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Deal to save NHS 7% on drugs bill

The NHS will save 7% on branded prescription drugs over the next five years after a deal was struck between the government and drugs industry. The UK-wide deal on medicines that are still under patent is worth £1.8bn in England alone. In return, the pharmaceutical industry has been given a 5% increase in its allowance for research and development. Primary care trusts (PCTs) said if they were handed the savings it would be spent on equipment, staff and premises.

The government has claimed the money will be invested into frontline primary care services but the NHS Alliance, which represents PCTs, maintained it was not clear whether trusts would be handed more cash. PCTs, which control 75% of the NHS budget, are responsible for commissioning services.

Michael Dixon, chairman of the NHS Alliance, said: "It is good news but we are not sure whether PCTs will see more money for services. And even if they do many PCTs are over budget so it may just go on reducing the overspend. A lot will depend on how clever PCTs can be with their finances."

However, Health Secretary John Reid said: "This new deal is a win-win. It is good value for money for the NHS and the taxpayer and it is good for the industry because it incentivizes research and innovation. The agreement delivers savings of more than £1.8 billion over the next five years, that I want put directly into front line services. At the same time, I believe it is important that we continue to encourage the pharmaceutical industry in its first class research and development work to deliver new and improved medicines for patients. For this reason, the agreement includes greater improved incentive for the research and development of new medicines, including those for children."

The deal has been agreed as part of the new Pharmaceutical Price Regulation Scheme (PPRS), which is negotiated every five years between the government and drugs industry. The 1999 deal saved the NHS 4.5%.

The latest deal increases the pharmaceutical industry research allowance from 23% to 28%. It covers the price of branded prescription, which tend to be more expensive, modern drugs still covered by patents as opposed to generic medications that are no longer under patent and can be produced by any drugs company. Branded drugs include the latest cancer and heart disease medications. copyright BBC Health News Wednesday 3rd November 2004

Excessive criers' later problems

Babies who continue to cry excessively for no obvious reason can go on to have difficulties in childhood, according to a new study. Excessive, uncontrolled crying that persisted beyond three months of age was linked with behavioural problems and lower IQ at the age of five. The US National Institutes of Health study, in Archives of Disease in Childhood, supports prior UK findings.

Experts said most crying was normal and parents should not be unduly concerned. The NIH team, working with researchers at the Norwegian University of Science and Technology, looked at 327 babies and their parents. They assessed the babies' crying patterns at six and 13 weeks of age and whether or not the crying could be explained by simple colic. When the children were five years old, the researchers assessed their intelligence, motor abilities and behaviour.

The children who had continued to cry beyond three months of age as infants, which was not due to colic, had intelligence scores (IQs) nine points lower than the other children studied. Prolonged crying was also linked with poorer fine motor abilities, hyperactivity and discipline problems in childhood.

In 2002, a team of UK researchers, led by Professor Dieter Wolke at Bristol University, found children who had cried excessively as babies, beyond three months, were 14 times more likely to develop attention deficit hyperactivity disorder (ADHD) and do worse at school as eight year olds. Professor Wolke said: "This confirms what we found. Now there really is more certainty there is really something going on." He believes the core of the problem is one of under-regulation. "With ADHD you can't regulate your attention. You can't concentrate, for example. The same thing is happening with crying. With these babies, it may be that their brains are built in a way that they have problems regulating themselves. They don't learn to calm themselves down, even with the best parenting." He pointed out that most crying in babies was completely normal, and that this excessive crying linked to later problems occurred in only about 2-5% of cases. But that's still quite a lot of children - between 14,000 and 35,000 children per year in Britain alone," he said.

He said it might now be possible to pick up ADHD as early as six months and intervene. These babies, because they are under-regulated, they need incredibly regular routines. Some babies you can take to noisy parties and they will sleep and won't cry. But these babies, any change to their routine and they can't cope. A very strict, regulated parenting pattern but which is warm and loving seems to reduce the amount of crying. What we really need now is a good randomised controlled trial on a large scale to look long term whether intervention has an effect." copyright BBC Health News Wednesday 3rd November 2004

Vices 'combine' to harm the heart

Think twice before lighting up during your coffee break because it could do more damage to your heart than either vice alone, according to researchers. A Greek team Athens Medical School found smoking and caffeine acted together to have a harmful effect on arteries and blood flow. Scientists have suspected the two might work synergistically rather than having just an additive effect on the heart. The findings appear in the Journal of the American College of Cardiology.

There is already a large body of evidence about the heart risks associated with smoking. Some studies have found caffeine can have a detrimental effect on the heart. Increasingly, researchers have been looking at whether a combination of the two might be even more damaging to the heart.

The current research had two parts - an acute study of the immediate effects of smoking and caffeine in 24 people, and a study that looked at the long-term consequences in 160 people. In each study, the researchers evaluated the stiffness of the aorta, the body's main artery leading from the heart, and the way blood flowed in the arteries.
These factors give an indication of cardiovascular disease risk.

Smoking and caffeine separately had a negative effect on aortic stiffness and blood flow. In the acute study, the final impact of the two stimuli was larger than the sum of the separate impacts of the two stimuli alone. The researchers said other studies had shown smoking and caffeine combined together had an unfavourable effect on blood pressure and increased the risk of heart attacks. But they added: "The underlying mechanism at the basic level responsible for the interactive effect of the two is unclear at this stage. Given the frequent combination of smoking and caffeine intake, these effects on arterial function may have important implications," they said.

Lead author Dr Charalambos Vlachopoulos said: "For individuals who have not yet quit smoking, it is advisable not to smoke while consuming coffee or other caffeine-containing beverages, as very frequently is the case. A healthy heart may be able to compensate, at least in the short run, for such unfavourable conditions, but for patients with impaired cardiac function these effects may be deleterious." copyright BBC Health News Wdnesday 3rd November 2004

Multiple mutations cause cancer

A number of genetic mutations could collectively raise bowel cancer risk, researchers have found. About 4% of bowel cancers are caused by mutations in single genes. But Cancer Research UK scientists found another 20% are caused by the combined effect of many genetic mutations - most insignificant alone.

They hope the research, published in Proceedings of the National Academy of Sciences, could lead to a sophisticated blood test for bowel cancer. This could enable doctors to identify and monitor people at high risk of the disease.

Bowel cancers can develop from small growths in the gut, called polyps. So having multiple polyps puts individuals at higher risk of developing the disease. In conditions such as familial adenomatous polyposis, or FAP, there is an inherited gene that is the clear culprit for the hundreds of polyps that develop. Now scientists have found rare genes may come together to cause some other cases of bowel cancer.

