Chronic cerebrospinal venous insufficiency (CCSVI) has become a popular topic for discussion among MS patients since an Italian scientist first linked the disease with the condition of veins in the neck. Dr Paolo Zamboni put forward the theory that MS can be caused by blockages in veins draining blood from the brain and that, if the blockages are cleared, symptoms of MS may be eased.

Blocked, damaged veins

Zamboni’s theory rests on a link between MS and iron deposits in blood vessels. He carried out ultrasound tests on blood vessels leading in and out of the brain and found that, in a majority of people with MS, the veins taking blood away from the brain were blocked or damaged. This was not the case in people without MS.

He further suggested that iron was damaging the blood vessels and allowing the heavy metal, along with other unwelcome cells, to cross the blood-brain barrier: a process he called Chronic Cerebrospinal Venous Insufficiency.

A number of clinics, notably in Poland and Bulgaria, are offering surgery to clear these blockages in veins — an angioplasty technique, also known as ‘liberation procedure’. MS patients in the UK have had to arrange treatment abroad for this surgery, although last year it was offered at a private clinic in Scotland for the first time in the UK.

Few clinical trials have been carried out and the procedure remains scientifically unproven.

Evidence review

NICE has announced a four week consultation on the technique before the Interventional Procedures Advisory Committee (IPAC) is asked to review the evidence. Its findings are expected to be published in Autumn 2011. The committee’s conclusions will be reviewed by NICE, which will issue UK-wide guidance.

Balloon angioplasty

The review will cover ‘balloon angioplasty with or without stenting’.

Balloon angioplasty involves inserting a catheter with a small balloon tip towards a narrowed stretch of a vein. Once in place, the balloon is inflated to stretch the vein or compress any fatty matter. In a variation of the procedure, a stent (a small metal mesh tube) is inserted to permanently keep the vein expanded after the balloon has been withdrawn.

IPAC will base its review on evidence from three professional bodies: the Association  of British Neurologists, the British Society of Interventional Radiology and the British Society of Neuroradiology.

‘Good news for people with MS’

“The single most important thing in this announcement is that NICE are seeking specialist advice from neurologists and interventional radiologists together, Helen Yates Chief Executive of the Multiple Sclerosis Resource Centre(MSRC) says.  Yates continues: “MSRC has long held the belief that these two specialities should be looking at the area of CCSVI together.  It is generally good news for people with MS that this procedure is now receiving this kind of attention.”

Writing in the online edition of the British Medical Journal (BMJ), four consultants say a 46% drop in transplants during the last 10 years is making it difficult for surgeons to maintain their expertise in the country’s six specialist units.

The authors say the fall has taken place despite a record number of organs available for transplant generally.

The Department of Health says it is carrying out a review into the country’s transplantation services.

UK problem

In their editorial, the consultants, all from the Freeman Hospital in Newcastle upon Tyne, note that the problem of declining numbers of heart transplants appears to be specific to the UK, as international data shows figures steady or only marginally falling in Europe and the US.

Lead author Guy MacGowan, a consultant cardiologist, says that there are probably a number of reasons for the drop in the UK, but that a concentration on using donors whose heart has stopped beating may be a contributing factor. “There’s two types of donor: where the  heart stops beating and where there’s brain death; and where the heart stops beating you can use organs such as liver, kidney and lungs, but you can’t use the heart,” he says.

The heart can be used for transplantation from individuals where brain death has occurred.

Rethink on number of transplant centres

MacGowan and colleagues say that one of the consequences of the fall in heart transplants is that surgeons are finding it difficult to keep their skills up to date. They say it is time to consider whether maintaining six units is appropriate.

“Generally, if surgeons are doing more operations of the same type then they get better at it; if they’re doing a few operations of one type – whether it’s transplants or any other type of operation – then results are usually poor,” MacGowan says. “So, to concentrate the few number of transplants amongst a few surgeons would certainly maintain results and make sure that people don’t become de-skilled.”

