Call to axe paediatric heart unit

15 October 2010 Last updated at 01:01 ET By Jane Hughes Health correspondent, BBC News

The children's heart surgery unit at Oxford's John Radcliffe Hospital should close, a national review of paediatric heart centres in England has said.

Surgery was suspended there in March after four children operated on by the same surgeon died in three months.

The review will recommend that three or four other paediatric heart units out of 11 in England also stop surgery.

The aim is to improve the safety of heart operations by having fewer, more specialised centres.

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"Start Quote

Pooling surgical expertise into fewer, larger centres is in the best interests of children"

End Quote Leslie Hamilton Review team member

Children's heart surgery at the John Radcliffe has been under the spotlight since it emerged that four children died there between last December and February of this year.

'Serious shortcomings'

An inquiry found that the deaths were not due to errors of judgement, but that the surgeon had not been given appropriate supervision.

It criticised the hospital trust for "serious shortcomings", in the way it had taken on more cases to try to avoid closure of the paediatric unit.

Paediatric cardiac surgery at the hospital remains suspended.

An expert group has been reviewing the work of the 11 centres across England which conduct this type of specialist surgery.

The review was launched in response to the 1990s Bristol heart babies scandal, when children having heart surgery died unnecessarily.

Its full recommendations are due early next year, but it is likely to say that the four or five smallest centres should stop carrying out operations.

This number would include the John Radcliffe cardiac centre, which it has already ruled is too small, and lacks the expertise to offer a good service to patients.

It will recommend that the Oxford children's cardiac unit stops doing surgery, but continues to offer diagnosis and pre- and post-operation care.

Leslie Hamilton, former president of the Society for Cardiothoracic Surgery and a review member, said the decision was aimed at improving the safety of heart operations.

"The NHS needs to ensure the very best outcomes for children," he said. "Children's heart surgery is complex and must be performed by highly skilled specialist surgical teams.

"Pooling surgical expertise into fewer, larger centres is in the best interests of children and their families."

The recommendation to close the Oxford surgical unit will be the subject of a public consultation. However, it is highly unlikely that children's operations there will now resume.

The John Radcliffe hospital described the news as disappointing for patients, their families and staff. But Director of Planning, Andrew Stephens, said it was not entirely surprising. "Oxford is one of the smallest centres," he said, "and the main thrust of the review is that there should be fewer, larger paediatric cardiac centres in the future."

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Nestle logo permitted 'in error'

14 October 2010 Last updated at 07:16 ET

Nestle, the food manufacturer, was wrongly allowed to use a government health logo on its website, the Department of Health admitted.

The anti-obesity Change4Life logo should only have appeared alongside a healthy lifestyle message.

Instead, it appeared on a website promoting snacks and cereals.

The government says it will review the logo's use and Nestle said they would act on any advice given.

Nestle displays the logo on its getsetgofree.com website, which encourages shoppers to collect tokens from their products to claim free family activities.

A survey by the Children's Food Campaign found that 24 out of 27 products included in the Get set go free promotion are officially categorised as "high in sugar", according to the nutrition labelling system developed by the Food Standards Agency.

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This is another example of the food industry claiming to promote healthy lifestyles whilst in fact encouraging families to eat more junk food"

End Quote Christine Haigh Children's Food Campaign

One of the key messages of the Change4Life campaign, of which Nestlé is a partner, is sugar swaps, asking families to swap food and drink with added sugar for products lower in sugar or sugar free.

Health Secretary Andrew Lansley recently announced that government funding for the Change4life campaign would be withdrawn.

Instead, Mr Lansley said he wanted to see business take on responsibility for the campaign.

Promoting activities

The Department of Health had encouraged businesses and organisations to help them promote a healthier and more active lifestyle.

A Nestlé spokesperson said: "The use of the Change4Life logo on our website was approved and agreed by the Department of Health.

"We will continue to work with the Department of Health and will act on any changes they advise us to make."

"Get Set, Go Free is about getting families active and giving them the chance to try out new activities for free. Through the promotion we have given away 1.6 million free activities since 2006.

"It runs across a range of products and to take part in a swimming or an exercise class you only need to buy one box of cereal or three single confectionery products."

The Department of Health admitted that an error had been made when it approved Nestle's use of the logo on the website.

A spokesperson said: "We are harnessing the power that companies like Nestle have with consumers to build awareness of Change4Life and healthy behaviours.

"Nestle has provided support to the Change4Life movement in a number of ways over the past year including promoting the importance of a healthy diet to their employees, as well as encouraging families to be more active as part of their Get Set Go Free campaign.

"We're working with Nestle to review the use of the Change4Life logo on the Get Set Go Free website."

Christine Haigh, co-ordinator of Children's Food Campaign, said: "This is yet another example of the food industry claiming to promote healthy lifestyles whilst in fact encouraging families to eat more junk food.

