Tennis elbow jabs 'make it worse'

21 October 2010 Last updated at 19:21 ET

Using steroid injections for tendon problems like tennis elbow could do more harm than good, says a study in The Lancet.

It found that injections reduced pain for the first few weeks, but made the condition worse in the long term.

University of Queensland researchers analysed the treatment of tendinopathy in more than 2,600 patients from 41 previous studies.

Experts say exercising the affected area is preferable.

In the study, Australian researchers looked at past randomised trials comparing steroid injections into the tendon with placebo, which is equivalent to no treatment at all.

When analysing the trials, they assessed the clinical efficacy of the treatments in the short term, intermediate and long term.

They also analysed different areas of tendinopathy, like rotator cuff tendinopathy (shoulder) and jumper's knee.

'Strong evidence'

Writing in The Lancet, the authors concluded: "Our systematic review challenges continued use of corticosteroid injections by providing strong evidence that they are worse in the long term than are most conservative interventions for tendinopathy."

This was particularly true for the treatment of lateral epicondylitis, known as tennis elbow.

The research found that in treating tennis elbow, corticosteroid injection had a large effect on reduction of pain compared with placebo in the short term, from three to six weeks.

Continue reading the main story

"Start Quote

Exercise stimulates the tendon to repair by stimulating the tendon cells to make new proteins."

End Quote Dr Karim Khan UBC, Vancouver

But treatment with injections over a longer period, from four to six months up to 12 months, was not found to be beneficial.

In fact, researchers found that it made the pain from tennis elbow worse.

Tennis elbow is most common in people between the ages of 30 and 50 and is caused by a strain to the extensor tendons in the forearm.

Any activity that involves heavy gripping and twisting of the forearm, not just tennis, can cause this type of strain.

Writing about the findings in The Lancet, Dr Alexander Scott and Dr Karim Khan from the University of British Columbia in Canada, recommend exercise as the best way to cure tendinopathies.

"Specific exercise therapy might produce more cures at six and 12 months than one or more corticosteroid injections."

Dr Khan said: "It sounds old-fashioned but specific exercise programmes are better than rest.

"Exercise stimulates the tendon to repair by stimulating the tendon cells to make new proteins.

"Tennis elbow and other tendinopathies have been shown to be a failure of tissue, not a result of inflammation, so exercise is the right thing to do."

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Fears over health budget promises

21 October 2010 Last updated at 08:47 ET <!-- Adding hypertab --> <!-- end of hypertab --> By Nick Triggle Health reporter, BBC News

Questions are being asked about the high-profile government promises made over health and social care spending.

Chancellor George Osborne claimed to have increased NHS spending as well as pumping an extra �2bn into social care in the Spending Review in England.

But shadow health secretary John Healey suggests the NHS figures do not add up, while campaigners fear social care may not see all the money.

The government said its plans meant NHS and social care were going to benefit.

The Tories made increasing NHS spending one of the central themes of the election campaign with the slogan "we will cut the debt, not the NHS".

Extra costs

The government said on Wednesday it had kept to that promise - the combined capital and resource budget will rise by 0.1% a year on average in real terms throughout this parliament.

However, in a letter to Health Secretary Andrew Lansley, Mr Healey said these rises ignore several extra costs the NHS is having to bear.

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"Start Quote

More effective partnership working must be the desired outcome"

End Quote Stephen Burke Counsel and Care

He said the government is taking �1bn a year out of the NHS for social care by insisting the health service invest in services that overlap with council social services departments, such as rehab care following discharge from hospital. He accused ministers of "double counting".

The bill for the shake-up of the health service - primary care trusts are being scrapped and GPs put in charge of local budgets - will also amount to between �2bn and �3bn over the next four years, while the VAT increase will cost �250m.

Mr Healey said: "The NHS will have to find these extra costs within a funding settlement which it is increasingly clear falls far short of what many in the NHS believed your government had promised."

These are on top of the extra long-term pressures from the cost of new drugs, obesity and the ageing population.

Independent experts, including the King's Fund and Nuffield Trust think-tanks, agreed a case could be made for saying the small real terms rise would be swallowed up.

The Nuffield Trust also raised concerns about the extra money earmarked for social care.