The team compared blood samples from 124 patients who had multiple polyps in their gut with samples from 483 members of the general population. They found a range of genetic variants in the group with multiple polyps, each twice as frequent on average as in the control group. Each of these variants appears to increase the likelihood that individuals will develop polyps.

Researcher Sir Walter Bodmer said: "Patients who had the genetic variants we studied were twice as likely to have multiple polyps in their gut than those who did not. Further work will identify additional similar key variant genes that raise a person's risk of bowel cancer. I believe we could eventually exploit this knowledge to develop a blood test to identify those at high risk of the disease."

Doctors could actively monitor such patients for cancerous changes in their polyps, and remove them before they develop into bowel cancer. Further research using samples from a larger number of patients is now planned to confirm associations between particular genetic mutations and multiple polyps. This work could also lead to the discovery of other mutations responsible for inherited susceptibility to bowel cancer. copyright BBC Health News Wednesday 3rd November 2004

Hyperactivity drugs found wanting

Parents of hyperactive children say drugs often fail to damp down symptoms at crucial times of day. Research suggests children with Attention Deficit Hyperactivity Disorder disrupt family life most in the mornings and early evenings. Doctors believe current treatments should be effective at these times - but a study found this often does not tally with parents' experiences.

An ADHD 24/7 campaign has been launched to provide practical help. ADHD affects an estimated 3-7% of school-aged children - roughly two children in every classroom. Symptoms include inattention, hyperactivity and impulsiveness.

A study conducted to tie in with the new campaign found that 85% of doctors believe that current ADHD treatments should control symptoms from 8am to 9am, whereas just 62% of parents agree that this is the case in reality. Similarly, 60% of doctors expect treatments to still be effective from 5pm to 7pm - but just 45% of parents feel that symptoms are under control at this time.

Although most parents and doctors agree that ADHD medication completely wears off between 7pm and 9pm, for a significant minority of parents (17%), symptom relief has already ended by 5pm. The research also found that over 90% of parents believe their child's ADHD has a moderate or severe impact on family life. copyright BBC Health News Wednesday 3rd November 2004

Drug boosts lung cancer survival

A drug that helps the immune system recognize and attack lung cancer cells may improve survival time among patients with advanced disease. A team from the Cross Cancer Institute in Edmonton, Canada, say preliminary trials on 171 patients showed many were still alive two years later. They hope the drug will one day be used alongside surgery, chemotherapy and radiotherapy. Details were presented at the European Society for Medical Oncology Congress.

A larger, phase three trial of the drug is expected to start next year. Researcher Dr Charles Butts said the drug had produced particularly promising results in patients whose cancer was too advanced for surgery, but had not spread to distant organs.

Standard chemotherapy blasts away at the tumour, and in doing so damages many normal cells. The new drug is more selective in its effect, priming the immune system to search out and attack only tumour cells. It does this by targeting an abnormal sugar-protein molecule only found on the surface of tumour cells.

The drug, called L-BLP25, was tested on patients with non-small-cell lung cancer, the commonest form of the disease. Overall, patients given the vaccine survived on average for 17.4 months, compared to an average of 13 months for those who received only standard care. But in those patients whose cancer was too advanced for surgery, but which had not spread to other organs, the effect was far more pronounced. Those who received standard care survived for an average of 13.3 months, but among those who took the new drug 60% were still alive after two years. One patients has been taking the drug for 3.5 years. copyright BBC Health News Tuesay 2nd November 2004

Older people have healthy futures

Older people are healthier than they have ever been and should live for longer thanks to improved services, says a report. The government says good progress is being made to meet the standards of care set out in the 2001 older people's National Service Framework. But services must continue to improve to meet the needs of an increasingly aging population, it acknowledged. Critics said targets had been key missed and immediate action was needed.

One of the challenges highlighted was supporting elderly discharged from hospital. Last month, the Commission for Social Care Inspection found older people were rushed out of hospital and into nursing homes to free up beds, in spite of their needs and wishes. But the government's report says significant headway has been made in preventing age discrimination. copyright BBC Health News Tuesday 2nd November 2004

Embryos to be screened for cancer

Scientists have been granted permission to screen test tube embryos for an inherited form of cancer. The Human Fertilisation and Embryology Authority (HFEA) approved the screening following a request from couples seeking IVF treatment. The watchdog said there was a strong chance of the genetic bowel cancer being passed from parent to child.

Scientists in London hope using the controversial technique could help to wipe out this type of cancer. A spokeswoman for the authority said: "We can confirm that we have issued a pre-implantation genetic diagnosis licence for that particular condition."

A team at University College London has been granted the licence to screen embryos for the gene that causes familial adenomatous polyposis (FAP). If a parent is a carrier of the gene there is normally a 50% chance it will be passed on to their children. The gene can lead to the development of rectal or colon cancer in early teenage years. Embryos created using IVF can be screened using the pre-implantation genetic diagnosis process. Then only embryos free of the gene will be implanted. copyright BBC Health News Monday 1st November 2004

Natural protein can starve cancer

A protein present in normal body tissue can prevent further growth in tumours, researchers have found. A tumour can grow only if its blood supply also expands to provide it with essential nutrients. The protein, discovered by Bristol University researchers, appears to block the growth of blood vessels past a certain size. The researchers hope their work, published in Cancer Research, will lead to new cancer treatments.

The key protein is one of a group known as vascular endothelial growth factors (VEGF). Most forms of VEGF stimulate blood vessel growth, including the new vessels formed as a tumour begins to develop. However, the Bristol team have identified a form called VEGF 165b, which appears to have the opposite effect by inhibiting the growth of new blood vessels required for tumours to grow above one millimetre in size. The researchers have also found that this form of VEGF is generally found in many normal parts of the body, including the prostate, but not in prostate cancer. They hope it may eventually be possible to use VEGF 165b to prevent tumour growth by effectively starving it of nutrients. The Bristol team believe that the fact that the protein is produced naturally by the body could make it more effective than other anti-cancer agents.

Many new cancer therapies are based on starving the tumour of nutrients by attacking the tumour blood supply rather than the cancer cells. Blocking VEGF using antibodies has recently been shown to be effective in large-scale trials in colorectal cancer in the US. New blood vessel growth is also necessary for many normal body functions. These include the development of the embryo and, in adults, wound healing, the development of the placenta in pregnancy and of muscles during physical training programmes.

