it had decided to cancel all routine elective inpatient surgery at its three hospitals until at least January 9.

The trust's chief executive, John Rostill, said the Worcestershire Royal hospital, Redditch's Alexandra hospital and Kidderminster hospital were all under "unrelenting pressure".

Rostill said the high number of diarrhoea and vomiting cases being admitted had reduced the number of beds available and the trust's capacity to carry out non-emergency operations.

Trust officials are talking to the private sector about using beds and operating theatre capacity.

Mr Rostill said: "Our intention now is to concentrate all our resources in treating patients who come in as emergencies over the next few days.

"We realise that cancelling operations causes distress and disruption and we apologise in advance to the 45 patients affected.

"However, we are sure that this decision is correct and we must do all we can to maintain a safe environment for those patients already in our care."

Bath's Royal United hospital had been forced to close seven wards since mid-November, and is asking people not to visit patients unless it is absolutely necessary.

Carol De Halle, deputy director of nursing, said: "We strongly urge visitors with symptoms to please avoid visiting the hospitals until symptoms have settled for two days.

"If a visitor has recently had diarrhoea or vomiting, we ask that they phone ahead for advice."

Leeds Teaching Hospitals NHS Trust said six wards had been closed at Leeds General infirmary and St James's hospital, although three had now reopened.

A trust spokesman said the wards were only closed to new admissions and in some cases only parts of the wards had been closed. Operations at the hospitals were continuing as normal, he added.

Penine Acute Hospitals NHS Trust said it had closed 26 beds across 11 wards at the 600-bed Royal Oldham hospital, where around 40 patients were admitted suffering from the vomiting bug yesterday.

A trust spokesman said 13 beds had also been shut at its other hospitals, Fairfield fospital and the North Manchester General hospital.

Cardiff and Vale NHS Trust has closed three wards to new admissions because of the norovirus. A spokeswoman said two wards at Llandough hospital and one at the University Hospital of Wales, Cardiff, had been affected with 46 patients currently infected.

The Royal Cornwall Hospitals NHS Trust said two wards were currently closed to new admissions.

A spokesman said the wards at West Cornwall Hospital in Penzance had been shut for three days but anticipated they would be reopened "soon".

Addenbrooke's hospital in Cambridge said three wards had been closed to new admissions because of a norovirus outbreak.

The Royal College of GPs yesterday advised anyone affected by the bug to remain at home until 48 hours after they last suffered symptoms in a bid to halt the outbreak.

There is no specific treatment for the virus apart from letting the illness run its course. Symptoms usually begin 12 to 48 hours after becoming infected and last for 12 to 60 hours. Most people make a full recovery within one or two days.

The bug can be spread by contact with an infected person, though contaminated food or water, or by contact with contaminated surfaces or objects. Outbreaks are common in hospitals, care homes, schools and nurseries, as well as on cruise ships.

Vomiting virus closes hospital wards, G, 4.1.2008, http://www.guardian.co.uk/society/2008/jan/04/health.nhs

3.15pm GMT

Stomach bug outbreak

worst in UK for five years

Thursday January 3 2008
Guardian Unlimited
David Batty and agencies

Thousands of people struck down by a severe stomach bug sweeping the UK have been advised to stay at home in an attempt to halt the outbreak.

More than 100,000 people a week are catching norovirus - also known as the "winter vomiting virus" - which causes vomiting and diarrhoea, but the figure could double this month, experts said.

The Health Protection Agency, which monitors infectious diseases, said the outbreak is the worst since 2002, with around two million people infected so far.

An HPA spokeswoman said: "This season we have seen an increase in reports of norovirus cases, almost double the number reported for the same period last year."

A spokeswoman for the health advice helpline NHS Direct said more than 13,500 (5%) of the 270,000 calls it received in the 11 days from December 21 to January 1 concerned the sickness.

Anyone affected by the virus should remain at home until 48 hours after they last suffered symptoms, says the Royal College of General Practitioners.

Professor Steve Field, the RCGP chairman, said the number of new cases each week could top 200,000 with children contracting the bug at school and then infecting their parents.

He said: "The number of norovirus cases this year is the highest in five years. Hospitals have been inundated by referrals and through casualty. Local GPs are also seeing a huge number of cases.

"People are at home with [the sickness] over the holiday, which is the best place for them, then next week the schools go back and you get a child outbreak and the children go home and give it to their parents.

"My advice for those affected is to stay at home, take paracetamol and drink plenty of fluids. You should also wash your hands regularly so you don't infect anyone else and stay at home two days after the symptoms have gone."
Norovirus is highly contagious but not usually dangerous. However, young children and frail elderly people are at risk of complications from dehydration and may require hospital treatment.

There is no specific treatment for the virus apart from letting the illness run its course. Symptoms usually begin 12 to 48 hours after becoming infected and last for 12 to 60 hours. Most people make a full recovery within one or two days.

The bug can be spread by contact with an infected person, though contaminated food or water, or by contact with contaminated surfaces or objects.

Outbreaks are common in hospitals, care homes, schools and nurseries, as well as on cruise ships.

    Stomach bug outbreak worst in UK for five years, G, 3.1.2008, http://www.guardian.co.uk/society/2008/jan/03/health

1pm GMT

Eating badly kills 70,000 yearly,

report says

Thursday January 3 2008
Guardian Unlimited
Staff and agencies

Nearly 70,000 Britons die prematurely every year due to a poor diet, a government report said today.

The average British adult currently eats too much salt, saturated fat and added sugar, but not enough fruit, vegetables, wholegrains or oily fish, according to research by the Cabinet Office strategy unit.

Bringing the nation's diet in line with nutritional guidelines would cut the number of deaths linked to cardiovascular disease and cancer.

Boosting fruit and vegetable consumption to the recommended five pieces per day would have the biggest impact on the nation's health - potentially cutting 42,200 premature deaths each year, the report said.

Reducing daily salt intake from the average 9g to the recommended maximum of 6g could reduce the death toll by 20,200 annually.

Cutting excess saturated fat and sugar intake could mean 7,000 deaths being avoided each year.

The interim report, called Food: An Analysis Of The Issues, said: "There can be few areas of public policy where the positive benefits to lives, health and well-being are potentially as dramatic as they could be in diet and nutrition.

"The potential benefits of changes to diets are huge, as are the issues to be tackled in effecting and sustaining long-term change."

In 2002 the cost of people being obese and overweight in England was estimated at nearly £7bn, including healthcare, state benefits and loss of earnings.

Obesity rates have trebled in the past 20 years with nearly a quarter of adults and around 10% of children in England now classed as obese. That figure will surge to 40% of Britons by 2025 and to 60% by 2050, according to a Department of Health report published last year.

Diabetes rates are expected to increase by 15% between 2001 and 2010, with 9% of this due to increasing obesity rates. Being overweight increases the risk of cancers, cardiovascular disease plus conditions such as arthritis and infertility.

The Cabinet Office's interim report cites evidence of older people having a slightly better diet because they eat marginally more fruit and vegetables and slightly less red meat than the average.

Women aged 50 to 64 years come closest to hitting the recommended diet and also eat the least fat and added sugar.

The traditional diets of Caribbean, Indian, Pakistani and Bangladeshi communities are healthier in terms of being lower in fat than that of the general UK population, although they consume more salt.

The health secretary, Alan Johnson, is due to publish a cross-government obesity strategy later this month. The final version of the Cabinet Office food report will be released in the spring.

Eating badly kills 70,000 yearly, report says, G, 3.1.2008, http://www.guardian.co.uk/society/2008/jan/03/health.foodanddrink