Of the �2bn a year extra that is being ploughed into the system by 2014, half is coming from a direct grant to local government.

But as councils are facing an overall cut of 27% in their budget from central government, the Nuffield Trust said social care may not end up seeing the extra money.

Jennifer Dixon, chief executive of the think tank, said: "The reality is that local authority budgets will be stretched and funds for social care are not ring-fenced, so the extra �1bn per year is by no means certain."

Stephen Burke, of Counsel and Care, the older people's charity, agreed it was a risk. He also said getting the NHS and councils to work together to make sure the �1bn of NHS funds benefited social care was a "major challenge."

He said in the past the two sectors had often failed to work together.

Health Secretary Andrew Lansley rejected Labour's criticisms and said the opposition was comparing different numbers from different sources.

He added: "We said in our Spending Review that up to �1bn of the NHS capital budget will be made available to be spent on measures that support social care and benefit health, by the end of the Spending Review.

"Without adequate social care, people would be admitted into hospital unnecessarily, and beds would be blocked because people could not be cared for at home. So this investment benefits both health and social care."

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Call for forceps birth training

20 October 2010 Last updated at 19:28 ET

More training in techniques used during difficult births could help reduce the number of caesarean sections, an expert suggests.

Prabbha Sinha, a consultant obstetrician, says that junior doctors need more time using simulators that help them practise forceps deliveries.

There are wide variations in caesarean rates from hospital to hospital.

The Royal College of Obstetricians and Gynaecologists said regulations cutting training hours were partly responsible.

Forceps, metal instruments which are placed on the baby's head so it can be pulled outwards, and ventouse, a suction cap which is also placed on the head, help doctors apply pressure when a woman is having difficulty delivering the head by pushing alone.

These "instrumental" deliveries have fallen over the years, as the rate of caesarean sections has risen. The suggestion is that doctors unsure of their abilities with these instruments are opting for caesarean where a forceps delivery could be made.

Mr Sinha, who works at Conquest Hospital in St Leonard's-on-Sea, wrote in professional publication "The Obstetrician and Gynaecologist" that extra training could reverse this trend.

He said: "Emergency caesarean sections carry the risk of severe obstetric morbidity, but if conducted properly, instrumental deliveries can be safe and make it easier to give birth again vaginally."

He backed the use of mannequins which allow doctors to try the techniques before encountering a woman in labour.

He said: "Enhanced practical training is required for all junior doctors using simulators to maximise expertise prior to clinical application.

Continue reading the main story

"Start Quote

It's true that if you have people who are very experienced with ventouse and forceps, the caesarean rate goes down"

End Quote Patrick O'Brien Consultant obstetrician

"It is essential that trainees perform these procedures under the direct supervision of a trained and experienced obstetrician."

A recent study looked at caesarean rates across England, and found wide variations, attributing this not to women choosing caesarean in preference to natural labour, but mainly to differences in the way clinical teams made decisions.

Patrick O'Brien, also a consultant, and a spokesman for the Royal College of Obstetricians and Gynaecologists, said junior doctors would be more likely to opt for caesareans if they were working unsupervised by a consultant, for example during a night shift, and if they had relatively little experience or training in forceps use.

He said: "The European Working Time Directive has meant falls in the number of training hours, and the total years of training have been reduced.

"It's true that if you have people who are very experienced with ventouse and forceps, the caesarean rate goes down."

He backed the call for more training, especially with more modern mannequins which help doctors assess their technique more accurately.

"Where I work, the mannequin actually tells you how hard you are pulling, so you can get that right."

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NHS gets &#39;bare minimum&#39; cash rise

20 October 2010 Last updated at 11:39 ET By Nick Triggle Health reporter, BBC News <!-- Embedding the video player --> <!-- This is the embedded player component -->

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George Osborne: "Productivity in the NHS fell steadily over the last ten years and that must not continue"

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The NHS budget in England will get the above inflation rises it was promised this parliament, but by only the "bare minimum" margin.

Funding will rise by �10bn to �114bn over the next four years - the equivalent of a 0.1% a year hike in real terms.

But the NHS still has to make some sacrifices.

Plans for one-week urgent cancer tests are being scrapped, while unions warned further cuts were inevitable.

Concerns are being raised because historically health spending has gone up by over 4% in real terms.

