Inside Health

Until recently it was assumed that placebo pills would only produce a therapeutic benefit if patients didn't know that's what they had been given. But there are early suggestions that patients can still get symptom relief even when they're told that there is no active ingredient at all in the pills they've been given. So should placebo pills be openly prescribed to patients? Ted Kaptchuk, Professor of Medicine at Harvard University tells Mark he believes open-label placebo could, if evidence continues to accumulate, form part of the physician's therapeutic toolbox. But Inside Health's Dr Margaret McCartney urges caution. She says there is insufficient evidence about the long-term impact on symptoms. Nearly 500 people died on the transplant waiting list last year and if you're one of the 7,000 waiting for a life-saving organ, how would you feel if the organ on offer came from a donor infected with hepatitis C? Such organs are about to be available on the NHS and this radical change has come about because of t

When is the best time to clamp a baby's umbilical cord? It is a controversial question that has perplexed maternity units for years but new evidence from Nottingham has changed practice at the hospital's busy labour ward. Mark Porter pays them a visit. Natural Cycles is a much promoted contraception app advertised as an alternative to more conventional methods. But the Advertising Standards Authority has ruled that claims of it being 'highly accurate' were misleading so Margaret McCartney expresses her concerns that the app doesn't live up to the hype. And once the initial enthusiasm of having a pedometer wears off do they keep people walking in the long term?

Four years ago, Peter, a retired engineer from Gloucestershire, suffered a small stroke and lost the ability to speak. He communicated by hand signals and writing notes to his wife, Carol. But this summer, as he tells Dr Mark Porter, he woke up one morning and, much to everybody's amazement, began to talk....and he hasn't stopped since. Later that same day, a second stroke was diagnosed but his newly-returned speech was unaffected. It's a remarkable story and Alex Leff, Professor of Cognitive Neurology at the Queen Square Institute of Neurology in London discusses Peter's experience but describes what usually happens when stroke patients experience aphasia. We're all familiar with devices like FitBits and gym monitors that measure your pulse rate but the latest development in wearable tech is a watch that monitors your heart. The latest Apple watch will offer ECG-like capabilities which can spot potentially worrying disturbances in heart rhythm. But Inside Health's Dr Margaret McCartney has serious concerns a

Every GP surgery should provide access to a dedicated social prescriber, according to the Royal College of GPs. Supporting peoples' non-medical needs - including housing, finance and social care - will, it is hoped, free up GP time for urgent medical care and at the same time, provide much-needed access to activities in the community. Arabella describes how social prescribing worked for her. A support worker helped her to join a choir, sort out finances and plan how to return to work after a period of serious illness. Dr Marie Polley, senior lecturer in health sciences at the University of Westminster and co-chair of the Social Prescribing Network (with Dr Michael Dixon) tells Dr Mark Porter that social prescribing will be embedded within medical and social care in the next decade as long as the voluntary sector is supported.Steroid cream and ointments - like hydrocortisone, clobetasone and betamethasone - are used to treat a number of skin problems. But for some patients long-term topical steroid use can lea

If you are taking low dose aspirin - typically 75 mg day - to protect against heart attack or stroke and you haven't been weighed then there is a good chance you are on the wrong dose. And from prevention to treatment; a new way of managing the most common form of stroke by grabbing the blockage in the brain and pulling it out. Charlotte Smith tells her story of a remarkable recovery from the procedure whilst she was pregnant with her second child. Plus a continuation of our guide to the help available when people lose the capacity to make decisions about their care. This week Mark Porter explains Best Interest Decisions and Lasting Power of Attorney. And GP Dr Margaret McCartney reflects on the Hadiza Bawa Garba case.

Does running damage your knees? And is cycling any better? Runner, cyclist, GP and Inside Health regular, Dr Margaret McCartney goes to the new Motion Analysis Lab at Glasgow's Jubilee Hospital and asks orthopaedic surgeon and competitive cyclist Jason Roberts about the latest evidence.Around 30,000 people a year suffer cardiac arrest - their heart suddenly stops pumping blood around their body - and fewer than one in ten survive. Paramedics and ambulance crews will give CPR and use a defibrillator to try to restart the heart, and for the past 50 plus years, most patients will be given a shot of adrenaline too. But a landmark new study funded by the government and run by Warwick Medical School reveals that giving adrenaline barely increases survival and almost doubles the risk of severe brain damage. Dr Margaret McCartney discusses likely changes to policy with Dr Mark Porter.It's said that eyes are the windows to the soul - and certainly looking into other peoples' is the key part of human interaction. But w

The relationship between when babies are weaned and the amount of time they sleep has hit the headlines after a new study has been published. Now UNICEF has got involved. Margaret McCartney reviews the evidence. Also proof that seeing the same GP saves lives. Mark Porter meets the man behind new research on mortality and continuity of care, Sir Denis Pereira Gray, who also works in the same GP surgery as his father and grandfather did. And a guide to Mental Capacity, an issue that touches many people but is increasingly pressing as more families manage elderly relatives living with dementia. Plus research and the NHS charter.