The authors say another consequence of the reduction in heart transplants is that doctors are having to increasingly rely on mechanical heart pumps.

At present, the six centres where transplants are carried out are in London, Cambridge, Birmingham, Manchester, Newcastle and Glasgow.

Availability of donor organs

Professor Peter Weissberg, medical director at the British Heart Foundation, says fewer units may be the answer. “In terms of medical resources, it’s often the case that fewer but bigger and better resourced centres provide the best treatment and care for patients,” he says.

Weissberg adds that he would like to see more work being done on increasing the number of available organs for transplant. “Encouraging more people to join the organ donor register, or even better, changing our organ donation system so people must ‘opt out’ if they don’t want to donate would help increase the number of donor hearts available,” he says.

NHS Medical Director Sir Bruce Keogh, who is a former heart surgeon, says in a statement: “The Department [of Health] is committed to strengthening the heart transplant programme, increasing the number of organ donors and hearts donated for transplant and giving more people the opportunity to benefit from a heart transplant.

“We want to ensure this is carried out in the most effective way. That is why I have asked the National Specialised Commissioning Team to undertake a formal review into heart transplantation services in the UK.”

The research found that tablets known as leukotriene receptor antagonists (LTRAs) managed symptoms of people with asthma as effectively as steroid inhalers and other ‘preventer’ inhalers used in addition to steroid inhalers.

UK: High asthma rate

The UK has one of the highest rates of asthma in the world. In the UK, 5.4 million people are currently receiving treatment for asthma, of which 1.1 million are children.

The charity Asthma UK called the research, led by the University of East Anglia (UEA) and the University of Aberdeen, “authoritative”, but cautioned that the results were preliminary.

Two year study

The researchers followed 650 patients with chronic asthma over two years in a randomised controlled study known as ELEVATE. Some of the participants were assigned to either receive an LTRA or an inhaled glucocorticoid (steroid inhaler) as a first-line treatment. The rest were either prescribed an LTRA or a ‘reliever’ (blue) inhaler, known as a long-acting beta-agonist (LABA), as well as an inhaled glucocorticoid, as an add-on therapy trial.

LTRAs are available under the brand names ‘Singulair’ (montelukast) and ‘Accolate’ (zafirlukast). They have been on the market as an alternative to the steroid inhalers commonly used by asthmatics for some time, but are less fashionable than inhalers and sometimes considered less effective.

The tablets are less frequently prescribed than the traditional inhalers. Study co-author Erika Sims, Honorary Research Fellow at UEA says the bias against LTRAs is not justified. She says that most of the trials comparing tablets against inhalers do not reflect the reality of life by, for instance, excluding smokers.  “This results in a selection bias, as in general practice many asthma patients are active smokers. Furthermore, inhaled corticosteroids have been shown to be less effective in smokers, but do not affect the effectiveness of anti-leukotriene therapy. Excluding smokers from these studies would therefore generate a bias against the LTRA.”

Effective

Writing in the latest edition of The New England Journal of Medicine, the researchers report that over the two year period of the study, LTRAs were as effective at controlling asthma symptoms as steroid inhalers and other ‘preventer’ inhalers when used in addition to steroid inhalers.

They said this could be useful for the more than 80% of patients who have problems using inhalers, who cannot use them due to side effects or who do not want to take steroids.

Clinical implications

The authors say their results should encourage GPs to consider LTRAs for their patients. “We hope these findings will increase the options for healthcare professionals when prescribing for this common but disruptive disease,” said lead author Professor David Price of the University of Aberdeen and UEA in a statement.

Price said that being given tablets also helped patients keep to their treatment regime. “We found that adherence to treatment was vastly improved – by as much as 60 per cent – when patients were given the once-a-day LTRA tablets and patients did not have to worry about using appropriate inhaler technique,” he said.

Dr Richard Stephens of Keele University, who first became interested in the subject when he hit his finger with a hammer during DIY, demonstrated two years ago how swearing can help people cope with pain.