However, it is thought that adults can live healthily without blood vessel growth for extended periods of time. This blood vessel growth is controlled by many factors, but VEGF is the most powerful factor. copyright BBC Health News Monday 1st November 2004

Cost of temporary nurses 'soars'

The cost of temporary NHS nursing staff has trebled in six years to more than 600 million, according to a report.
The Royal College of Nursing warns 30,000 nurses leave the profession yearly, and it faces a fragile future.

Efforts to cut agency costs with the creation of an internal NHS temporary nursing pool have had "disappointing" results, it says.

But England's Chief Nursing Officer Chris Beasley said the temporary pool had made a positive difference.

She added that a new deal offering more pay and flexible hours would help the NHS retain staff.

BBC News Online 1/11/04

Vaccine against cervical cancer

A vaccine that prevents infections known to cause cervical cancer could be available to women within three years, UK experts believe. By guarding against human papilloma virus, it could save thousands of lives and may end the need for smears tests. The vaccine would be given to girls before they are sexually active.

Trials have shown a jab can offer 100% protection against strains of HPV linked to about 70% of cervical cancers. Some forms of the HPV virus only cause genital warts, but others cause cervical cancer. It is estimated up to half of the young women in Britain have been infected with a high-risk strain of HPV by the time they are 30. 'High risk' HPV types, strains 16, 18 and 31 and 33, have been found to be present in close to 100% of all cervical cancers, according to the NHS Cancer Screening Programmes.

Since cervical cancer is the second most common cause of cancer death in women worldwide, preventing HPV would save many lives. Both GlaxoSmithKline and Merck Sharp & Dohme have developed a vaccine against HPV and are in a race to get their products approved. The two vaccines are being tested in thousands of women around the world, including the UK. These will seek to confirm the vaccines' effectiveness and safely.BBC Health News Friday 29th October 2004

Children's teeth 'best for years'

Tooth decay among children is at its lowest recorded level since 1983, figures show. The biggest fall was among 15-year-olds, with only 13% suffering from decay compared with 42% in 1983 the Office for National Statistics found. But the survey discovered variations across the UK, with Northern Ireland having the highest level of tooth decay among children. The lowest levels were found in England, followed by Wales.

The survey looked at the dental health of 10,381 children aged five, eight, 12 and 15. The inequalities appeared to be partly linked to the type of school a child attended as well as where they lived in the UK. The survey found 78% of eight-year-olds from "deprived" schools had plaque compared with 70% of "non-deprived" schools. But three-quarters of children in all age groups reported brushing their teeth twice daily, with many using electric toothbrushes. Almost half of 15-year-olds are using mouthwash and sugar-free chewing gum.

Despite the apparent fall in levels of decay in permanent teeth, more children had plaque and gum disease - particularly the boys. About 68% of 15-year-old boys had some plaque, compared to 57% of 15-year-old girls, and 56% of 15-year-old boys had some gingivitis, compared to 48% of girls. And more children are now having fillings. Among eight-year-olds, 52% of obviously decayed permanent teeth had been filled, compared to only 37% 10 years earlier.

The survey found that most parents would prefer their children's decayed permanent teeth to be filled. But the majority of parents would prefer their children's "milk teeth" to be removed rather than filled. Among children aged five, over half had evidence of some early damage to their teeth. BBC Health News Friday 29th October 2004

'Stethoscope' hears kidney stones

Scientists have developed a "smart stethoscope" that can hear when a kidney stone has been successfully broken down by treatment. The device listens to echoes created by shock wave therapy (lithotripsy) to let the doctor know if therapy has worked. Trials at Guy's Hospital in London have showed promising results, saving patients unnecessary repeat therapy and x-ray monitoring. The device was developed along with scientists from Southampton University.

Lithotripsy works by focusing thousands of shock waves onto the kidney stones in an effort to break them into pieces small enough to urinate out of the body or be dissolved by drugs. But there is no way of monitoring how the process is getting on.

Doctors can take an x-ray before and after treatment to see if there is any change in the appearance of the stone. But it is often difficult to tell from these pictures and is more a case of trial and error - if the symptoms return then the patient will need more shock wave therapy.

Professor Tim Leighton and colleagues at the Institute of Sound and Vibration Research at Southampton University, along with kidney experts at Guy's, decided to see whether the echoes produced by the shock waves could be interpreted in some way. Prof Leighton said: "It's a bit like the man on the railway who walks along the length of the train, hitting the metal wheels with a hammer to find out if any are cracked. If the wheel is cracked it gives a duller sound. What we are looking for is a stone to go from being intact at the start of treatment to fragmented at the end of the treatment."

The smart stethoscope is a small probe, similar to those used to trace heart patterns using an ECG, which is taped to the flank of the patient. Just like a normal stethoscope, it picks up sound. From here, the sounds are transmitted to a box the size of a packet of biscuits which amplifies and changes the frequency of the sounds so the doctor can hear them. When the stone is intact the sound given off is a 'tick'. When it has been shattered into small pieces the sound changes to a 'tock'.

Prof Leighton said the device could also be wired up to a computer that would analyse the sounds and display the results using a traffic light system - red for no success, amber for some success and green for fully successful treatment. So far, they have used the device to monitor treatment in 50 patients with kidney stones.

With funding from the Engineering and Physical Science Research Council, the researchers have developed a prototype they say works extremely well. Prof Leighton said: "It's been superbly successful. I have been astounded by how effective it is as a monitor. Plus, it's completely non-invasive. It does not expose you to any radiation." He said it would reduce rather than replace the need for x-rays, which would still be used to locate the stone within the kidney. BBC Health News Saturday 30th October 2004

Complex cause for brittle bones

A mix of bad genes and poor conditions in the womb and early life may be responsible for some cases of brittle bone disease, research suggests. A team from Southampton University has pinpointed a genetic mutation that increases the risk of osteoporosis. However, the gene is more likely to result in disease if the carrier also lacks nutrients before birth, and in their early years. Details appear in the Journal of Clinical Endocrinology and Metabolism.

The Southampton team say their work provides a graphic illustration of the fact that disease is often the result of an interaction between genes and environmental factors, rather than each acting in isolation. They identified a gene which regulates the amount of growth hormone produced by the body, and therefore plays a key role in how well bones develop and grow. However, they also found that the function of the gene appears to be modulated in part by environmental factors in early life.

Carrying the wrong mutation only seemed significantly to increase the risk of osteoporosis if the carrier also had to endure harsh environmental conditions - such as poor nutrition - in the womb, and during the early years of life. The researchers analysed data on a group of 300 Hertfordshire men and women who were born during the 1920s and 30s. Many are still living locally, giving researchers a unique insight into the health of a group of people who are also representative of the population as a whole.

