Inside Health

Care.data, the scheme to build an enormous database containing the medical records of all English patients has been scrapped. Dr Mark Porter investigates the fall-out following the cancellation of this expensive programme, which foundered on concerns about confidentiality and public and professional trust. Chair of the national EMIS user group and Sheffield GP Dr Geoff Schrecker and GP Dr Margaret McCartney discuss the scale of the failure of the care.data programme and outline what needs to happen in the future if valuable patient data is to be used for the public good.Twelve hundred adults and children die every year in the UK from asthma attacks, and these grim statistics have remained stubbornly consistent for decades. But there is light on the horizon as researchers in the field begin to stratify the disease; identifying patients with different types of asthma and treating them accordingly. Mark visits the Churchill Hospital in Oxford where some pioneering work has taken place to develop new diagnostic

David Haslam, chair of NICE, discusses with Mark Porter how doctors should treat patients with 'multi-morbidity', the millions of people receiving many different drugs for many different conditions. There's plenty of trial data for starting treatments, but a dearth of evidence for stopping them! And one-shot radiotherapy during surgery for breast cancer may help 20,000 women in the UK. Rather than daily hospital visits for radiotherapy over 5 weeks, a dose is given straight to the open wound during the operation. It is quicker, cheaper and much more convenient, so why isn't it more widely available?

NHS health checks or 'mid-life MOTs' have hit the headlines as new research claims they are a success. The aim is prevention - of diabetes, heart attacks and strokes - but their introduction has been controversial amid criticism they are not evidence based or cost effective. Resident sceptic Dr Margaret McCartney debates the issues with National Clinical Advisor Dr Matt Kearney.And putting the family back into planning. As more couples leave it later before starting a family there is growing concern from fertility experts that many people don't know enough about when female fertility starts to decline. Professor Adam Balen and Professor Joyce Harper discuss the issues. And how accurate is the perception, often reported in the media, that fertility 'drops off a cliff' in the mid to late thirties? Professor Richard Anderson reviews the so called 'broken stick' study, a mathematical model which first defined the sharp drop off of female fertility.And another instalment of Inside Language where Dr Margaret McCart

The average five-year-old consumes their own body weight in sugar every year in this country - a scary illustration of the scale of the sugar problem. The new sugar tax is supposed to tackle this, but what's the evidence that a tax on sugary drinks alone will make a difference? Dr Margaret McCartney reviews the evidence from other countries, which have also used fiscal measures to nudge their populations into eating a healthy diet.PrEP - pre-exposure prophylaxis - is the latest advance in the ongoing battle against HIV. Studies show this preventive HIV therapy can reduce the risk of HIV infection by 86%. So the announcement by NHS England that it wasn't its responsibility to commission the drug has been met by shock and disappointment. Sexual Health and HIV consultant, Dr Jake Bayley, tells Mark that PrEP is a game changer in preventing HIV in high risk groups and the news that it won't be rolled out nationally, as expected, means the UK is falling behind in HIV prevention."We don't like to talk about our bot

Why asthma is both over diagnosed and undertreated. Professor Mike Thomas and GP Dr Margaret McCartney discuss this apparent contradiction and look behind recent headlines that half a million children in the UK could be taking asthma medicines they don't need. A new study finds that putting doctors under pressure or being a difficult patient may backfire, inducing them to make diagnostic errors. With scarlet fever and measles in the news, Margaret McCartney gives a quick guide on the key symptoms as both diseases have a characteristic rash. A listener has emailed to ask about visual snow, a condition where your vision is like an untuned TV set. World expert, Professor Peter Goadsby explains the latest understanding of visual snow, and says that even 15 years ago it hadn't been universally accepted as a condition. Plus the first in the latest Inside Language series with Margaret and Dr Carl Heneghan of Oxford University. This week, they discuss confounding factors and why they matter to your health.