Analgesia

“We think that when people swear it makes them feel more aggressive and stirs a flight or flight reaction in themselves,” he says. Stephens says this ancient response can create stress-induced analgesia, similar to what Stone Age man might have experienced when confronted by a bear. “He had the adrenalin surge and he had to fight the bear or flee away – and one component of fight or flight is increased pain tolerance, which makes complete sense because you will be better able to flee or fight if you’re not so susceptible to pain.”

Stephens says after the publication of his original paper, he was frequently asked whether this pain-relieving effect was influenced by how often people swore in their day-to-day life. So he and student Claudia Umland set out to discover whether habitual cursers benefited less as a result of using bad language more frequently.
Swearing questionnaire

They recruited 71 people aged between 18 and 46 to repeat the earlier experiment. However, this time participants also completed a questionnaire about their swearing habits. Each person was then tested to see whether they could hold their hand under cold water (5 degrees C) for up to five minutes while either repeating a swear word or a non-swear word.

After the experiment the participants were tested on how painful they had found the experience.

Swearing pain relief

The researchers found that 73% of participants kept their hand in the cold water for longer if they repeated a swear word compared with repeating a neutral word. On average, participants held their hand in the ice-cold water for 31 seconds longer if they swore.

They also found that the more often people swear in daily life, the less extra time they were able to hold their hand in the icy water when swearing, compared with when not swearing.

“When we ran the analysis that we did last time about how long people keep their hands in the cold water for – and included swearing frequency as an extra variable in that – the people who don’t swear very much get a much bigger benefit when they do swear in the experiment than when they don’t swear in the experiment,” Stephens says.

He adds that “as you go up the daily swearing frequency, the difference gets less and less until eventually – at the top end of the range we had – they’re getting next to no benefit from swearing”.

The latest research is being presented at the British Psychological Society’s Annual Conference.

The Swansea-born Hollywood star, 41, was admitted to rehab after helping her husband, actor Michael Douglas, recover from throat cancer.

“After dealing with the stress of the past year, Catherine made the decision to check in to a mental health facility for a brief stay to treat her Bipolar II Disorder,” publicist Cece Yorke said in a statement. The Oscar winning actress reportedly checked into a clinic in Connecticut for five days earlier this month.

Mood swings

Bipolar disorder — sometimes known as manic depression — is a severe mental health problem. It involves extreme mood swings that alternate between highs and lows. Around one person in every 100 is diagnosed with the condition.

“For some of the time people are very, very depressed — and that’s not the same as just being a bit blue or having a bit of a bad day,” says Jane Harris, Associate Director of the mental health charity Rethink. She says that a typical symptom is “a complete lack of emotion about anything” and during episodes “people are very down, they lack self-worth and they may have problems even getting out of bed, let alone out of the house”.

Harris says the other side to the condition is a period when people feel “absolutely euphoric and pretty manic and really feel like they can take on the world and do anything”.

Harris says stressful situations such as bereavement, divorce or money worries can trigger bipolar. “Certainly caring for a husband who is very ill will certainly be a very stressful time,” she says.

Celebrities

Zeta-Jones, who won a best supporting actress Oscar for her role in Chicago, joins a list of well-known people who have had bipolar, such as Stephen Fry, Bill Oddie, Gail Porter and possibly Sir Winston Churchill.

Harris thinks publicity surrounding the actresses treatment for bipolar will be good for other people with the disorder who are prone to feeling stigmatised. “Somebody like Catherine Zeta-Jones talking so openly about it … just shows that this can happen to anybody, and I think that is a bit of a comfort for people who are really struggling.”

Some mental health professionals categorise bipolar into four main subtypes with bipolar II — which Zeta-Jones is said to have — categorised mainly by depression with episodes of hypomania.

Treatment

Harris says people with bipolar usually need a mixture of some kind of medication and talking therapy. “What’s really important is that if people do go to a medical professional, be that a psychiatrist or a GP, they shouldn’t just be given medication because really you need both to really maximise your chances of getting over it.”

