Med Blog

The Wellington woman who made national headlines last week for attempting to starve herself to death has died. Margaret Page’s refusal to eat food sparked a vigorous ethical debate. She was 60. Page, who suffered a cerebral haemorrhage 20 years ago, had refused to eat food for the past 16 days, taking only the occasional sip of water.

She told the Dominion Post newspaper a week ago that she no longer wanted to live. Her death, at 7.30pm, was confirmed by the St John of God Haurora Trust, who owns the St John of God Wellington residential care home in suburban Karori where she was staying. Trust chief executive Ralph La Salle said staff and residents were deeply saddened by Page’s death.

A Remarkable Book from Wiley-Finance

---

"An excellent book!"   — Paul Wilmott Want to break into the lucrative world of trading and quantitative finance? You need this book!

“Our thoughts and prayers are with Mrs Page and her family and have been throughout the past weeks – a time which has been exceptionally difficult and emotional for Mrs Page, her family, other residents, staff and everyone who knew her,” he said. “We continued to provide a very high level of care for Mrs Page until her death. We worked closely with her GP, who visited daily, the Ministry of Health and staff from the Mary Potter Hospice, who also provided care to Mrs Page.”

Page suffered a cerebral haemorrhage 20 years ago and was cared for by her husband Barry Page until 2006 when she went to Residential Care at Maddison, as it was known before its acquisition in February this year by the St John of God Hauora Trust. La Salle said that food and water had been offered to Page by staff members whenever they went into her room and at regular intervals.

In addition, a staff member was dedicated to Mrs Page’s care during the last period of her life. “Mrs Page maintained her resolve to refuse food until the very end of her life,” he said. Page’s refusal to eat sparked a vigorous debate between pro-euthanasia and pro-life groups. Police told ONE News they will be investigating the death and the details have been referred to the Coroner.

Schools, employers and GPs all have more of a role to play in mental-health care in the UK, ministers say.
Investment in recent years has focused on improving treatment, but the new 10-year strategy calls for more emphasis on prevention and early intervention. In particular, it highlighted the importance of helping people back into work to aid recovery from mental illness and preventing it recurring.

Campaigners said the move represented a “promising start” in changing policy. Mental illness accounts for a greater burden of disease than any other condition. A fifth of early deaths are related to mental health problems, compared to under a sixth for both heart disease and cancer. Since 2001, spending on mental health services has increased by nearly 50%.This has helped improve access to a range of services, such as talking therapies.

Now that this benchmark has been set, it represents a turning point that no new government can turn back from Depression or anxiety affect one in six people at any given time, but research shows only a quarter of those get medical help. The new strategy – set out in a series of reports which were based on recommendations made by a government-appointed panel of experts – focuses mainly on ways the approach to mental health can be broadened.

Employment is one of the key priorities, ministers drawn from the Department of Health, Cabinet Office and Department for Work and Pensions – and given the backing of the devolved administrations – said.
Research shows that working is beneficial for people with mental health issues. One study found for every £1 spent on employment programmes, £1.72 is saved on treatment.

To help improve the low rates of employment among those with problems, the government is planning to appoint mental health co-ordinators to work with Job Centres across the country. Dedicated advice lines are also to be set up for small businesses to give their staff direct access to occupational health professionals to help them stay in work.

A Remarkable Book from Wiley-Finance

---

"An excellent book!"   — Paul Wilmott Want to break into the lucrative world of trading and quantitative finance? You need this book!

Government-backed work placements are also to be piloted to help people return to work.
But ministers have also called for employers to their bit by making managers more aware about how to handle mental illness. And the government wants to see GPs intervening early.

Employment – Network of coordinators to work with Job Centres to help mentally ill back into work and dedicated helplines to work with small businesses.
GPs – To be encouraged to do more to intervene early
Schools – Counselling services to be rolled out to start educating children about the issue

The strategy argued doctors should be routinely raising the issue of depression and then referring people on to specialist services if need be. A specialist training programme is to be designed by the Royal College of Psychiatrists to help doctors with this. Schools were also highlighted. Schools-based counselling services are already being trialled in some places and these are expected to be rolled out nationally next year.
But the reports also said there should be more integration between councils and the NHS, pointing out people with mental health problems often need help with issues such as housing.