This is because the ageing population, obesity and the cost of new drugs mean an extra 3% is needed just to stand still.

'Fair society'

Fears were confirmed shortly after Chancellor George Osborne confirmed the rise in the budget in the House of Commons.

In his address, Mr Osborne explained the rise by saying: "The NHS is an intrinsic part of the fabric of our country. It is the embodiment of a fair society. To govern is to choose. And we have chosen the NHS."

Continue reading the main story

Analysis

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The funding settlement is one of the worst since the creation of the NHS in 1948.

It is the first time there has been such a sustained period of small rises.

The worst one-off cut was in 1953-4 when the budget fell by 6.3%, but that was followed by rises of 2.8% and 4.8%.

Small dips in the late 1970s and early 1980s were more than compensated for in subsequent years.

In fact, the �10bn rise by 2014 was virtually the minimum the government could get away with.

Ahead of the election, the Tories said the NHS budget would get above inflation increases.

It has, but only just.

The increase is the equivalent of just 0.1% a year on average - a sum which will be easily swallowed by rising costs from factors such as obesity and the ageing population.

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But as soon as he finished the Department of Health confirmed capital spending, on things such as buildings, would be cut by 17%.

Pledges made by the previous government to offer one-week cancer testing with an urgent GP referral and to extend the free prescriptions scheme were both scrapped as well.

The health service has also been ordered to find �1bn a year by the end of the parliament to help social care services that overlap the NHS, such as rehabilitation care after discharge from hospital.

Meanwhile, the government was unable to guarantee that the cancer drugs fund would get �200m as previously promised.

This comes on top of the public pay freeze and purge of quangos already announced.

The NHS had already been planning for a squeeze.

The previous government asked the NHS to make between �15bn and �20bn of efficiency savings by 2014 - the equivalent of 5% productivity gains a year.

This target has been kept in place by the coalition despite the increase in the budget.

Health Secretary Andrew Lansley acknowledged the health service was facing a tough time.

He said: "The budget will have to stretch further than ever in these difficult times."

But unions said the consequences could be even greater, saying services could be closed and waiting lists rise.

Peter Carter, of the Royal College of Nursing, said the rise would "still feel like a cut".

'Havoc'

Unison general secretary Dave Prentis added it was a "facade".

"The NHS is not safe. Some hospitals are already cutting back on vital life-improving operations such as cataract, hip and knee replacements.

"The NHS needs extra funding just to stand still. It will not be able to keep up."

He also reiterated his criticisms of government reforms, which will see GPs take control of the budget and primary care trusts abolished.

He said they would "create havoc and instability just when the NHS can least afford it".

Professor John Appleby, chief economist of the King's Fund think-tank, even questioned whether the government had really kept to its promise.

"The NHS has got the bare minimum and I'm not sure you can say it is a real terms increase.

"There is an element of double counting to the social care promise. It is money the NHS is giving to other services. I'm not saying social care doesn't deserve it, but it is not money the health service can spend on what it wants to and if you take that out of the budget it is no longer a real rise."

However, the NHS Confederation, which represents managers, said the settlement was probably the best the health service could have hoped for.

The rest of the UK will not make a final decision on health spending until later this year. All have promised to offer some protection to the NHS, although not in such a categorical manner as ministers in England did.

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&#39;More pay&#39; call for sperm donors

19 October 2010 Last updated at 20:22 ET By Adam Brimelow Health Correspondent, BBC News

Men who donate sperm for IVF should possibly be reimbursed more than women who donate eggs, a leading fertility campaigner has suggested.

Laura Witjens, who chairs the UK's National Gamete Donation Trust and has donated her own eggs, says most people are not aware of the "serious commitment" involved in sperm donation.

She argues it is wrong to see it as less worthy than egg donation.

But fertility experts say donating eggs is invasive and carries greater risks.

Fertility clinics are not allowed to pay for eggs and sperm, but they can compensate donors up to �250 for loss of earnings plus expenses.

That limit is about to be reviewed by the fertility watchdog, the Human Fertilisation and Embryology Authority, particularly for women, who have hormone treatment and an operation to take out the eggs.

The question of reimbursement is being debated at the Royal Society of Medicine later.