Harris adds: “As long as Catherine Zeta-Jones gets the right treatment, she should certainly be back in films in the near future.”

The Sunbeds (Regulation) Act 2010 will stop young people from using sunbeds in a wide range of places, including tanning salons, hotels, gyms and leisure centres.

However, one environmental health body said the rule changes did not go far enough and called for even tougher controls – due to come into effect in Wales later this year – to be applied in England as well.

Steep rise in melanoma rates

Today’s announcement of substantial fines for firms who allow young people to use tanning beds came just days after Cancer Research UK revealed an “alarming” tripling in melanoma rates among British people aged 15 to 34 since the late 1970s.

The change in the law means that people under the age of 18 will be prevented from:

• being allowed to use tanning salons and sunbeds at premises including beauty salons, leisure centres, gyms and hotels
• being offered the use of a sunbed
• being allowed in an area reserved for sunbed users

ID checks

Businesses will be forced to ask for ID or keep a register of customers. Local authorities will be responsible for enforcing the Act and inspectors will visit premises with sunbeds to ensure they are complying with the legislation.

Public health minister Anne Milton said: “Cases of skin cancer continue to rise each year. This new law will go some way to help reduce one of the biggest cancers among 15-24 year olds.

“We want to protect under 18s from the dangers of sunbeds and reduce the number of young people getting skin cancer.”
100 deaths a year

Rules ‘not tough enough’

However, the Chartered Institute of Environmental Health (CIEH) said the rules were not tough enough and should have encompassed extra regulations being introduced in Wales. From 31st October, unstaffed tanning salons in the principality will be banned and under-18s will be prevented from buying or hiring tanning equipment.

Sunbed businesses in Wales will also have to provide health information and protective eyewear to customers.

Andrew Griffiths, CIEH Policy Officer, said: “We are now urging the Government to follow the example set by Welsh Assembly Government by implementing the powers given to it under the Act to introduce subsidiary regulations increasing the protection given to sunbed users.”

A ban on sunbed use by under-18s was introduced in Scotland in December 2009. The Scottish legislation also included a ban on unstaffed tanning salons and forced operators to provide health information and eyewear.

Sunbed operators say they were ‘ignored’

The Sunbed Association, which represents the tanning industry, also said the latest legislation should have gone further. It says it lobbied unsuccessfully for unstaffed tanning salons to be outlawed and for all sunbeds to have a maximum UV output.

In a press release, the Association said there was “no science” to support the ban being imposed for under-18s and that its members had always been required to prohibit use by under-16s. It said, as a result of the new law, the age bar was now being raised to 18.

Earlier this week, Cancer Research UK released figures showing more than 900 young Britons aged between 15 and 34 are being diagnosed with melanoma each year – more than two a day. It said that compared with around 290 cases of the disease annually in the late 1970s.

They joined the Health Secretary Andrew Lansley for a press conference at a Surrey hospital two days after the announcement that the planned changes were being ‘paused’ so that ministers could hold a two month consultation exercise with health workers and patients’ groups.

‘Safeguard and improve the NHS’: PM

Cameron insisted that sticking with the status quo was not an option, but said he was “passionately” committed to a health service free at the point of delivery. “I’m in politics not to take risks with the NHS but to safeguard and improve the NHS for today and future generations,” he told an audience of doctors and nurses at Frimley Park Hospital.

He announced that a new panel would look at some of the concerns that have been put forward about the changes. The NHS Future Forum would be chaired by Professor Steve Field, the former chairman of the Royal College of GPs.

The forum would look at four main areas of concern which were highlighted earlier this week in a report by the Commons Health Committee.

The British Medical Association (BMA) said it remained to be seen how serious the Government was about making changes to its legislation.

Privatisation fears

The health service reforms would see GPs forming themselves into consortia to take control of the bulk of the health commissioning budget. Once the system was in place, the Strategic Health Authorities and the Primary Care Trusts which currently fulfil this function would be scrapped.

Ministers also propose allowing hospitals to compete with private healthcare providers and for private firms to offer services too.