Professor Louis Appleby, the government’s mental health tsar, said: “We need to be better at preventing depression, better at treating it and better at reducing the impact of depression.” Prof Louis Appleby: return to work is ‘good for the employee and the employer’

And care services minister Phil Hope said: “If we can get this right, we can improve the lives of many people.”
Mental Health Foundation chief executive Dr Andrew McCulloch described the strategy as a “promising start”.
Paul Farmer, head of Mind, the mental health charity, added: “Now that this benchmark has been set, it represents a turning point that no new government can turn back from. “Good mental wellbeing isn’t just about treatment, it’s also about prevention. “By focusing on the factors that take their toll on our wellbeing in the first place, we have a chance at achieving better mental health for everyone.”

The government is to scale back its £12bn NHS IT system in what the Tories are calling a “massive U-turn”.

Chancellor Alistair Darling said he would be delaying parts of the scheme in Wednesday’s pre-Budget Report as it was “not essential to the front line”.

The move may save hundreds of millions but Mr Darling admitted it was only a fraction of total spending cuts needed.

The Tories and Lib Dems have been calling for the IT system, which has been hit by costly delays, to be axed.

Mr Darling told BBC One’s Andrew Marr show he was determined to halve Britain’s budget deficit over the next four years and as a result public spending would be “a lot tighter than it was in the past”.

He stressed that the pre-Budget report was not a spending review, but added: “I do think it is necessary for me to indicate areas where we are going to cut spending or where we’re not going to spend as much as we were.

It has held back the development of IT at a local level, cost billions and is running years behind schedule
Norman Lamb MP
Liberal Democrats

“For example, the NHS had a quite expensive IT system that, frankly, isn’t essential to the front line.

“It’s something I think we don’t need to go ahead with just now.”

A Remarkable Book from Wiley-Finance

---

"An excellent book!"   — Paul Wilmott Want to break into the lucrative world of trading and quantitative finance? You need this book!

He said the full picture of cuts would not emerge until “the first half of next year at some point” – a reference to the comprehensive spending review, which the government has delayed until after an election.

‘Procurement disaster’

Treasury officials have stressed that only part of the NHS IT programme is facing the axe, and the whole project will not be scrapped.

WHAT IS THE IT PROGRAMME?
The vision is for patients’ records to be electronically available to any GP or hospital in England, thereby replacing local NHS computer systems. Other services include electronic prescriptions, an e-mail and directory service for all NHS staff, computer accessible X-rays and a facility for patients to book outpatient appointments online. It is the largest single IT investment in UK – costs are expected to hit £12.4bn over 10 years to 2013-14

But the Conservatives said Mr Darling’s words represented a “massive U-turn”. Shadow Health Secretary Andrew Lansley said it was “another government IT procurement disaster. After seven years Labour have finally acknowledged what we’ve said for years, that the procurement for NHS IT was costing billions and not delivering,” he said.

The electronic patient record system, which is thought to have cost about £12bn so far, was commissioned in 2002 by then prime minister Tony Blair, and was meant to be completed by 2010. It was supposed to computerise medical records in a central database and link up more than 30,000 GPs to nearly 300 hospitals.

Mr Lansley told BBC One’s Politics Show the Tories would scrap the “enormous centralised IT system” and instead give hospitals “the opportunity to buy IT systems” that could transfer images, patient records and prescriptions electronically. It comes as the Conservatives called for a moratorium on all government computer projects, ahead of the publication of the government’s five-year IT strategy later this week.

They say Labour has spent £100bn on IT since 1997 and contracts worth another £70bn are due to be renewed or commissioned in the next two years. The Liberal Democrats said the NHS programme had been “flawed from the start”.

The party’s health spokesman, Norman Lamb, said: “It has held back the development of IT at a local level, cost billions and is running years behind schedule.” BMA spokesman Dr Grant Ingrams says the IT system is an “essential tool” for doctors. But Dr Grant Ingrams, from the British Medical Association, said the system currently scheduled to come into effect would result in the NHS saving money. It’s an essential tool for clinicians, for doctors and other staff to be able to treat patients,” he said. “The NHS pays out a third of a billion pounds a year on mistakes; a lot of that could be put right if the IT was in place.”