Researcher Professor Cyrus Cooper said: "This has altered our understanding of the complex relationship between genes and the early environment. We have known for a long time that genetic and environmental influences contribute to who we are and our health prospects. This is the first time research has shown the extent to which these early environmental factors (such as maternal nutrition, smoking and exercise) impact on the function of genes which have a key role to play in the development of a healthy skeleton. Although there is a strong genetic contribution to skeletal growth, our work also suggests that the impact of an adverse genetic make-up might be minimised by improving the environment in the womb."

Prof Cooper said the next challenge was to try to pinpoint the best diet and lifestyle that mothers could follow in order to reduce the risk of their children developing brittle bones. BBC Health News Saturday 30th October 2004

EU plans 'risk patients' safety'

Patients could be put at risk by new proposals from the European Union, doctors' leaders have warned. The British Medical Association has warned against a lowering of doctors' standards in the UK. The BMA's Dr Edwin Borman said: "Patients in the UK have different expectations from patients in Germany."

The draft directive - unlikely to come into effect for some two years - aims to create a common internal EU market in various services. There are also concerns the proposed EU Services Directive could bring an excessively business-oriented approach to healthcare. It is designed to ensure free movement of doctors and other providers of services around the EU.

The BMA is lobbying for healthcare to be excluded from the measure as it fears the UK would then not be able to ensure doctors are of the highest standard. It says safeguards must be guaranteed before the plans are approved. Dr Borman, head of the BMA's international committee, said the proposals undermined a country's ability to decide what was in the best interests of patients. "In the UK, clinical guidelines, referral schemes, licence to practice procedures and many other safeguards could all be removed if this directive is adopted," he said. Our concerns must be met if patient safety is to be guaranteed and standards assured across the NHS."

Doctors in Germany, France and Poland say they share UK doctors' fears, although the European Commission denies it is trying to tell individual countries how to run their health services.

At present, each EU member state regulates its own healthcare system - setting the standards, clinical guidelines and rules on qualifications for doctors working within its borders. Under the directive, a member state would have to justify any rules under market requirements, proving them to be "non-discriminatory, necessary or proportional". In addition, a doctor working in the UK who had qualified in another EU country would effectively be regulated by their home country.

At present, anyone working as a doctor in the UK is regulated by the General Medical Council (GMC). The GMC said it was studying the directive's implications and working with the commission to ensure safeguards were in place. BBC Health News Saturday 30th October 2004

Bowel cancer trials 'offer hope'

A treatment breakthrough should mean many more people with bowel cancer can be cured, say experts. When caught early and treated, there is already a good chance of survival, but in some patients the cancer can return. In trials, surgery combined with a new mix of chemotherapy drugs completely cured as many as one in 10 patients - more than with standard chemotherapy. The data was presented by its Paris-based author at a European Society for Medical Oncology meeting in Vienna.

Bowel cancer affects about 38,000 people in the UK each year - mainly over 60s - killing about 14,000. While it is obvious that picking up the disease and treating it as early as possible is the best way to ensure a cure, the success rates have not been high enough.

Dr Rob Glynne-Jones, Macmillan lead clinician at the Mount Vernon Cancer Centre in Middlesex, said: "This is the first time for years that we have had a major advance where patients are actually going to be cured." He said for about 50 years there had been only one chemotherapy treatment available to treat bowel cancer, which was based on a drug called 5-FU. Giving this treatment after surgery to remove the tumour reduces the risk of the cancer coming back by about 30%, he said.

In the trials on 2,246 patients with colon cancer, adding another drug, called oxaliplatin, reduced the risk by a further 25%. Dr Glynne-Jones explained: "I know that may not sound very much, but when you think there are 38,000 patients getting colon cancer a year and probably 10 or 15,000 of them having chemotherapy afterwards, you are going to save quite a lot of lives. For the 30% of those who would have relapsed you are going to reduce that by a quarter. That's quite a big issue," he said. He said adding in the extra drug did make the chemotherapy side-effects worse, but he said patients tended to accept that as a trade off for the increased likelihood of a cure.

In particular, the treatment can cause numbness or tingling in hands by affecting the nerve endings. Oxaliplatin chemotherapy is available in some places in the UK. The National Institute for Clinical Excellence is looking at its availability and is expected to make recommendations in May 2006.

The patients in the study all had stage three bowel cancer, which means the tumour is confined to the bowel and has not spread.

Author of the research, Dr Aimery de Gramont, from the St Antoine Hospital in Paris, told the Vienna conference the findings confirmed the importance of treating early with chemotherapy and surgery. BBC Health News Friday 29th October 2004

'Do not rush into cosmetic surgery'

Plastic surgery aimed at making people look more beautiful could end up leaving them scarred and deformed, unless they do their homework properly, surgeons are warning. The British Association of Aesthetic Plastic Surgeons (BAAPS) has produced a series of guidelines warning people contemplating cosmetic surgery to take their time and go to reputable and approved surgeons.

Simon Withey, consultant plastic surgeon, and member of BAAPS, said he is regularly called upon to try to repair botched surgery. "Every day we will see people who have had problems from operations. In some cases you can do revisional surgery, but in some cases they are scarred for life." Someone I saw went to a clinic in Eastern Europe. She wanted an operation on her eyelid to tighten it up. She chose her surgeon very carefully and got a professor of ocular surgery. But when I saw her she had a scar halfway up the lid and cheek. It brought the lower lid down and the whites of her eyes were showing. It was hideous. Her eyelid will not close properly and she is at risk of scarring to the eye. She can't afford to have the restoration work done privately, so I am having to do it on the NHS."

Mr Withey said another patient had liposuction on her legs in South Africa. Her surgery was so radical that her legs were left badly dimpled and in need of more fat to fill them out. She has already had two operations, but her legs will never be right again," he said. Another had a UK operation on her nose, but Mr Withey said she suffered great skin loss and her nose had been left badly deformed. We can always improve it, but it will never be anywhere as nice as her original nose. It will always be scarred."

Mr Withey, a member of the London Plastic Surgery Association, said patients must ensure they are fully aware of the risks of surgery before agreeing to it. "Most of us who care for our patients will spend two or three sessions of 45 minutes each time going through what their expectations are. Those people going abroad do not get that. They meet a sales person in the UK telling them how much it will cost and how long they will be in South Africa etc, but they do not get anyone talking to them about the risk. Plastic surgery is not formulaic, every patient is different." He said it was in the plastic surgeon's interest, as well as the patient's, to ensure they were fully aware of any potential problems. It is relatively low risk. You are not going to offer high-risk surgery for something which is going to make you more beautiful, but if you choose your patient badly or combine your treatments badly, you can have a disaster."