Health unions have expressed fears that this amounts to privatisation by the back door, with private health firms ‘cherry picking’ the most profitable treatments, while some have questioned whether GPs have the skills and experience to manage huge budgets.

The BMA, The Royal College of Nursing and the Royal College of Midwives have all warned of the “risky” pace and scale of the changes being planned.

MPs concerned

On Monday, MPs on the cross-party Commons Health Committee made a number of recommendations for altering the legislation. Among these were that GPs should not be given sole responsibility for handling health commissioning budgets but should share the responsibility with nurses, doctors, public health experts and representatives from local communities.

The Health and Social Care Bill has already passed its committee stage in the Commons, but Cameron said: “We’ve got a natural break before the legislation reaches its final stages in parliament, so we are taking this time to pause, to listen, to reflect and to improve our NHS modernisation plans.”

He continued: “Let me be clear, this is a genuine chance to make a difference. Where there are good suggestions to improve the legislation … those changes will be made.”

‘Listen, engage and improve’

Lansley said the Government’s ‘listening’ exercise would focus on four areas:

• choice and competition
• public accountability and patient involvement
• new arrangements for education and training to support the modernisation process
• how advice from a range of healthcare professions can improve patient care

Reaction

Dr Hamish Meldrum, Chairman of Council at the BMA, said: “While we share the objectives of improving services for patients and empowering staff, we believe the Bill as it is currently written is taking the NHS in England in the wrong direction. We have particular concerns about the emphasis on a statutory duty to promote competition in the NHS – with the accompanying risk of fragmentation of care, the proposed new model for the delivery of education and training, and the detail of how commissioning will work.”

Chris Ham, Chief Executive of health think-tank The King’s Fund’s, said in a statement: “The real choice is not between the status quo and change, but between the right reforms, executed well or poorly planned reforms that could undermine NHS performance.”

Ham continued: “We welcome the listening exercise announced today but it must result in significant changes to the current proposals if the reforms are to succeed. These changes should be based on clearer accountability, a stronger emphasis on collaboration between services, a more inclusive and gradual approach to GP commissioning and a clearer understanding about where and how far to extend competition.”

The changes — outlined in the Health and Social Care Bill, already before parliament — include abolishing Primary Care Trusts and giving GPs a substantial share of the health commissioning budget.

The radical reform package has come in for concerted criticism from doctors, nurses and patient groups who have warned that the changes risk undermining the NHS and would lead to partial privatisation of the health service.

MPs have further undermined the proposals in a new report which urges “significant changes”.

‘Reckless’

Late on Monday afternoon, the Health Secretary Andrew Lansley promised a listening exercise with scope to “improve” the reforms.

Earlier in the day, the Labour leader, Ed Miliband, had described the Government’s plans as “dangerous” and “reckless”.

In a House of Commons statement, Lansley said: We recognise that the speed of progress has brought with it some substantive concerns, expressed in various quarters. Some of those concerns are misplaced or based on misrepresentations, but we recognise that some of them are genuine.

Pause

“We want to continue to listen to, engage with and learn from experts, patients and front-line staff within the NHS and beyond and to respond accordingly. I can therefore tell the House that we propose to take the opportunity of a natural break in the passage of the Bill to pause, listen and engage with all those who want the NHS to succeed, and subsequently to bring forward amendments to improve the plans further in the normal way.”

Lansley did not say how long he expected the delay to last. The Bill passed its committee stage last week.

Speculation that the Government was losing the media battle to sell its reforms culminated at the weekend in No 10 denying there were any plans to pause the Bill or offer major concessions.

Opposition

Political commentators have compared the situation with the now abandoned plan to sell-off the nation’s forests. The health reform legislation will also have to pass through the House of Lords where it can expect to meet fierce scrutiny from peers of all political persuasions.

Labour has also shown that it is hardening its stance over the proposals. In a speech in London, Ed Miliband said he accepted the need for reform but added that “the Government’s changes would undermine the values of the NHS and make it harder to meet the challenges of the future”.

