Saturday, November 20, 2010

Pope's condom comments welcomed

Catholic reformers and groups working to combat HIV have welcomed remarks by Pope Benedict that the use of condoms might not always be wrong.

The Pope said their use might be justified on a case by case basis to prevent the spread of HIV/Aids.

The remarks, due to be published in a book next week, mark a softening of his previously hard line against condoms in the battle against HIV, analysts say.

The Vatican has long opposed condoms as an artificial form of contraception.

This has drawn heavy criticism, particularly from Aids campaigners,who say condoms are one of the few methods proven to stop the spread of HIV.

'Significant shift'

Pope Benedict said during a visit to Cameroon last year that handing out condoms might actually make HIV infection worse, drawing criticism from several EU states.

In his latest comments, however, he said the use of condoms might be justified in exceptional circumstances.

He gave the example of male prostitutes where, he said, using condoms to prevent the spread of AIDS could be seen as an act of moral responsibility, even though condoms were "not really the way to deal with the evil of HIV infection".

This marks a significant shift in his previously implacable opposition to the use of condoms, says the BBC's religious affairs correspondent, Robert Pigott.

UNAIDS, the United Nations programme on HIV/Aids, welcomed the comments as a "significant and positive step forward".

"This move recognizes that responsible sexual behaviour and the use of condoms have important roles in HIV prevention," said UNAIDS Executive Director Michel Sidibe.

The Kenya Treatment Access Movement (KETAM), which works to combat the spread of HIV, welcomed what it said was the Pope's acceptance of reality that abstinence did not always work.

"It's accepting the reality on the ground," said David Kamau, head of the KETAM. "If the Church has failed to get people to follow its moral values and practice abstinence, they should take the next best step and encourage condom use."

The Catholic reform group We Are Church said the comments showed the Pope was able to learn from experience.

The British gay rights campaigner, Peter Tatchell, told the BBC the Pope's comments were significant but needed "clarification".

'Not a moral solution'

The new book - Light of the World: The Pope, the Church and the Signs of the Times - is based on a series of interview the Pope gave the German Catholic journalist, Peter Seewald, earlier this year.

When asked whether the Catholic Church was not opposed in principle to the use of condoms, the Pope replied: "She of course does not regard it as a real or moral solution, but, in this or that case, there can be nonetheless, in the intention of reducing the risk of infection, a first step in a movement toward a different way, a more human way, of living sexuality."

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Pope Benedict said the "sheer fixation on the condom implies a banalisation of sexuality" where sexuality was no longer an expression of love, "but only a sort of drug that people administer to themselves".

Although Pope Benedict reiterated the Church's fundamental opposition to contraception, and repeated his view that condoms were not the answer to curbing HIV, he added that there was much in the area of sexual ethics that needed to be pondered and expressed in new ways.

Austen Ivereigh, coordinator of the Catholic Voices group, said that while this was the first time the Pope had voiced such an opinion on condoms, it was in line with what Catholic moral theologians have been saying for many years.

"The Church's teaching on contraception predates the discovery of Aids," Mr Ivereigh told the BBC news website.

"The prevalence of HIV raised the question of whether condoms could be used to prevent the transmission of the virus.

"If the intention is to prevent transmission of the virus, rather than prevent contraception, moral theologians would say that was of a different moral order."

But Clifford Longley, who writes for The Tablet, a British Catholic newspaper, said the development was far more significant than a nuanced change in attitude.

He said the "small concession... could easily become a collapse in the whole edifice of Catholic teaching on contraception".

"The implication seems to me to be much vaster than even the Pope anticipates," said Mr Longley.

The Vatican newspaper, L'Osservatore Romano, published excerpts of the book in its Saturday edition.



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GP leader warns over NHS reform

Doctors could be faced with angry patients questioning spending decisions if NHS reforms go ahead, the new leader of the Royal College of GPs has warned.

Clare Gerada criticised plans to put �80bn of annual funding into the hands of GPs as part of widespread reform.

Patients could end up begging doctors for life-saving drugs while drug companies lobby GPs, she warned.