He said some patients, such as heavy smokers, were often not suitable for surgery as it affected the way their scars healed and that any reputable surgeon would take this into account before agreeing to operate. Mr Withey said surgeons must be prepared to spend time with their patients before and after the operations to ensure they are happy and that they would not agree to operate on patients without an agreed "cool-off period". Most of us are very wary about operating on the wrong people, such as those in a fragile state of mind. These guidelines are a way of saying to people that this is the way that surgeons should behave."

The guidelines advise researching the background and experience of a chosen surgeon, being aware of any risks and possible side-effects and having a realistic idea of what can and cannot be achieved. Jane Elliott, BBC News Health Reporter Friday 29th October 2004

Pylons 'double child cancer risk'

Children living under high-voltage power lines could run double the risk of getting cancer, new research reportedly suggests. Those living within 100 metres of the cables are more likely to suffer from leukaemia, the study indicates. The Childhood Cancer Research Group at Oxford University studied 70,000 children under 15 for the Department of Health report, half of whom had cancer. The seven-year study is reported in the Times and the Independent newspapers.

The research looked at the prevalence of high-voltage power cables near children's homes. Children born or living near the power lines were 1.7 times more likely to contract leukaemia than those in the control group, the research found. Some studies have already shown an association between some types of electromagnetic fields and increased childhood leukaemia.

Research author Dr Gerald Draper said other research suggested power lines might account for 20 to 30 of 500 cases of childhood leukaemia each year. But, he said, his work indicated a far smaller number of cases were affected. The findings were "surprising" and prompted further research, he added. The Department of Health said it would not comment on the findings until Dr Draper submitted his final report. BBC Health News Saturday 30th October 2004

Molecule offers Alzheimer's hope

The development of a molecule which appears to stop a protein forming into clumps could lead to new treatments for Alzheimer's disease, scientists say. The onset of the disease has been linked to plaques which form when fragments of the protein, amyloid-beta, gather into clumps in the brain. The Howard Hughes Medical Institute and Stanford University researchers say lab tests show the molecule stops this. They told the journal Science they hope to begin tests on animals next year.

Despite 30 years of research, scientists have made little progress in developing drugs that inhibit interactions between proteins. This is, in part, because the drug molecules are many times smaller than the proteins, so even if they can attach themselves to the larger molecules they are too small to prevent other proteins binding elsewhere.

The latest study got round this problem by creating a molecule that was able to attach itself to another protein found in the brain cells. Thus the molecule was effectively able to increase its size 15-fold before binding to the amyloid-beta protein fragments - greatly reducing the ability of other fragments to gain a foothold. As a result, the molecule proved effective at reducing protein clumping at concentrations 100 times lower than other blocking agents that have been tested. It also seemed to reduce the toxicity of the rogue protein to nerve cells.

Researcher Dr Isabella Graef told BBC News it was possible that the molecule could be modified to attach itself to even larger 'chaperone' proteins, so that its bulk would be increased 50-fold. At present the work has only been carried out in the lab, but Dr Graef said the team hoped animal tests would start in a year. She said: "We hope that our work will contribute to the development of therapeutic agents that will eventually prevent Alzheimer's, or delay its onset. What we have developed is a completely new way of designing drugs to inhibit protein to protein interactions, not only in neurodegenerative diseases, but also potentially in other diseases, such as HIV and cancer."

Rebecca Wood, chief executive of the Alzheimer's Research Trust, called the research "striking and original". However, she stressed there was no way yet of telling whether the molecule would work in a human brain, or whether interfering with chaperone proteins would produce side effects. There is clearly much work still to be done, and it will be necessary to investigate this drug further in animals such as mice before this potentially valuable method can be tried in patients. This is the first, exciting step in what could be a long path towards a new treatment for Alzheimer's disease."

Professor Clive Ballard, research director of the Alzheimer's Society, said: "There are many exciting approaches currently being investigated to target the accumulation of amyloid, some of which are already being investigate in clinical trials." BBC Health News Friday 29th October 2004

Smaller pill packs 'cut suicides'

Selling painkillers in smaller pack sizes has slashed rates of suicides involving overdoses, research suggests. Legislation, introduced in 1998, cut pack sizes and the number of tablets retailers and pharmacies could sell. Oxford University researchers looked at suicides involving painkillers in the UK between 1993 and 2003. Almost 25% fewer people took fatal aspirin and paracetamol overdoses in the three years after 1998 than before, they told the British Medical Journal.

The Oxford team also found that numbers of tablets taken in non-fatal overdoses of aspirin and paracetamol fell significantly after the legislation. As a result, admissions to liver units for paracetamol poisoning and numbers of related liver transplants also dropped heavily - down by nearly a third (30%) in the four years after the laws came into force.

PAINKILLER SALE RESTRICTIONS Before September 1998: Pharmacies: unrestricted Other retail outlets: max of 24 tablets After September 1998: Pharmacies: max of 32 tablets Other retail outlets: max of 16 tablets Researchers analysed rates of suicides and non-fatal overdoses from paracetamol, salicylates (aspirin) and ibuprofen across the UK between 1993 and 2003.

While overdosing from paracetamol and salicylates - both covered by the new laws - decreased, patterns of overdosing from ibuprofen, which was not targeted in the legislation, remained roughly the same. The researchers argue that although smaller pack sizes do not prevent someone from buying multiple packs from various retailers, many of those who overdose do so impulsively - using tablets to hand in the home. They say their research provides a strong argument for reducing pack sizes still further. ©BBC Health News Thursday 28th October 2004

Prozac use 'risky for children'

Using the anti-depressant Prozac at an early age could lead to emotional problems later in life, US scientists have told the journal Science. Researchers also said pregnant women may also be risking the mental health of their unborn child by using Prozac. A team at Columbia University in New York found young mice given the drug grew up anxious and appeared depressed in tests on their emotional state. But Prozac's makers said care should be taken when interpreting rodent studies. The age of the mice were the equivalent of the last three months of pregnancy to children aged eight.

Prozac is the only anti-depressant which doctors can prescribe to under 18s in the UK. However, doctors have been reluctant to prescribe it to young children, tending to refer children with depression to child psychologists instead. Pregnant women are advised to use the drug with caution.