Copycat biologic drugs, to treat conditions from arthritis and psoriasis to breast cancer and lymphoma, could save hundreds of millions of pounds off the NHS drugs bill. Called biosimilars, these close copies give the same clinical benefit at a fraction of the cost. Up to now the problem has been take-up, but a new initiative led by the specialist UK cancer centre, London's Royal Marsden, run across the NHS Cancer Vanguard, has demonstrated that patients can be switched effectively onto the cheaper drugs. Chief pharmacist at the Royal Marsden, Dr Jatinder Harchowal, who led the national staff education programme, tells Mark that getting clinicians and patients on board was key to achieving an 80% take up for the blood cancer biosimilar, rituximab. This month a biosimilar copy of the breast and stomach cancer drug, Herceptin (generic name trastuzumab) is being introduced to patients too. Imogen had sleep problems for almost 30 years and she admits that at times, her insomnia left her in a desperate state. For

Tamoxifen, the so called "statin of breast cancer prevention" is recommended for healthy women with a family history of the disease. So why are only 1 in 7 of those eligible taking it? And Mark Porter speaks to Professor Gareth Evans working with his team at the Wythenshawe Hospital in Manchester to reliably identify women at higher risk of breast cancer. They are testing for SNPS, spelling mistakes in the DNA that influence growth and survival of cancer cells and that give a more accurate assessment of a woman's risk.

The UK has one of the highest recorded rates of acid attacks in the world, nearly 500 cases in 2016. Most of the victims are men and most have corrosive liquid, typically acid or bleach, squirted into their faces while they are being mugged for their phone, bag or car. Andrew Keene was attacked in London last year while he sat in his car, and blinded by a robber who then drove off in his car. He's had five operations, including two corneal grafts, to try to restore the sight in his right eye. Dr Mark Porter talks to Andrew at Queen Victoria Hospital in East Grinstead, where sight-saving eye surgery was pioneered over sixty years ago. This hospital set up the UK's first Eye Bank for donor eyes and it is from these donations that eyes, damaged like Andrew's, are repaired using grafts. Mark hears about the shortage of donated corneas which mean long waiting lists for eye surgery and Eye Bank head Dr Nigel Jordan tells him they're having to import donor eyes from the USA to meet demand. BBC News anchor George Ala

Deciding between healthy ageing and early dementia; how useful are modern imaging techniques in deciphering this difficult question that many families are grappling with. Margaret McCartney tries to make sense of conflicting research on the impact of fish oils on children's reading ability and memory - how can the same research group, in the same university run two trials and get completely opposite results? And recently Baroness Tessa Jowell called for more access to adaptive trials but what does this type of research actually mean for patients taking part? Plus the evidence for the health benefits of yoga.

There are many myths about recovery from a heart attack. The most dangerous is that exercise is too risky. The truth is that for most people, they should be doing much more exercise, not less. Patrick Doherty, Professor of Cardiovascular Health at York University and lead author for the National Audit of Cardiac Rehab tells Dr Mark Porter that 70,000 people who should be accessing life saving cardiac rehabilitation therapy are missing out. The answer? Don't blame the patients but improve the design of rehab packages, he says. Inside Health visits a rehab session at Charing Cross Hospital in London and hears from cardiac patients about the impact of supported exercise programmes on their health.A group of psychiatrists, psychologists and patients have complained to the Royal College of Psychiatrists about the withdrawal effects of antidepressants. They say claims that side effects are resolved, for the majority of patients, within a few weeks of stopping treatment are false and in fact, many people suffer unpl

This week it has been hard to miss news on prostate cancer. The papers were full of a 'one stop shop' service for the diagnosis of the disease being rolled out in three hospitals in England. Plus celebrities have described their diagnosis and encouraged men to see their doctor for a PSA test. But just published today, the largest every study of prostate cancer over 10 years confirms that a single screening test of PSA does not save lives. With all these headlines this week is an ideal time to repeat Inside Health's prostate special. One in eight men in the UK will develop prostate cancer at some stage, but deciding who needs treatment - and when - is still far from clear. Mark Porter and Margaret McCartney report on two landmark trials that could provide some clarity, and hears from men and their doctors, faced with the dilemma of choosing the right course of action.