Tony Collins, executive editor of Computer Weekly magazine, said the government should scrap central contracts. “What they’ve done is to set up these very large, central contracts which have an intermediary who delivers the systems to the trusts,” he said. “They could save money by cancelling those central contracts and giving trusts the ability to choose what systems they want.”

Scientists believe that worms could hold the key to why some people develop Parkinson’s Disease. Worms share 50% of their genes with humans, including those involved with inherited Parkinson’s. Dundee University researchers will study a simple worm called C. elegans to try to work out why the condition causes patient’s brain cells to die. The Parkinson’s Disease Society has given the university £190,000 to carry out the research.

There are about 120,000 people with Parkinson’s in the UK. In up to 5% of those cases, the disease is believed to be directly inherited. Parkinson’s is a progressive neurological condition affecting movements such as walking, talking and writing. It occurs as a result of a loss of nerve cells in the brain. Dr Anton Gartner, who is leading the study, said: “Research leading to an eventual cure for Parkinson’ s disease is a daunting task and requires a very broad and multidisciplinary approach.

Dr Kieran Breen, Parkinson’s Disease Society: “I am grateful to the Parkinson’s society to recognise this and to so generously support our research. It’s fascinating that such a simple animal as a worm can be an excellent model for Parkinson’s researchers.” Worms will be used in the study as they are one of the simplest organisms with a nervous system.

The way worms’ nerve cells communicate with each other is also similar to how it works in humans.
Several genes, including one known as LRRK2, have been linked to the hereditary form of Parkinson’s Disease.
Dr Gartner’s team want to understand how changes or mutations in this gene lead to the development of Parkinson’s – and how drugs could stop the damage that these mutations cause to nerve cells.

Dr Kieran Breen, from the Parkinson’s Disease Society, said: “It’s fascinating that such a simple animal as a worm can be an excellent model for Parkinson’s researchers to study what happens in specific nerve cells.
“We are delighted to be funding this research with Dr Gartner in Dundee. It will help us to understand better what causes nerve cells to die in Parkinson’s, and will help us to develop new treatments for the condition.”

The dudhi also called the calabash or bottle gourd is a vine grown for its fruit, which can either be harvested young and used as a vegetable or harvested mature, dried, and used as a bottle, utensil, or pipe. For this reason, one of the calabash subspecies is known as the bottle gourd. The fresh fruit has a light green smooth skin and a white flesh. However the rounder varieties are called Calabash gourds whereas the longer and slimmer kinds are usually well known as bottle gourds or dudhis. The calabash was one of the first cultivated plants in the world, grown not for food but as a container. It was named for the calabash tree (Crescentia cujete).

There are many health benefits of dudhi, if you include it in your daily diet plan. You can include it in natural form or in the form of juice in your diet plan. The biggest advantage of dudhi is related to immune boosting property. Having juice of dudhis on regular basis can help to increase your immunity in an effective manner. It can also helps to make your digestive system stronger.

It also helps to take care of problems like constipation and indigestion. There are many other health benefits of dudhis, which you can keep in mind:

• to cure problems related to urine infections. You can easily cure the burning related to your urine infections.
• It’s also very effective for curing all your kidney disorders.
• prevention of kidney stones.
• You can also reduce other kidney infections by including this juice on daily basis.

You can also include it in natural form in your daily diet plan. Try to include it once in a week, for effective results. Having dudhis on regular basis can help with the condition of diabetes. It helps to maintain the blood sugar level in the body. It also helps to reduce your bad cholesterol level in the body. You can include natural dudhi on daily basis to reduce the condition in an effective way.

Dudhi is also good for the condition of your skin. You can include it in natural form for internal cleansing of your skin. Try to include it along with carrot juice for clear skin. It also helps to protect against various types of skin infections. It also helps to prevent from condition of acne and other breakouts on your skin.

Dudhi is also useful in curing different types of ulcers. As it is cooling in nature, it helps to reduce condition of mouth ulcers and stomach ulcers.

People who smoke potent skunk are more at risk of psychotic illnesses such as schizophrenia than those who use other types of cannabis, scientists suspect. According to new research, regular users double their risk of psychosis but heavy skunk users increase theirs seven-fold. UK experts have a theory it is down to skunk’s composition – it contains more of the chemical that gets users stoned.

The findings come only weeks after the UK’s chief drugs adviser was sacked after he criticised the government’s decision to reclassify cannabis up to Class B from C. Public education about the risks of heavy use of high-potency cannabis is vital.