The NHS has been told by Health Secretary Andrew Lansley to make up to �20bn of savings by 2014.

Mr Lansley believes GPs know what works best and wants to tap into their entrepreneurial spirit to drive improvement.

'Begging letters'

The plans move the responsibility of deciding who gets treatment from the National Institute for Health and Clinical Excellence and primary care trusts in England to GPs, from 2013.

"At worst, the negative impact for GPs could be patients lobbying outside their front door, saying 'You've got a nice BMW car but you will not allow me to have this cytotoxic drug that will give me three more months of life'," she told the Guardian newspaper.

"I'm concerned that my profession, GPs, will be exposed to lobbying by patients, patient groups and the pharma industry to fund or commission their bit of the service. There could be letters from MPs and patient groups, and begging letters from patients."

She added: "Patients might think that the decision made about their healthcare will be based on self-interest - GPs saving money for themselves rather than spending it on patients."

"Start Quote

I think it is the end of the NHS as we currently know it"

End Quote Clare Gerada Royal College of GPs

Currently about 80% of the budget is held by local managers working for the 151 primary care trusts in England.

Ministers want to transfer much of that responsibility to GPs working in consortiums across the country, phasing out primary care trusts and regional bodies known as strategic health authorities over the next few years.

NHS break-up

But Dr Gerada predicted the demise of the NHS through such reform.

"I think it is the end of the NHS as we currently know it, which is a national, unified health service, with central policies and central planning, in the way that (Aneurin) Bevan imagined," she said.

A Department of Health spokeswoman said the reform was "a necessity", not an option.

"We share a common goal with the RCGP that we all want patients to get the best health and care services," she added.

Shadow health secretary John Healey said the plans were "signalling a break-up of the NHS that will see it move away from a consistency of service that can be accessed whatever people's means."

He accused Mr Lansley of not listening to warnings from doctors, nurses and health experts "to slow down on his high-cost, high-risk plans."



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Friday, November 19, 2010

E. coli O157 linked to heart risk

Catching the most dangerous strain of E. coli could increase the risk of high blood pressure and heart problems years later, say researchers.

A Canadian study of almost 2,000 who fell ill during an outbreak of E. coli O157 found heart attack risk doubled.

Writing in the British Medical Journal, the researchers recommended annual health checks, even for patients who had apparently fully recovered.

A microbiologist said basic food hygiene could prevent many cases.

There are an estimated 1m cases of food poisoning in the UK each year, but the O157 strain of E. coli is regarded as one of the most dangerous.

Low numbers

It can cause severe gastroenteritis and contact with small numbers of the bacteria, carried in animal faeces, is enough to make you ill.

There are approximately 1,000 confirmed cases each year in the UK, and while it is known to cause kidney problems in a small number of people, there has been little investigation into other possible longer-term complications.

The research team, based in Victoria Hospital, London Ontario, followed up people affected when the municipal water system in Walkerton became contaminated in May 2000.

Seven people died, and thousands fell ill, and while some were only mildly affected, many had significant symptoms, including severe diarrhoea.

Checking their medical history in the intervening years revealed that the rate of kidney problems tripled among those with gastroenteritis compared with those who were relatively unaffected.

"Start Quote

It is a rare strain, but the key thing is to stop yourself falling ill in the first place"

End Quote Bob Martin Food Standards Agency

The severely-hit patients were also slightly more likely to develop high blood pressure, and more than twice as likely to have a heart attack during this period.

The researchers suggested that the powerful toxin released by E. coli O157 could trigger inflammation that could affect blood vessel linings, and making heart and blood pressure problems more likely.

They recommended annual blood pressure checks for people who had been seriously affected by the strain.

The number of E. coli O157 cases in the UK has remained stable in recent years, ranging from approximately 800 to 1,200 annually.

However, despite the low numbers, Bob Martin, a microbiologist at the Food Standards Agency, said that people still needed to follow basic hygiene rules when buying and cooking meat products, or after handling animals.

He said: "It is a rare strain, but the key thing is to stop yourself falling ill in the first place.