"No company that uses these practices should be allowed to be associated with a government health campaign, and this should be a wake up call for the Department of Health which wants to see companies like this more involved in the Change4Life campaign, not less."

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Prostate cancer urine test nears

14 October 2010 Last updated at 00:01 ET

British scientists have moved a step closer to developing a simple urine test to identify men at risk of getting prostate cancer.

They have discovered that a protein found in urine is affected by a genetic change linked to the cancer.

More research was needed, but their work could lead to the development of a reliable test costing �5.50.

Prostate cancer is the most common cancer in men in the UK, killing about 10,000 men in Britain every year.

There is currently no routine screening programme in the UK, although men with a family history of the disease can have a prostate specific antigen (PSA) blood test to detect signs of the disease.

But this is notoriously inaccurate and although 10-15% of men will have high enough PSA levels to warrant carrying out a prostate biopsy, only 2-3% will require any treatment.

Research published in the online journal Public Library of Science ONE showed that the protein, called MSMB, is present at reduced levels in men diagnosed with the disease.

Levels also appear to be affected by tumour aggressiveness.

Potentially 'powerful'

Study leader Dr Hayley Whitaker, from Cancer Research UK charity's Cambridge Research Institute, said: "We looked in tissue and urine from over 350 men with and without prostate cancer to find out how much MSMB they had.

"We then looked to see who had the genetic change. It was really exciting to find out that the genetic change and the amount of protein were linked.

"The protein is easy to detect because it is found in urine and would potentially be a very simple test to carry out on men to identify those most at risk of developing the disease."

Dr Kate Holmes, research manager at The Prostate Cancer Charity, described the test as "potentially... a powerful way to predict how likely a man is to develop prostate cancer".

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Walking 'could ward off dementia'

13 October 2010 Last updated at 20:51 ET

Elderly people who get about by walking are less likely to suffer mental decline or even dementia, a study says.

Brain scans revealed that older people walking between six and nine miles a week appeared to have more brain tissue in key areas.

The Pittsburgh University study of 299 people suggested they had less "brain shrinkage", which is linked to memory problems.

The research was reported in the journal Neurology.

The volunteers, who had an average age of 78, were checked for signs of "cognitive impairment" or even dementia.

The Pittsburgh team also had access to brain scan results from four years previously which measured the amount of "grey matter" in their brains.

Brain health

This is found at various parts of the brain and is known to diminish in many people as they get older.

Each of them had been quizzed in their 60s about the number of city blocks they walked each week as part of their normal routine.

The results showed that those who walked at least 72 blocks - six to nine miles - a week had a greater volume of grey matter.

Four years after the scans, 40% of the group had measurable cognitive impairment or even dementia.

Those who walked the most were half as likely to have these problems compared with those who walked the least.

Dr Kirk Erickson, who led the study, said: "If regular exercise in midlife could improve brain health and improve thinking and memory in later life, it would be one more reason to make regular exercise in people of all ages a public health imperative."

Susanne Sorensen, from the Alzheimer's Society, said that the study was further evidence that a healthy heart could lead to a healthy brain.

She added: "One of the benefits of this research is that it eliminates the impact other socio-economic factors may play and focuses specifically on walking rather than exercise more generally.

"Although a link has been found between lack of exercise and brain shrinkage, we need more research to find out why physical activity may affect the brain.

"The best way to reduce your risk is to take regular exercise, eat healthily, don't smoke and get your blood pressure and cholesterol checked."

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Love 'is a drug which eases pain'

13 October 2010 Last updated at 20:29 ET

Love hurts, at least according to many a romantic songwriter, but it may also help ease pain, US scientists suggest.

Brain scans suggest many of the areas normally involved in pain response are also activated by amorous thoughts.

Stanford University researchers gave 15 students mild doses of pain, while checking if they were distracted by gazing at photos of their beloved.

The study focused on people early in a romance, journal PLoS One reported, so the "drug of love" may wear off.

The scientists who carried out the experiment used "functional magnetic resonance imaging" (fMRI) to measure activity in real-time in different parts of the brain.

It has been known for some time that strong feelings of love are linked to intense activity in several different brain regions.

These include areas linked to the brain chemical dopamine, which produces the brain's feel-good state following certain stimulants - from eating sweets to taking cocaine.

"Light up"

The Stanford University researchers had noticed that when we feel pain, some of the same areas "light up" on the scans - and wondered whether one might affect the other.

They recruited a dozen students who were all in the first nine months of a relationship, defined as "the first phase of intense love".

Each was asked to bring in a picture of the object of their affection and photos of what they deemed an equally attractive acquaintance.