The authors of the latest research from the Institute of Psychiatry were quick to stress that their work is merely to inform. And they point out that drug use only accounts for the minority of cases of psychotic illnesses – somewhere between 10% and 15%. Other risk factors, such as family history of mental health problems, play a far bigger part. However they say cannabis, and particularly stronger skunk, should be considered a potential health hazard in a similar way to alcohol.

Just as downing a bottle of whisky a day is riskier than drinking half a glass of wine each evening with your dinner, smoking strong skunk every day poses a greater threat than smoking less potent types of cannabis every now and then, they say. When Dr Marta Di Forti and colleagues at the Institute of Psychiatry screened 280 patients admitted to their hospital with psychotic symptoms for the first time, they found most – nearly 80% – were heavy skunk users.

You never truly know what you’re getting and stronger cannabis, such as skunk, can increase the chance of suffering a nasty reaction. They also questioned healthy controls of a similar age and social background, who they recruited through newspaper ads and the internet, about their personal drug use. They found no real difference between the two groups in whether they had ever used cannabis or their age at first use. But the patients with psychosis were twice as likely to have used cannabis for longer than five years, and over six times more likely to use it every day.

Moreover, among those who had used cannabis, patients with psychosis were seven times more likely to use skunk than controls. The experts believe skunk is particularly damaging because it contains more THC.
This is the main psychoactive ingredient and has been shown to produce psychotic symptoms like hallucinations and delusions in experiments.

Unlike skunk, hashish – cannabis resin – contains substantial quantities of another chemical called cannabidiol or CBD and research suggests this can act as an antidote to the THC, counteracting its psychotic side effects. Dr Di Forte said their findings were concerning, particularly as skunk has come to dominate the UK cannabis market in recent years. “Public education about the risks of heavy use of high-potency cannabis is vital.”

She said more far work was needed to assess the exact risks of smoking different types and quantities of cannabis. Experts do know that the risks go up with both duration and amount of use. A spokesman from The Legalise Cannabis Alliance UK said: “We don’t need to worry about the health harms of people smoking cannabis per se, whether it is skunk or not. “What is a concern is that as a result of prohibition some dealers put other stuff into the cannabis they sell that may be damaging. I’ve heard of lead and glass being put in it.”

Chris Hudson, addictions expert at the charity Frank, said: “You never truly know what you’re getting and stronger cannabis, such as skunk, can increase the chance of suffering a nasty reaction.” A Home Office spokesman said: “The reclassification of cannabis as a Class B drug was partly in response to emerging concerns about the growing use of stronger strains of cannabis, such as skunk, and the harm they may cause to users’ mental health.

“We remain determined to crack down on all illegal substances and minimise their harm to health and society as a whole.” Marjorie Wallace of the mental health charity SANE said: “We receives daily evidence that the long-term use of skunk, with its specific chemical make-up, can trigger frightening psychotic episodes, cause relapse and may bring about mental conditions such as schizophrenia. “It can also rob developing young minds of their potential and wreck their futures and those of their families.”

The World Health Organization is changing its advice on HIV drugs, asking that they be given sooner and to breastfeeding mothers with the virus. Experts say the advice is based on the most up-to-date information available and will cut infection rates and save lives but it will mean many more people needing treatment, which will cost more money and time.

The World Health Organization (WHO) wants adults and adolescents to receive anti-retroviral therapy (ART) before their immune system strength falls below 350 cells per cubic millilitre of blood, regardless of whether they show symptoms.

It also wants the drug Stavudine, widely used in developing countries because of its low cost and widespread availability, to be phased out in favour of Zidovudine or Tenofovir, which do not have the same long-term and irreversible side effects. The Department for International Development is committed to increasing access to effective and affordable HIV treatments. For the first time, the WHO is calling for breastfeeding mothers, or their babies, to be given the drugs to prevent transmission of the disease.

The International Development Minister, Mike Foster, said the guidelines would be supported though they would “significantly increase the demand for treatment. The Department for International Development is committed to increasing access to effective and affordable HIV treatments,” he said. “That is why UK aid supports the cheaper manufacturing of current treatments, and the Unitaid [the UN body on drugs for killer diseases] patent pool to help develop new, effective and affordable HIV treatments, particularly for children and for people living in developing countries.”