Millions of anti-depressants are prescribed every year and more than half of people taking them have been doing so for two years or more. But how do you know when you're better and how can you tell that the time is right to stop taking them? Withdrawal symptoms are often confused with a return of the original depression so careful tapering of medication is crucial. Tony Kendrick, Professor of Primary Care at the University of Southampton gives Dr Mark Porter a run down of what to do, and what not to do, when it comes to coming off medication. If you're 40 or above you're to receive dementia awareness as part of the latest Prime Minister's Challenge on Dementia 2020, just announced. The plans to include dementia education for middle aged people in future NHS Health Checks are aimed at making England - no plans as yet to replicate this in Scotland, Wales or Northern Ireland - the best country in the world for dementia care. Dr Margaret McCartney reviews the new proposals.Seven thousand people in the UK are curr

The use of talc and its potential connection with ovarian cancer has hit the headlines after a court ruling in America. Given that nearly half the UK population uses talc to some degree GP Dr Margaret McCartney looks at the evidence and puts any link in perspective. PBC is an often missed condition that causes severe itching and fatigue with the resulting liver damage mistakenly associated with drinking too much. Laura Gilmore lived with the symptoms for many years - scratching herself raw and falling asleep during the day but still not waking refreshed - before getting a diagnosis. Professor James Neuberger explains the science behind PBC.Plus treating severe head injury and why a commonly used intervention used in intensive care units across the country is being questioned. Professor Peter Andrews is the man behind a new trial looking at the evidence for hypothermia, or cooling people with head trauma to prevent damage. The trial was stopped because early evidence suggested harms from this commonly used pra

Up to half a million people in the UK could have it, but it's a condition that hardly anybody has heard about: Charles Bonnet Syndrome. It happens to people who are losing their sight through age-related macular degeneration, cataracts, diabetic eye problems or glaucoma. They see vivid and often frightening visual hallucinations and these images are soundless. Judith Potts' mother Esme was in her 90's when she eventually admitted to her daughter that she was seeing frightening images of goblins and Victorian children all around her. Judith had never heard of the condition and as she tells Dr Mark Porter, neither had any of the health professionals taking care of her mother. Shocked that there was so little awareness about something that is so common, she set up an awareness group, Esme's Umbrella. Dr Dominic Ffytche, Clinical Senior Lecturer at King's College London's Institute of Psychiatry and an expert in visual hallucinations, tells Mark that a key area of research is why some people have Charles Bonnet S

The UK's first licensed e-cig, owned by a tobacco company, is now classed as a medicine paving the way for it to be prescribed on the NHS to help people quit. Robert West, Professor of Psychology at University College London and one of the world's leading experts on smoking cessation, and GP Margaret McCartney debate the issues.Asherman's Syndrome, a little known complication of surgery that is often missed but can cause infertility. Obstetrician Virginia Beckett explains how Asherman's Syndrome occurs and how it is treated.Rugby is growing in popularity, particularly among children, with 1.2 million of them now playing at schools and clubs in England alone. But at what cost? Rugby is rough and injuries are more common than most parents think.After her son and other young people were hurt repeatedly on the rugby field, Allyson Pollock, Professor of Public Health Research and Policy at Queen Mary, University of London, explored the incidence of injuries. From her research she is now recommending an end to the

Dr Margaret McCartney reviews advice to pregnant women concerned about the Zika virus while Andrew Shennan, Professor of Obstetrics at King's College and St Thomas' Hospital in London tells Dr Mark Porter about the risks of infection closer to home - chicken pox.One in every one thousand babies born in the UK has congenital talipes, or club foot. This is where the foot points inwards and downwards, the sole facing backwards. But thanks to the late Ignatio Ponseti, an orthopaedic surgeon from Iowa in the USA, 95% of children born with club foot will make a complete recovery. Dr Ponseti was concerned about the low success rate of surgical treatment, which often resulted in life-long pain and stiffness and a 50% chance of recurrence. He developed a new technique in the 1960's that involves stretching the foot, holding it in plaster casts and eventually braces. The problem was that nobody believed him and it wasn't until the early 2000's that his technique became the new gold standard for club foot treatment - th