Last month the US Food and Drug Administration ordered drug manufacturers to put strong labels on anti-depressants such as Prozac after they found they increased the risk of suicide. Columbia University Mark Ansorge, who led the research, said: "Increasingly, these drugs are used to treat emotional disorders in children and pregnant women. However, the long-term effects of these medications on brain development are largely unknown." But he added his study showed that using drugs such as Prozac during the early years of life and late pregnancy "may entail unexpected risks for affective function later in life".

During the study, the scientists injected the mice, which were between four and 21 days old, with Prozac. Nine weeks after their last injection the mice were given tests to reveal their emotional state. They showed a reduced inclination to explore when put in a maze, took longer to start eating when placed in a novel setting and were slower to try escaping from a part of their cage that delivered mild electric shocks. All these behaviours are regarded as signs of anxiety and depression, the team said.

A spokesman for Eli Lilly, the makers of Prozac, said: "Great care should always be taken when trying to interpret mice and rodent studies." And he added the company does not promote the use of Prozac by children. BBC Health News Friday 29th October 2004

Surgical training 'cut by half'

Junior doctors who want to become a surgeon will be fast-tracked through the NHS under a new curriculum. Consultants of the future could be in their early 30s thanks to a halving of the current minimum 12 years that it takes to train after medical school.

The Royal College of Surgeons said its scheme, to be introduced in 2007, would recognise excellence rather than reward time-serving. It denied that the move, hoped to boost staff numbers, was a 'dumbing down'. Mr Hugh Phillips, president of the college said: "Not every surgeon needs to be trained to be a super-specialist doing the most complex surgery in their chosen field. This is not a dumbing down. At present, arrangements for training surgeons are unsatisfactory and we need to make surgical training very much more effective."

Currently, doctors who have graduated from medical schools spend one year as a house officer and then a minimum of two years as a senior house officer (SHO). In practice, the average SHO takes five-and-a-half years to reach the next stage in the surgical career, a specialist registrar job, and only 50% of applicants are successful. Mr Phillips said this was too long and meant many talented surgeons-in-training were stuck at the SHO grade. "Not only is it wasteful of human resources, but it makes for an insecure and difficult time at a crucial stage in the surgeon's career," he said.

On graduation from medical school, the trainee will in the future undertake a two-year foundation programme after which he or she will enter specialist training. The college anticipates it would take most young surgeons only six years to be trained to nationally agreed standards across nine surgical specialties. It has placed a maximum of eight years on the training time.

THE NINE SPECIALTIES SURGEONS WOULD TRAIN IN General surgery Cardiothoracic surgery Neurosurgery Otolaryngology Paediatric surgery Plastic surgery Trauma and orthopaedic surgery Urology Oral and maxillofacial surgery

Restrictions in doctors' working hours as a consequence of the European Working Time Directive means surgical training is seriously compromised, according to the college. Mr Phillip said: "There is still a serious shortfall in the number of consultant surgeons in the UK and yet we need these hard-pressed consultants to train their future colleagues and successors. The new scheme will recognise excellence rather than reward time-serving."

A spokesman from the Department of Health said: "We are working with the Royal College of Surgeons to modernise medical training. The purpose is to make it more focused and contemporary. Patient safety will be at the heart of any changes we make to this training."

Mr Simon Eccles, chair of the British Medical Association's Junior Doctors Committee, said: "Seven years may be enough time for a particularly talented doctor to qualify as a consultant surgeon, but only if the quality of their training is exceptionally high. With recent legal cuts in junior doctors' hours, the NHS and the Royal Colleges need to make sure that the best use is made of the limited training time available. What matters most is that we produce doctors capable of delivering the highest possible standards of care to patients." BBC Health News Thursday 28th October 2004

Abortion row fears over eye cure

US scientists have successfully restored a woman's vision using eye cells taken from aborted foetuses. But while hailing their results as a triumph, the University of Louisville researchers are worried critics will say they are promoting abortion. The UK has clear guidelines to ensure people cannot conceive and terminate a baby to treat another person, but similar rules do not exist in the US. The findings appear in New Scientist magazine.

Elisabeth Bryant's sight was restored by a transplant of retinal cells taken from the eyes of aborted foetuses. The transformation appears not to have been a short-term effect, as the team who carried out the operation had feared. Before the experimental surgery on her left eye, Elisabeth, who was 63 at the time, could barely see anything with it. "Now I can see people's eyes, noses and mouths when they're sitting across the room from me," she told New Scientist.

So far, six patients with degenerative diseases of the eye - either advanced retinitis pigmentosa or another disease called macular degeneration - have received similar transplants in the US. Dr Robert Aramant, who developed the technique at the University of Louisville, said: "We have shown the way. It is possible to reverse these incurable diseases." But his colleague Mr Norman Radtke, the surgeon who carried out the transplants, said: "People are going to claim that we are promoting abortion." The team has been given the go-ahead by the US Food and Drug Administration to carry out more transplants on people with less advanced disease.

Earlier this week, Canadian researchers from the University of Toronto announced that they had shown that retinal stem cells taken from adults were capable of forming the cells needed to repair damaged eyes. Although this method has only been tested in animals, the scientists are hopeful that it could be used to treat humans.

David Wong, chairman of the scientific committee of the Royal College of Ophthalmologists, said: "As ophthalmologists, we welcome research into stem cells as indeed it offers hope for patients suffering from degenerative conditions such as retinitis pigmentosa and macular degeneration. Particularly exciting is the fact that the Toronto group could harvest stem cells from adult human eyes," he said, which would overcome some of the ethical concerns.

A spokesman from Comment on Reproductive Ethics said using tissues from aborted foetuses was totally unnecessary. "Why bother doing something that's ethically difficult or unacceptable when you can take stem cells from adults?" he said. BBC Health News Wednesday 27th October 2004

Asthma risk 'fixed before birth'

The chances of a child developing asthma or other allergies may largely be fixed by the time they are born, a study suggests. Researchers found babies with high levels of antibodies in their umbilical cord blood were more at risk. Antibodies are a sign that the immune system has begun to respond to the irritants that cause allergies. The research, by the David Hide Asthma and Allergy Centre in Isle of Wight, is published in Thorax.

The researchers analysed data on cord blood serum samples taken from more than 1,300 children born between 1989 and 1990. Each sample was measured for levels of a chemical called IgE, which is produced by the immune system in response to the presence of allergens, such as pet waste, house dust mites and grass pollen. The children were also assessed at the ages of one, two, four and 10 years of age to find out if they had developed allergies and/or asthma. By the age of four, one in five children had become sensitised to allergens, and by the age of 10 more than one in four (27%) had done so.