"You can reduce the risk by keeping things clean in the domestic setting, and cooking food thoroughly, as this will kill off bugs, particularly things like sausages and burgers which are made from minced meat.

"Keeping food properly refrigerated is also important, as is preventing cross-contamination between raw meat and cooked food."



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Wednesday, November 17, 2010

Call to extend breast screening

Annual screening for women in their 40s with a family history of breast cancer may save lives, research suggests.

The NHS breast screening programme currently offers mammograms to women aged between 50 and 70.

But UK researchers say a pilot study suggests regular mammograms should be given to younger women who have relatives with breast cancer.

A cancer charity said more data was needed to weigh up risks and benefits.

The study, published in the journal Lancet Oncology, looked at women deemed at moderate risk of breast cancer because they have relatives with the disease.

Screening is considered unjustified in women with no family history of breast cancer because of the risk of a false-alarm.

Women at high-risk - because they are thought to have a gene mutation associated with the disease - are already closely assessed, with many given MRI scans or offered early surgery.

False alarms

The study recruited 6,710 moderate risk women across the UK who were given mammograms to check for signs of breast cancer every year for four years.

"Start Quote

It will be important to weigh up these benefits carefully against potential risks of routine mammography before deciding whether screening really is the best course of action for this group"

End Quote Hazel Nunn Cancer Research UK

These women are not currently included in the main NHS breast screening programme, which offers mammograms to women aged 50-70 every three years.

The researchers, led by Professor Stephen Duffy of Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, compared cancer rates and deaths in this group with women from other trials who were not given annual screening.

They say the women given screening were significantly more likely to be alive 10 years after a diagnosis of cancer than women in the two control groups.

Professor Duffy told the BBC: "It means that annual mammography does reduce the risk of dying of breast cancer in this group of moderate risk women.

"It means they can go and seek medical help knowing that there is something that can be done."

Rough figures suggest that it would probably save an extra 50 lives a year, he added.

"It doesn't sound like much but it means alot to the people who are in that group because they have relatives who have had breast cancer," he explained. "It's not a huge expense to the NHS."

Surveillance

But Hazel Nunn, senior health information manager at Cancer Research UK, said the full picture was not yet clear.

"Since it seems 5,000 women would need to be screened to save one life, it will be important to weigh up these benefits carefully against potential risks of routine mammography before deciding whether screening really is the best course of action for this group," she said.

"We await the results of further research measuring the risks."

The NHS Breast Screening Programme said plans were in place to extend screening to women with a family history of breast cancer in the future.

Assistant Director, Sarah Sellars, said current guidelines for women at risk of breast cancer because of their family history recommend that certain women should be offered surveillance.

She said these services were currently commissioned locally but in the future would be run by them.

"In the future, the NHS Breast Screening Programmes will be taking on responsibility for routinely screening higher risk women under 50," she said.

"Several breast screening sites are currently testing the software to be able to manage these women effectively.

"This service will sit alongside our current breast screening programme for women aged 50 years old and over."



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Kidney zap lowers blood pressure

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Fred Quatromini: Trial treatment "has done something that tablets can't do, to me anyway"

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A short blast of radio waves to the kidneys can help control high blood pressure in patients who do not respond to medication, a study shows.

The pioneering work, described in The Lancet medical journal, selectively severs nerves to the kidney that play a key role in regulating blood pressure.

Although still in the testing phase, experts say the procedure could one day help hundreds of thousands of patients.

Half of patients fail to achieve good blood pressure control with drugs.

This is partly because it can be difficult to remember to take medication every day. But for up to a fifth of patients it is because the drugs simply have no effect.

High blood pressure is an exceedingly common condition, affecting around one in three adults in England.

"Start Quote

This trial opens up a potentially exciting new avenue for the treatment of patients with high blood pressure who do not respond well to current medicines"

End Quote Professor Jeremy Pearson British Heart Foundation

Experts believe the new procedure could help many of these better control their condition, thereby lowering their risk of future strokes and heart attacks.