How low should you go when treating blood pressure? Mark Porter talks to the author of landmark study that was stopped early because the benefits of aggressive treatment were so convincing. This looks set to change the management of high blood pressure and millions more people in the UK will be taking extra medication. Dr Margaret McCartney debates the issues with Professor Tony Heagerty.Imagine if your high blood pressure could be cured by an operation that meant no pills at all? That's possible if it's due to a condition called Conn's syndrome, now thought to be much more common than previously thought. Mark Porter hears from leading specialist, Professor Morris Brown, plus a school teacher who spent 10 years on pills before being diagnosed and is now cured.And an Inside Health listener asks: why is palm oil in everything?

Scotland is considering whether to add folic acid to staple foods like flour to protect babies against conditions like spina bifida. Frustrated at the lack of action by the UK government on the issue - despite government advisers recommending for 16 years that flour should be fortified with folic acid - the Scottish government is preparing to go it alone. Spina bifida is one of a group of severe congenital abnormalities known as neural tube defects that affect around 5000 developing babies in Europe every year. It's long been known that taking folic acid supplements, before and after pregnancy, can reduce the likelihood of these defects, as Helen Dolk, Professor of Epidemiology at the University of Ulster explains to Dr Mark Porter. Professional footballers are vulnerable to hip and groin injuries and much more likely to get arthritis as they get older. Southampton Football Club has introduced a new hip stretch and flexibility programme for all their players and the result is a dramatic reduction in injuries

Dr Mark Porter unpicks the science behind the so called 'weekend effect'. Politicians have quoted research claiming that people are 20% more likely to die of a stroke at the weekend, while another much cited study finds 11,000 more deaths in people admitted at the weekend. But how valid are these figures and the research that generated them? Dr Margaret McCartney reviews the stroke data that has been criticised by experts as being out of date. While Mark Porter talks to Editor of the BMJ, Fiona Godlee, who published the 11,000 figure but is concerned about the political use of the findings. And discusses the study with lead author Nick Freemantle, plus Consultant Surgeon Sam Nashef who is sceptical about the results.

Inside Health listener and keep fit enthusiast, David Heathcote, wanted advice on how far he should safely push himself when he's training in the gym.In this special programme about the health benefits of keeping active, Dr Mark Porter helps David to find the answer to his question about the exercise "sweet spot". If you struggle to screw the top off a jar, or use your arms to push yourself out of your chair, that's a sure fire sign, according to Dr Philip Conaghan, consultant rheumatologist and Professor of Musculoskeletal Medicine at the University of Leeds, that your muscles are weak. And the good news is that building muscle strength will protect your joints, not damage them. Dr Conaghan tells Mark that there's a worrying lack of understanding about the impact of muscle weakness on arthritic joints.Over the last decade there's been a growing interest in the relationship between activity and the risk of developing cancer. Studies have demonstrated that exercise appears to have a protective effect against a

Prescriptions for nerve drugs pregabalin and gabapentin have risen dramatically in recent years and at the same time, concerns about abuse. Former prisoner and addict "Patrick" tells Dr Mark Porter that "gabbies" or "pregabs" are drugs of choice in jail and Dr Iain Brew, a GP who works in prisons, says misuse is a growing problem and there are examples of doctors being pressurised into prescribing them. Dr Cathy Stannard, consultant in pain medicine at Southmead Hospital in Bristol, chaired an expert group that drew up new prescribing guidelines for pregabalin and gabapentin and she tells Mark that more attention needs to be paid to emerging evidence of misuse. Many women say that if they've had one caesarean section, they feel pressurised to have another one and Sara describes how her medical team planted "a seed of doubt" about the potential risks to her baby which she says for her meant another C-Section was inevitable. But new guidelines from the Royal College of Obstetricians and Gynaecologists spell out