Children who had high umbilical cord blood levels of IgE at birth were around twice as likely to have become sensitised. One in 10 of the children had been diagnosed with asthma by the time they were one to two years old, and by the age of four, one in seven (15.2%) of the children had asthma. Almost 13% of the children had asthma by the time they were 10.

High IgE cord blood levels were not associated with the development of asthma up to the age of four. But children with high IgE levels in their umbilical cord blood were around 66% more likely to have a diagnosis of asthma by the age of 10.

The researchers also found that children who showed no signs at all of an increased sensitivity to allergens in their early years were three times more likely to develop asthma if they had high levels of the antibodies in their umbilical cord blood. This apparent paradox can occur because in some cases of asthma the immune system triggers airway inflammation without any specific reaction to a known allergen.

The researchers say dramatic changes in the immune system occur during pregnancy - and the immune response of the foetus - to make IgE antibodies - can start as early as the 11th week. This can be influenced by the mother's environment as the same factors that impact on her may reach the baby via the placenta. They suggest their findings indicate that foetal immune system programming could be more important than what happens after birth in influencing the development of childhood allergies.

Lead researcher Dr Hasan Arshad told BBC News Online: "Over the last 10-15 years a lot of research has focussed on the early life influences that may contribute to the development of asthma in a child, but it may be that we have to go back even further and look at the pregnant woman's environment."

However, Dr Seif Shaheen, of King's College London and Asthma UK Research Fellow, said it would be wrong to overlook the impact of exposure to allergens following birth. "Whilst there is an increasing body of evidence that the environment in the womb may influence the development of atopy (allergy) and asthma, it is also likely that the environment once the child is born plays an important role too. We are all born, to a lesser or greater extent, with our immune system skewed towards an allergic type response. Environmental exposures after birth are likely to determine whether this allergic tendency carries on through childhood or disappears."

Professor Andrew Peacock, of the British Thoracic Society, said: "This research indicates that umbilical cord blood may hold valuable clues as to why one in five children in the UK have asthma and one in three adults are developing an allergy. More research needs to be done in this area if we are to have any chance of turning round the four fold increase in allergic conditions that we have seen take place in the UK over the last 20 years." BBC Health News Wednesday 27th October 2004

People with psoriasis 'shunned'

People with psoriasis are being treated as social outcasts, survey findings show. Telephone interviews with more than 5,000 European people revealed half would not kiss, swim with or eat food prepared by someone with psoriasis. This was despite most realising this skin condition is not contagious. Friday 29 October is the first world psoriasis day, aimed at increasing awareness and breaking down prejudices about this common skin disease.

Taylor Nelson Sofres surveyed 5,029 people from France, German, Italy, Spain and the UK. Most knew that it was a type of skin disease but, less than a third of those questioned knew that psoriasis was a common disorder, affecting one in every 50 people. Nearly two in 10 people thought poor hygiene was the root cause of psoriasis, even though three-quarters correctly knew that the condition is partly inherited and partly down to environmental factors. Many would not want to have close physical contact, such as hugging, with someone who had psoriasis, men more so than women.

Michele Corvest, founder of APLCP - Association for the Fight Against Psoriasis - said: "I was shocked to see that half of the people surveyed would refuse to kiss or hug me or eat a sandwich from my hand." Lars Ettarp, president of the International Federation of Psoriasis Foundations behind World Psoriasis Day, said: "For the 125million people worldwide who suffer from psoriasis, life can be extremely difficult and we are still discriminated against due to the unsightly appearance of our skin. We want a better standard of care for people with psoriasis." BBC Health News Thursday 28th October 2004

School meals 'must be healthier'

Ministers must do more to protect pupils from primary school dinners high in fat and salt, a report says. The Soil Association, which promotes organic farming, said it had analysed five typical lunches. Children eating such meals every day would consume 40% more salt, 28% more saturated fat and 20% more sugar than recommended, it said. The Department of Education said it had started a monitoring exercise to check the quality of food served in primary schools. The warning comes amid widespread concern over childhood obesity. A "typical" school meal including cheese fritters, roast potatoes, peas and flapjacks would only provide 80% of the amount of iron and 70% of the amount of zinc needed, the Soil Association said.

Education Secretary Charles Clarke recently announced he would review the standard of dinners served in secondary schools. But the Soil Association, said it wanted him to act on primary schools too. Peter Melchett, the group's policy director, said: "It is well known that most school dinners in primary schools do not provide the correct level of nutrients and give children too much fat, sugar and salt. But still Charles Clarke refuses to act to protect children at their most crucial stage of development. If children are encouraged to eat healthily in primary school, they are likely to demand good quality food as they get older." A Department for Education and Skills spokeswoman said work was already under way to improve the quality of school meals. She added: "We are also undertaking a specific monitoring and evaluation exercise on the quality of primary school meals. We are determined to ensure young people are inspired to eat and live healthily." © BBC Health News Thursday 28th October 2004

Bid to cut sudden epilepsy deaths

Guidelines have been issued to try to make unexpected deaths from epilepsy will be a thing of the past. Epilepsy affects more than 300,000 people living in the UK, and official figures suggest about 1,000 die every year as a result of the condition. The National Institute for Clinical Excellence aims to ensure people with epilepsy are being given proper advice to help them manage their condition. It is advising doctors on how best to care for their epileptic patients. A government-funded report in 2002 concluded that more than 40% of deaths from epilepsy were probably avoidable. According to experts, most people with epilepsy can be free of seizures with the right drug treatment. But research suggests up to a quarter of cases are misdiagnosed, meaning patients don't get the treatment they need. The report found failures in the provision of care all through the system. This included problems of timely access to expert specialists and a lack of structured and effective review at primary and secondary care. The report concluded that poor epilepsy management resulted in a substantial number of potentially avoidable deaths. NICE believes its guidance on the diagnosis and management of epilepsy in children and adults should address these issues. Andrea Sutcliffe, executive lead for the guideline, said: "The guideline covers issues of real concern to people with epilepsy, such as accurate and timely diagnosis, appropriate communication and the need for regular reviews of medication." Key recommendations include ensuring precise and early diagnosis, tailored drug therapy and regular structured reviews of care, at least annually, for each patient. It says patients should be actively involved in treatment decisions, something that has not been happening, according to the National Society for Epilepsy. The guideline also emphasises the importance of appropriate advice to women with epilepsy who are of childbearing age. There have been concerns that some epilepsy drugs harm unborn children, but uncontrolled epilepsy can also be damaging. Dr Helen Cross, epilepsy expert at Great Ormond Street Hospital and member of the guideline development group said: "This guideline is comprehensive in both its scope and coverage and will contribute toward the development of an optimal standard of epilepsy care across the NHS." © BBC Health News Wednesday 27th October 2004

Patient tagging 'first in world'

Patients at a Birmingham hospital are to be electronically tagged in a bid to prevent medical mistakes in what has been described as a "world first". Heartlands Hospital is piloting the system which will track the movements of people undergoing surgery through a wireless network. Their records are then brought up on screens for use by staff at key points. Developers believe the system will reduce the risk of human errors and improve medical efficiency.