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It's important to recognise that people who feel alone and depressed may have very low pain thresholds, whereas the reverse can be true for people who feel secure and cared for"

End Quote Professor Paul Gilbert University of Derby

While their brains were scanned, they were shown these pictures, while a computer controlled heat pad placed in the palm of their hand was set up to cause them mild pain.

They found that viewing the picture of their beloved reduced perceptions of pain much more than looking at the image of the acquaintance.

Dr Jarred Younger, one of the researchers involved, said that the "love-induced analgesia" appeared to involve more primitive functions of the brain, working in a similar way to opioid painkillers.

"One of the key sites is the nucleus accumbens, a key reward addiction centre for opioids, cocaine and other drugs of abuse.

"The region tells the brain that you really need to keep doing this."

Professor Paul Gilbert, a neuropsychologist from the University of Derby, said that the relationship between emotional states and the perception of pain was clear.

He said: "One example is a footballer who has suffered quite a painful injury, but who is able to continue playing because of his emotionally charged state."

He added that while the effect noticed by the Stanford researchers might only be short-lived in the early stages of a love affair, it may well be replaced by something similar later in a relationship, with a sense of comfort and wellbeing generating the release of endorphins.

"It's important to recognise that people who feel alone and depressed may have very low pain thresholds, whereas the reverse can be true for people who feel secure and cared for.

"This may well be an issue for the health service, as patients are sometimes rushed through the system, and perhaps there isn't this focus on caring that might have existed once."

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Public 'misled' over drug trials

13 October 2010 Last updated at 03:31 ET By Michelle Roberts Health reporter, BBC News

Doctors and patients are being misled about the effectiveness of some drugs because negative trial results are not published, experts have warned.

Writing in the British Medical Journal, they say that pharmaceutical companies should be forced to publish all data, not just positive findings.

The German team give the example of the antidepressant reboxetine, saying publications have failed to show the drug in a true light.

Pfizer maintains its drug is effective.

Reboxetine (Edronax), made by Pfizer, is used in many European countries, including the UK.

But its rejection by US drug regulators raised doubts about its effectiveness, and led some to hunt for missing data.

This is not the first time a large drug company has come under fire about its published drug trial data.

Trial information

Pharmaceutical giant GlaxoSmithKline (GSK) was criticised for failing to raise the alarm on the risk of suicidal behaviour associated with its antidepressant Seroxat.

GSK rejected claims that it improperly withheld drug trial information.

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"Start Quote

Our findings underline the urgent need for mandatory publication of trial data"

End Quote The research authors

But GSK has also been forced to defend itself over allegations about hiding negative data regarding another of its drugs, Avandia, which is used to treat diabetes.

Now researchers from The German Institute for Quality and Efficiency in Health Care say there is unpublished trial data for Pfizer's antidepressant reboxetine that should be made public because it could change views about the drug.

Dr Beate Wieseler and colleagues carried out their own assessment of reboxetine, looking at the results of 13 trials, including eight previously unpublished trials from the manufacturer Pfizer.

They found the drug was no better than a placebo in terms of remission and response rates. And its benefit was inferior when compared with other similar antidepressants.

Furthermore, a higher rate of patients had side effects with reboxetine than with placebo. And more stopped taking the drug because of side effects compared with those taking a placebo or a different antidepressant.

Biased picture

The researchers said there has been a publication bias and this had overestimated the benefit of reboxetine and underestimated potential harm. And, they said, it was a widespread problem that applied to many of the drugs in use today.

"Our findings underline the urgent need for mandatory publication of trial data," they say in the BMJ.

They warn that the lack of all information means policy makers are unable to make informed decisions.

In the US, it is already a requirement that all data - both positive and negative - is published. The UK is also striving to achieve this.

The UK's regulator, the MHRA, said: "There is a European initiative to provide public access to the results of clinical trials. The currently planned timeline is that this information could become available in late 2011/early 2012."

A spokeswoman for Pfizer said: "In the UK, Pfizer's reboxetine is licensed for the acute treatment of depressive illness/major depression and for maintaining the clinical improvement in patients initially responding to treatment.

"This medicine presents an effective treatment option to clinicians for the use in patients suffering from these conditions.

"Pfizer discloses the results of its clinical trials to regulatory authorities all around the world. These regulatory authorities carefully balance the risks and benefits of each medication, and reflect all important safety and efficacy information in the approved product labelling.

"Pfizer will review the meta-analysis relating to reboxetine published in the British Medical Journal on 13th October 2010 in detail and will provide further comment after completing the review."

Others lay at least some of the blame with the medical journals that publish drug trial data.

In response, the BMJ has promised to devote an entire issue to the topic next year.

BMJ Editors Dr Fiona Godlee and Dr Elizabeth Loder said: "It is time to demonstrate a shared commitment to set the record straight."

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