First urine testing then finger pricking and now high-tech scanning. The monitoring of glucose levels is undergoing a revolution for patients with Type 1 Diabetes. Dr Margaret McCartney reports from Glasgow on the new sensing devices which allow for endless glucose scanning without the need for multiple finger prick blood tests. She talks to parents like Ben, who's paying for a continuous glucose monitor because the fingers of his young son George, were so sore from constant finger prick testing that he couldn't even play with his lego. And to 18 year old Matthew and his mum, Barbara, about the flash glucose monitor which they say has transformed the control and management of his diabetes. Dr Kenneth Robertson, who's led NHS Greater Glasgow and Clyde's Children's Diabetes Service for the past 25 years tells Margaret that the new technology is a game changer for diabetes, but urges a cautious, evidence-based roll-out of the best devices.Many patients, as Margaret hears, are paying for the devices out of their

There are questions in Parliament following the story of 6 year old Alfie Dingley who was refused medical cannabis to help relieve his epileptic seizures. But what is the body of evidence for medical cannabis and does the reality live up to the hype? And age, immunity and the poor performance of this season's flu vaccine. Why do our defences decline as we get older and what can be done to improve vaccines that aim to protect the elderly against flu? Plus blood in your urine - pee the colour of Ribena is hopefully enough to drive anyone to their doctor - but what about tiny traces invisible to the naked eye frequently picked up by sensitive dipstick tests? If that has happened to you listen to our comprehensive guide.

Rickets was eradicated from the UK after World War Two but "The English Disease", as rickets has long been known, is back. Two children have died of this completely preventable disease in the past two years. Dr Mark Porter talks to paediatrician Dr Benjamin Jacobs at the Royal Orthopaedic Hospital in Stanmore about the importance of Vitamin D supplementation and calcium for proper bone growth. He meets Zana, whose toddler son was diagnosed with rickets six months ago and talks to Dr Priscilla Julies, paediatrician from the Royal Free Hospital in London about the forthcoming British Paediatric Surveillance Unit survey of the disease. Consultant Paediatric Endocrinologist Dr Wolfgang Hogler from Birmingham Children's Hospital tells Mark that the UK's record of vital Vitamin D supplementation is woeful compared to our European neighbours and warns that unless rickets is given a higher priority, more lives will be lost.The number of drug related deaths has soared in recent years and this is against a background o

Over half of all blood clots are acquired during hospitalisation, particularly for surgery, so prevention is key. Deep vein thromboses - DVTs - typically occur in the veins of the leg and central to prevention is the need to assess individual risk, while taking steps like special stockings, leg massagers and anticoagulant "blood thinning" drugs to mitigate them. But there are concerns in some quarters - particularly among orthopaedic surgeons - that the drive to protect patients against clots has exposed them to risks of bleeding and that the pendulum has swung too far the other way. Three leading specialists discuss the issues. And iron deficiency, a very common problem, but what is the best way to treat it? New research from Switzerland unexpectedly suggests that giving less iron, less frequently, leads to more absorption. Plus, what's in a doctor's bag?

About six thousand people in the UK lose a leg every year from amputations due to vascular problems, trauma and disease. Others are born without limbs. Standard prosthetic knees often meant frequent falls and stumbles as well as the need to use two sticks. But microprocessor power is set to change all that. A new generation of intelligent joints is now available for the first time on the NHS in England - you can already get them in Scotland and Northern Ireland - and they adjust the knee stiffness to match the individual's weight, gait and activity and they even have anti-stumble software. Dr Mark Porter joins Dr Imad Sedki, consultant in rehabilitation medicine at the Royal National Orthopaedic Hospital in Stanmore at a retrofitting clinic, where patients like Naitik Patel are fitted with these new smart knees.Almost a decade ago, researchers in Scotland coined the term "The Glasgow Effect" after they exposed the shocking fact that premature deaths were 30% higher in Scotland's biggest city compared with cit

News that the pharmaceutical giant Pfizer has pulled out of research into Alzheimer's and Parkinson's disease is casting doubt over the future of long promised breakthroughs in this area. Mark Porter hears from two leading experts who explain that due to the complexity of the disease the pharmaceutical industry's single agent 'magic bullet' approach needs to change. And while over the last 15 years nearly every trial into new treatments for Alzheimer's has ended in failure, lifestyle and medical prevention are starting to make a difference. Plus clarity on headlines that women who've had the HPV vaccine to prevent cervical cancer will need far fewer smear tests in future. But how will the national screening programme know for sure who has been vaccinated - and who hasn't? And Margaret McCartney's thoughts on other news that women treated for breast cancer who carry the BRCA1 and BRCA2 mutations that dramatically increase the risk of developing the disease, are just as likely to survive their illness as women

It's fifty years since the first human heart transplant but the number of donor organs - about 200 per year in the UK - remains dwarfed by demand. About 2,000 people under the age of 65 a year will die of heart failure without a transplant. Kevin Fong explores new ways that people with heart failure can be helped. He talks to Dr Doris Taylor, director of the Center for Cell and Organ Biotechnology, at the Texas Heart Institute, in Houston, about her research into growing hearts from stem cells. Kevin discusses the prospect of taking organs from pigs and using them for so-called xenotransplants with cardiothoracic surgeon Prof John Dark, of Newcastle University, who says this approach has not delivered benefits. An alternative to a heart transplant is the left ventricular assist device (LVAD) - an artificial pump that helps the left side of the heart do its job. This has shrunk from a large external piece of kit to a tiny battery-operated device that can be implanted into the chest. For the first year, they ar