Digital photographs are taken of patients who are then tagged on arrival and the information is synchronised with their electronic records. David Morgan, a consultant ENT surgeon at the hospital who helped devise the process, said the patients location could then be tracked to within yards and their details fed to visual display units in theatres, anaesthetic rooms and waiting areas. Mr Morgan added he could make changes to the digital operating list while on his rounds using a pocket PC instead of working with typed copies. "This is the only system of its kind in the world," said Mr Morgan. It saves time for doctors because we don't have to go round wards changing typed lists and it enhances security as patients know they are going to have the right operation at the right time and with the right person." He added: "It allows better use of resources so you don't have wasted time in theatre, so it actually saves money in the long term."

The system was developed by Intelligent Medical Microsystems and cost £25,000 to install in one ward and two theatres. © BBC Health News Wednesday 27th October 2004

Cancer services 'need shake-up'

Cancer services in England are disjointed and need to be reformed, according to a parliamentary report. The All-Party Parliamentary Group on Cancer said the new funding system was "exacerbating" the postcode lottery. It claimed GPs were not referring those needing urgent treatment quickly enough and said primary care trusts (PCTs) should not be responsible for funding. It comes as the government announces a national screening programme for bowel cancer, aimed at cutting deaths by 15%.

The first such scheme in Europe, the government would be spending £37.5m on it over the next two years, Health Secretary John Reid told the BBC Breakfast programme. Bowel - or colorectal - cancer is the third most common cancer in men and the second most common in women in the UK. Each year, there are over 18,700 new cases of the disease in men, and over 16,800 cases in women. Dr Reid said thousands of lives would be saved by the screening.

Answering the cross-party report's criticism of cancer funding, Dr Reid said there had been a 12% reduction in the number of cancer deaths since 1997. "We will listen, but I am yet to be persuaded that it is better than what we are doing," he said. The proof of the pudding is in the eating and the results speak for themselves."

The report called for the control of cancer budgets to be handed to the country's 34 cancer networks. The networks are non-statutory alliances between primary care trusts, hospitals, councils and the voluntary sector, which support and plan services on a regional level. It said many of the country's 302 PCTs, which commission health services and have responsibility for spending three quarters of the NHS budget, were "struggling". As a result, it said, there were "worrying implications for the provision of all NHS services but particularly for national priority areas like cancer". The report also recommended GPs go on cancer education programmes to help them recognise which patients need urgent treatment.

Report's main recommendations Strip PCTs of funding powers Hand budgets to cancer network Send GPs on cancer education courses Set up cancer treatment database

Witnesses told the inquiry, which took evidence from the Department of Health, PCTs and patient groups, that PCTs lacked experience - and in many cases expertise - in commissioning cancer services. Ian Gibson, chair of the All Party Parliamentary Group, said: "The inquiry has exposed a serious problem. PCTs are struggling to cope and lack experience in commissioning cancer services. The budget for cancer services must therefore go directly to cancer networks to allow them to plan for sustained improvements in cancer care."

Joanne Rule, chief executive of CancerBACUP, a cancer information charity which co-authored the report, said cancer services needed specialist commissioning. "If not, access to cancer drugs, equipment and services will continue to vary widely from one part of the country to another," she said. Cancer patients deserve more."

The report also suggested data be collected at both national and local levels on the prescribing of cancer treatments recommended by the National Institute for Clinical Excellence. Mayur Lakhani, chair-elect of the Royal College of GPs, denied family doctors were at fault. GPs don't have a problem referring patients for cancer screening - the issue is the availability of scans and tests."

Professor John Toy, medical director at Cancer Research UK, said cancer treatment was improving but that it was unacceptable that quality of care was still being "determined by a person's address". © BBC Health News Wednesday 27th October 2004

Lungs 'best in late afternoon'

Lung function dips and rises on a 24-hour cycle, reaching a peak for most people in late afternoon, researchers have found. Researchers from Long Island Jewish Medical Center say their work suggests this might be the best time of day to take exercise. It might also be the time when respiratory medications are likely to have the most effect. The study was presented at an American College of Chest Physicians meeting.

Many of the body's processes are governed by circadian rhythms which repeat in 24-hour cycles. The new study, which only focused on the hours between 8am and 5pm, suggests that lung function may be controlled by the same pattern. A five-year analysis of 4,835 patients found lung function was at its least effective around midday, rising to a peak between 4pm and 5pm.

Researcher Dr Boris Medarov said: "Circadian rhythms regulate our biological cycles for sleep, activity level, metabolism, and many other processes through our body's exposure to sunlight and darkness. Our study finds that lung function has its own rhythm that may govern how much energy we exert throughout the day and the best times to engage in certain activities. We often associate the end of the work day with being tired and less motivated for physical exertion; however, lung function seems to be at its best during this time. As a result, exercising or engaging in other physical activities in the late afternoon may help us to achieve optimal performance."

Dr Medarov said circadian rhythms of lung function may also have implications for the administration of asthma medications and the timing of medical procedures. Many patients with asthma and chronic obstructive pulmonary disease administer bronchodilators around the clock, when they actually may need less treatments and a different regimen that includes administering the medication at midday when their lung function is at its lowest. It also may be better to extubate (remove tubes) patients in the late afternoon when their lung function is at its best and breathing on their own is easier." Dr Medarov said it might be possible to use relaxation techniques and other types of therapy to modify lung function circadian rhythms.

Dr Mark Britton, chairman of British Lung Foundation, said that it was well known that people with asthma showed signs of a circadian rhythm in their lung function. However, he said they tended to reach a low in the small hours of the morning, and to reach a peak in early afternoon. Dr Britton said it would be advisable to administer preventative medication at a time when the lungs were working most effectively, and this would enable it to penetrate as far as possible into the respiratory tissues. However, he said many people with lung disease often required therapy at the point when their lungs were at their least effective. He said the goal of medication was to try to ensure that any circadian rhythm was flattened out, so the lungs worked steadily all the time. He said this was now much more achievable with the advent of longer-lasting treatments. © BBC Health News Tuesday 26th October 2004

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