Ms Witjens argues that sperm donors, who are asked to avoid sex and alcohol for several months while making regular visits to a clinic, should receive "at least the same payment if not more than egg donors".

'Heroes'

In an article for the BBC News website's "Scrubbing Up" column, she says it is wrong that most attention is paid to egg donors who enjoy "elevated status", while sperm donors may be subjected to "jokes or smutty comments".

"Assuming [sperm donors] follow the guidelines, it means we're asking healthy men aged between 20 and 45 (and their partners) to have very limited sexual activity for months on end. This has a significant impact on their normal life," Ms Witjens writes.

"Just like egg donors, to the families these guys help, they are heroes. And that's something that deserves recognition from us all."

She acknowledges that donating eggs involves risks and is much more intrusive; 10 years ago she donated her own eggs for use in IVF treatment.

But Ms Witjens concludes that payment should not be based solely on medical risk, and that sperm donors should be rewarded for their "commitment, dedication and selflessness".

Many fertility experts disagree with higher reimbursement for sperm donors.

Dr Allan Pacey, a senior lecturer in andrology at Sheffield University, says he is personally uncomfortable with the debate over money, arguing that "the clue is in the name - donations".

But he says: "We have argued historically that women should be paid more because they take more risk."

'Woefully inadequate'

However, he agrees that sperm donors are not treated well enough. "In society we tend to sneer. That chips away at potential donors."

Sarah Norcross, director of Progress Educational Trust, also disagrees with the idea of offering more for sperm donors, arguing that women face a "much more intrusive procedure".

She said: "There's always a risk attached, much higher than for a man turning up and doing the business in a jar."

However she agrees that the level of compensation for men and women should increase, describing the current limit as "woefully inadequate".

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&#39;Tipsy&#39; alcohol gene discovered

19 October 2010 Last updated at 21:01 ET By Michelle Roberts Health reporter, BBC News

Experts say they have found a "tipsy" gene that explains why some people feel alcohol's effects quicker than others.

The US researchers believe 10% to 20% of people have this gene - called CYP2E1 - and that it may offer some protection against alcoholism.

That is because people who react strongly to alcohol are less likely to become addicted, studies show.

The University of North Carolina said the study aims to help fight addiction, not pave the way for a cheap night out.

Ultimately, people could be given CYP2E1-like drugs to make them more sensitive to alcohol - not to get them drunk more quickly, but to put them off drinking to inebriation, the Alcoholism: Clinical and Experimental Research journal reported.

Straight to the head

Lead researcher Professor Kirk Wilhelmsen said: "Obviously we are a long way off having a treatment, but the gene we have found tells us a lot about how alcohol affects the brain."

Most of the alcohol people consume is broken down in the liver, but some is metabolised in the brain by an enzyme which the CYP2E1 gene provides coded instructions for.

Continue reading the main story

"Start Quote

Alcoholism is a very complex disease, and there are lots of complicated reasons why people drink. This may be just one of the reasons"

End Quote Professor Kirk Wilhelmsen, who led the research

People who have the "tipsy" version of CYP2E1 break down alcohol more readily, which explains why they feel the effects of alcohol much quicker than others.

The researchers made their discovery by studying more than 200 pairs of students who were siblings and who had one alcohol-dependent parent but who did not have a drink problem themselves.

They gave the students a mixture of grain alcohol and soda that was equivalent to about three average alcoholic drinks. At regular intervals the students were then asked whether they felt drunk, sober, sleepy or awake.

The researchers then compared the findings with gene test results from the students.

This revealed that CYP2E1 on chromosome 10 appears to dictate whether a person can hold their drink better than others.

Professor Wilhelmsen says more research is now needed to see if the findings could be used to make new treatments to tackle alcohol addiction.

"Alcoholism is a very complex disease, and there are lots of complicated reasons why people drink. This may be just one of the reasons," he added.

Don Shenker, of the charity Alcohol Concern, said that, in most cases, alcohol abuse stemmed from social problems, with alcohol used as a prop.

Professor Colin Drummond, an expert in addiction at London's Institute of Psychiatry, said it was likely to be combination of genes and environment.

"It is well recognised that alcohol dependence runs in families," he said.

He said research suggests having an alcoholic parent quadruples a person's risk of developing a drinking problem.

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