There are also concerns that the overhaul could endanger the Conservative-Liberal Democrat coalition. Dr Evan Harris, a former Lib Dem MP and health spokesman, has demanded a greater local authority say over GP commissioning bodies as well as stricter democratic oversight and accountability . The Lib Dem peer Baroness Williams told BBC radio that, without concessions on health reform, the coalition would be in “very great trouble “.

Significant changes: MPs

In a new report on the proposals contained in the Health and Social Care Bill, the cross-party Commons Health Committee says GPs should not be given sole responsibility for handling health commissioning budgets but should share the responsibility with nurses, doctors, public health experts and representatives from local communities.

The committee’s chairman, former Health Secretary Stephen Dorrell, said in a statement: “We believe this broadening of the base for commissioning is vital if we are to achieve the changes that are necessary to allow the NHS deliver properly coordinated healthcare”.

The warning comes as the Department of Health officially launched the fund to coincide with the start of the new financial year.

Details of the Cancer Drugs Fund were announced last year as a response to a report which revealed the low level of spending in the UK on cancer medication compared with the rest of Europe.

Three year spending boost

A total of £600 million has been allocated to fund a wider range of cancer medications spread over the next three years.

The cash is on top of money already being spent by Primary Care Trusts (PCTs). Under the new scheme NHS doctors or cancer specialists can apply to a local board for funding on behalf of their patients to obtain medications that have not been approved by the National Institute for Health and Clinical Excellence (NICE).

The scheme effectively started last October when the Government allocated £50 million for an interim fund.

‘Postcode lottery’ warning

Macmillan Cancer Support is warning of a postcode lottery in the way the new money is distributed. Mike Hobday, the charity’s Head of Policy, said in a statement: “Although a large number of cancer patients have received life extending treatment because of the interim Fund in England, we know that there is sadly considerable variation in the way that it has been administered between regions.”

Hobday said more work is needed to ensure a fair distribution. “To prevent a postcode lottery the Government could develop best practice advice to complement national guidance, and ensure this knowledge is shared between different regions to prevent this happening with the full funding,” he said.

‘Helped 2,000 patients’: Health Secretary

The Government insisted that the scheme had been a success with the cash injection already giving patients access to a wider range of life-extending medications. The Health Secretary Andrew Lansley said in a statement: “The interim fund has already helped over 2,000 cancer patients across England. We are confident that the £600 million Cancer Drugs Fund will, over the next three years, continue to meet this previously unmet need and improve the lives of many thousands more cancer sufferers, giving them precious extra time with their loved ones.”

A study of 4,000 first-time mums found that almost two in five (39%) had been handed a piece of advice that could actually put their child at risk.

When it comes to getting some helpful hints, new mums often seek the help of a close relative. However, the survey shows that this is the source of a good deal of misinformation.

‘Old wives’ tales’

Some of the tips they are given turn out to be ‘old wives’ tales’ handed down through the generations, while other advice comes from complete strangers without them even being asked. Frequently the results leave a new mother feeling overwhelmed, put down or even guilty, the research found.

The survey forms part of the ‘Real Parenting Revolution’ campaign being run by Netmums and aims to shatter the image that there is such a thing as ‘the perfect parent’.

The survey found that more than three-quarters of mothers (78%) go to a member of the family for parenting advice. However, a good deal of what they are told turns out to be dubious. Thirty-nine percent of advice given by mothers-in-law turns out to be wrong, followed closely by that proffered by their own mums (36%). Tips handed down by grandmothers appear to be more reliable, with only 11% dispensing misinformation, the survey suggests.

A lot of the advice originates from parenting rules that are handed down through the generations. The most common of these concern sticking to routines for the new baby, such as sleep and breastfeeding. The importance of manners and education are also common themes reported by mothers.

Feeling guilty

Netmums says the result of all this advice is that first-time mothers often feel their parenting skills are being criticised, with 40% feeling put down all the time and 23% feeling guilty when they break one of the parenting ‘golden rules’ they have been given.