Falling prices and increased testing have led to a marked rise in the number of people in the poorest parts of the world receiving treatment for HIV. The number of people on anti-retrovirals had risen by a million by the end of 2008, a 36% increase from the previous year, the WHO said. Despite the progress, less than half of those needing treatment, currently receive it. The WHO estimates that since the availability of effective HIV drugs in 1996, some 2.9 million lives have been saved.

Figures suggesting two-thirds of men and more than half of women in Scotland are overweight have been branded “appalling”. The data from 2008 was disclosed by Public Health Minister Shona Robison in answer to Tory parliamentary questions. Conservative MSP Jackson Carlaw said the statistics disclosed the true scale of “Scotland’s obesity epidemic”.

Ms Robison said £56m was being spent on healthy eating and active living projects. The health figures suggested 66.3% of men aged 16 to 64 and 59.6% of women in the same age range were overweight.
About a quarter of both sexes were classed as being obese, with 24.9% of men and 26.5% of women falling into this category. And 1.4% of men and 3.5% of women were so overweight that they were morbidly obese.

Figures for children aged between two and 15 showed that more than a third of boys and a quarter of girls weighed too much. Mr Carlaw, the Conservative public health spokesman, said: “This problem did not appear overnight, nor will it disappear overnight. We need a complete change of culture.”

He also called for more child health visitors to help tackle the problem.

He added: “Scotland needs a health service that encourages a greater degree of personal responsibility than the one we have at present. More health visitors are an ideal way of helping address that challenge.”

Ms Robison said the Scottish government recognised obesity was an increasing problem that posed a serious threat to the nation’s health.

She added: “This is why we are making tackling the problem a high priority. We have a range of initiatives under way to support those who are overweight and obese and to help people from becoming overweight in the first place.”

US scientists are testing a radical new theory that multiple sclerosis (MS) is caused by blockages in the veins that drain the brain. The University of Buffalo team were intrigued by the work of Italian researcher Dr Paolo Zamboni who claims 90% of MS is caused by narrowed veins.

He says the restricted drainage, visible on scans, injures the brain leading to MS. He has already widened the blockages in a handful of patients. The US team want to replicate his earlier work before treating patients.
Experts welcomed the research saying it was important to confirm the basic science before evaluating any therapy.

MS is a long-term inflammatory condition of the central nervous system which affects the transfer of messages from the nervous system to the rest of the body.This is not something patients can expect as a treatment now. This is experimental work and is being tested. The Buffalo team, led by Dr Robert Zivadinov, plan to recruit 1,100 patients with MS and 600 other volunteers as controls who are either healthy or have neurological diseases other than MS.

Using Doppler ultrasound, they will scan the patients to see if they can find any blockages within the veins of the neck and brain. If they can prove Dr Zamboni’s theory of “chronic cerebrospinal venous insufficiency”, they say it will change our understanding of MS. Margaret Paroski, who is chief medical officer at Kaleida Health, where the Buffalo researchers are based, said the work could overturn prevailing wisdom that the damage in MS is predominantly the result of abnormal immune responses. “When I was in medical school, we thought peptic ulcer disease was due to stress. We now know that 80% of cases are due to a bacterial infection. I found the evidence of narrowing – narrowing of the veins just in MS patients”

“Dr Zivadinov’s work may lead to a whole different way of thinking about MS.” Dr Zamboni, of the University of Ferrara, believes the blockages are the cause rather than the consequence of MS and that they allow iron from the blood to leak into the brain tissue, where it causes damage. He has performed procedures similar to angioplasty to unblock the veins and get the blood flowing normally again.

He claims this “liberation procedure” can alleviate many of the symptoms of MS and is due to publish his findings in the Journal of Vascular Surgery. In an interview with CTV News in Canada he said: “I found the evidence of narrowing – narrowing of the veins just in MS patients. “I’m fully convinced that this is very, very important for people.”

Kevin Lipp, an MS patient from the US, has been symptom-free since being treated by Dr Zamboni. He said: “It’s only been 10 months. If nothing happens in the next two to three years, we’ll know it’s working.” The BBC has heard anecdotally of other surgeons in Europe testing out the same treatment. The MS Society said more research was needed to see if this was an avenue that should be explored further. “This is not something patients can expect as a treatment now. This is experimental work and is being tested. We need to know more about its safety and effectiveness.”