Promising results

Doctors led by Professor Murray Esler at the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, have been testing the safety and effectiveness of the therapy.

To get to the kidneys, the doctors use a long, thin piece of tubing called a catheter that is threaded into an artery in the groin and guided up to the kidney.

Once in place, the catheter is connected to a machine that generates radio waves, known as radiofrequency energy.

In this way, a short burst from the machine can knock out a number of tiny nerves that run in the lining of the arteries of the kidney.

By stopping these nerves from sending signals the treatment lowers blood pressure.

The Australian team, working with 24 centres across the globe, have tested the treatment in trials involving more than 100 patients.

They found the therapy lowered blood pressure by about 10mmHg or more - which although is not enough to return blood pressure to a 'normal' level is enough to reduce some of the associated health risks of very high blood pressure.

And, importantly, there were few side effects if any.

Six months after the treatment, 41 (84%) of 49 patients who underwent the procedure had a reduction in systolic blood pressure of 10mmHg or more, compared with 18 (35%) of 51 controls.

The first patient in the UK received the innovative procedure at Barts and The London NHS Trust a year ago.

Commenting on the findings, Professor Jeremy Pearson of the British Heart Foundation said: "This trial opens up a potentially exciting new avenue for the treatment of patients with high blood pressure who do not respond well to current medicines.

"Further studies are needed to see if this invasive procedure will be acceptable to patients and produce long-lasting effects that are safe and reduce future cardiovascular events."

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Professor Graham MacGregor, chairman of UK charity the Blood Pressure Association, said: "This is exciting research which could play a part in tackling the massive issue of high blood pressure, which affects 16 million UK adults and is a major killer through the strokes and heart attacks it causes."

But he said most people would not need to undergo such invasive treatment as, for the majority, high blood pressure can be successfully controlled through prescribed medicines and a healthier lifestyle.



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Ministers &#39;broke midwife pledge&#39;

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Cathy Warwick: "The government is not delivering on its pre-election pledge...we are incredibly disappointed"

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The Royal College of Midwives (RCM) has accused the government of backing down on a pre-election pledge to increase midwife numbers in England.

It says mothers and babies will suffer unless the 3,000 extra midwives it says were promised are delivered by 2014.

RCM general secretary Cathy Warwick will tell its annual conference there are too few to cope with a rising birth rate and increasingly complex births.

The Tories said the rise was now not needed as the birth rate was stable.

Speaking ahead of Wednesday's conference in Manchester, Ms Warwick told BBC Radio 5 live ministers had gone back on their word.

Vacant posts

"Start Quote

There is a need for more consultants to deal with the increase in the number of high-risk pregnancies"

End Quote Dr Tony Falconer Royal College of Obstetricians and Gynaecologists

She said: "Just before the election, both the prime minister and the deputy prime minister told us that they would commit to continuing the previous government's promise to give us more midwives.

"We've just done a survey of all the heads of midwifery and they've got vacant posts but they're having difficulty filling them."

The RCM survey of 83 out of 194 heads of midwifery suggested maternity units were already seeing budget and staffing cuts.

Some 30% said their budgets had fallen over the past year, while a third had been asked to reduce staff.

And two-thirds surveyed said they did not have enough midwives to cope with demand.

Meanwhile, the number of live births in England has risen by 19% between 2001 and 2009, to 670,000 a year.

The RCM said births over the same period had become more complex, with obese pregnant women and older or teenage women needing extra support.

The Royal College of Obstetricians and Gynaecologists (RCOG) said maternity services were facing many challenges.

President, Dr Tony Falconer, said: "As well as need for more midwives, there is a need for more consultants to deal with the increase in the number of high-risk pregnancies."

A Conservative Party spokesman said: "The commitment to 3,000 midwives made in opposition was dependent on the birthrate increasing as it has done in the recent past. It was not in the coalition agreement because predictions now suggest the birthrate will be stable over the next few years.

"People can be absolutely clear that our commitment to meet the needs of expectant mothers remains, and we will continue to train new midwives to meet the demands arising from the births."



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