As cars were banned from central Paris this weekend and the health risks of pollution hit the headlines, Mark Porter examines the statistic that pollution kills 29,000 people a year in the UK.And he visits a pioneering clinic at Southampton General Hospital where falls in the elderly are seen as a risk factor for underlying health problems; 'Having a hip fracture is like having a heart attack or stroke' explains Dr Mark Baxter. 50% of people who have a hip fracture will have previously presented with a fall, but once they go on to break a hip, 1 in 10 elderly people may not be alive at the end of the month and up to 25% by the end of the year. Many elderly people are found to be on multiple treatments - blood pressure pills or bladder pills for example - that make people fall over. In recent years there has been much more attention paid to the cumulative burden of the side effects of medicines in the elderly - particularly the group of commonly used drugs known as Anticholinergics. And according to new resear

For five years the Cancer Drugs Fund has supplied seventy five thousand patients in England with cancer drugs, but its days are numbered. Spiralling costs have led to a reduction in the number of drugs the CDF will pay for, meaning newly-diagnosed patients may miss out. Dr Mark Porter talks to Vicky Rockingham about the anxiety that reform of the CDF is causing. Vicky is a mother of two, working full time, and receiving regorafenib paid for by the CDF for her rare type of gastrointestinal stromal tumour, or GIST. She tells Mark that the drugs from the CDF are giving her extra time with her family and enabling her to carry on working. And Jonathan Pearce, Chair of Cancer 52, an alliance of organisations that represent people with less common and rarer cancers like Vicky's, tells Mark why any new-model CDF must take into account individual patient needs. Regular Inside Health contributor, Dr Margaret McCartney, describes how patients access cancer drugs in Scotland, Wales and Northern Ireland and discusses with

Are league tables listing surgical outcomes the best way to assess your surgeon or are high risk patients being turned away as surgeons keep an eye on their figures? New data published this week list the clinical outcomes for heart surgery - cardiac surgeons are just one speciality from an ever expanding list of doctors whose performance is now published in league tables and subject to public scrutiny. But what impact has their introduction had on patient care? Sam Nashef, a consultant cardiac surgeon at Papworth Hopsital, discusses this issue with Mark Porter.Recent research in schools in Wales suggest that as many as one in 12 primary school children get them at this time of year - and that compares favourably with Australian research, which suggests the figure's much higher - closer to one in five. Resident sceptic Dr Margaret McCartney explains which treatments are supported by evidence.Lyn e-mailed Inside Health to understand why she often feels colder than other people. How, she asked, do we regulate ou

Dr Mark Porter presents a programme devoted to questions from the listeners.Dr Mike Knapton from the British Heart Foundation answers a question about whether aspirin can protect against a second heart attack.A number of people asked about the treatment of vertigo. Vertigo is a symptom of a variety of conditions ranging from migraine and Meniere's, to strokes and tumours, but by far the most common is a condition called BPPV - benign paroxysmal positional vertigo. It is caused by debris floating around in the fluid in the balance sensors of the inner ear and typically affects people over 40. And there is a relatively simple way to treat it called the Epley movement, which is much underused. Dr Louisa Murdin, consultant in vestibular and balance disorders at Guy's and St Thomas's hospitals in London, explained how she uses the technique.Dr Margaret McCartney and Mark discuss why doctors sometimes use patronising language when talking to patients.Carpal tunnel syndrome - which normally eventually affects both h

From this week all UK babies will be vaccinated against that most feared disease, meningitis B, the first country in the world to take this step. But the decision to include Men B in the national immunisation programme has come too late for parents, Freya and Ross. A year ago their baby daughter, Harmonie, nearly died after contracting the infection. Her arms and legs as well as the tip of her nose had to be amputated because of the resulting sepsis. Sue Davie, Chief Executive of Meningitis Now tells Mark that the vaccine is great news and will save many lives. But she hopes in the future that it will be offered to older babies and young children, as well as another at risk group, adolescents. Mental health problems have long been linked to fluctuating hormone levels, at times of menstruation, childbirth and menopause. Dr Michael Craig who runs the Female Hormone Clinic at the Maudsley Hospital in London discusses the role of hormone replacement treatments.Statins are the most commonly prescribed medicines in