Helen Yates, of the MS Resource Centre, said: “There is no doubt that this area warrants a great deal more study. “This could represent a completely novel approach to MS research which, if proven to be relevant, could be a “sea change” in the understanding of the mechanisms involved in the condition.”

A major study has suggested that drinking alcohol every day cuts the risk of heart disease in men by more than a third. The Spanish research involving more than 15,500 men and 26,000 women found large quantities of alcohol could be even more beneficial for men, however the study found that the same was not the case for women.

The research involved men and women aged between 29 and 69, who were asked to document their lifetime drinking habits and followed for 10 years. Crucially the research team claim to have eliminated the “sick abstainers” risk by differentiating between those who had never drunk and those whom ill-health had forced to quit. This has been used in the past to explain fewer heart-related deaths among drinkers on the basis that those who are unhealthy to start with are less likely to drink. The researchers, led by the Basque Public Health Department, placed the participants into six categories – from never having drunk to drinking more than 90g of alcohol each day. This would be the equivalent of consuming about eight bottles of wine a week, or 28 pints of lager.

For those drinking little – less than a shot of vodka a day for instance – the risk was reduced by 35%. And for those who drank anything from three shots to more than 11 shots each day, the risk worked out an average of 50% less. The same benefits were not seen in women, who suffer fewer heart problems than men to start with. Researchers speculated this difference could be down to the fact that women process alcohol differently, and that female hormones protect against the disease in younger age groups.

The type of alcohol drunk did not seem to make a difference, but protection was greater for those drinking moderate to high amounts of varied drinks. The exact mechanisms are as yet unclear, but it is known that alcohol helps to raise high-density lipoproteins, sometimes known as good cholesterol, which helps stop so-called bad cholesterol from building up in the arteries.

UK experts said the findings should be treated with caution because they do not take into account ill-health from a range of other diseases caused by excess drinking.

“Whilst moderate alcohol intake can lower the risk of having a heart attack, coronary heart disease is just one type of heart disease. Cardiomyopathy, a disease of the heart muscle, is associated with high alcohol intake and can lead to a poor quality of life and premature death,” said the British Heart Foundation’s senior cardiac nurse, Cathy Ross.

“The heart is just one of many organs in the body. While alcohol could offer limited protection to one organ, abuse of it can damage the heart and other organs such as the liver, pancreas and brain.”

The Stroke Association meanwhile noted that overall, evidence indicated that people who regularly consumed a large amount of alcohol had a three-fold increased risk of stroke.

“Six units within six hours is considered ‘binge-drinking’ and anyone indulging in regular ‘binge-drinking’ increases their risk of stroke greatly,” said research officer Joanne Murphy.

Public health specialists warned no-one should be encouraged to drink more as a result of this study.

With alcohol responsible for 1.8 million deaths globally per year experts are critical, warning heavy drinking can increase the risk of other diseases. Professor Martin McKee claims that: “People should not be encouraged to drink more as a result of this research. The relationship between alcohol and heart disease remains controversial,” said Professor Martin McKee of the London School of Hygiene and Tropical Medicine. “While there is good evidence that moderate consumption is protective in people who are at substantial risk of heart disease – which excludes most people under the age of 40 – we also know that most people underestimate how much they drink. This paper adds to the existing literature but should not be considered as definitive. ”

In the UK, the recommendation is no more than two to three units of alcohol a day for women – the equivalent of one standard glass of wine – and three to four units for men. The British Liver Trust said: “There have been several studies suggesting that small amounts of alcohol can reduce the risk of coronary heart disease in men over the age of 40. “But these are often misinterpreted by people looking for a health reason to consume alcohol. “If you want to look after your health, stay within the limits of no more than 3-4 units a day for men or 2-3 for women and aim to give yourself at least two days off alcohol a week.”

Professor Alan Maryon-Davis, president of the UK Faculty of Public Health, agreed that the message from this study was not clear: “At the end of the day, you’re juggling different risks and benefits, maybe helping your heart or maybe damaging your brain and liver.

This is another one of those issues where studies don’t seem to be able to agree some claim that alcohol is good whilst others make it out to be the root of all evil. To be honest as long as you are not binge drinking but are enjoying alcohol in moderation then there isn’t a problem,