Aspirin a day cuts cancer risk after just three years

People can significantly reduce their chances of being diagnosed with cancer by taking an aspirin a day for as little as three years, according to new research.Aspirin a day cuts cancer risk after just three yearsThe cheap drug not only appears to stop cancers developing in the first place, but also prevents them from spreading to other parts of the body, the new work shows.

Those who start taking low dose (75mg) aspirin daily in their 60s appear to benefit just as much as those who start taking it earlier.

The study Effect of daily aspirin on risk of cancer metastasis published in The Lancet, add to the argument that low dose aspirin should be taken widely from middle-age, said the lead author, Professor Peter Rothwell, of Oxford University’s Stroke Prevention Research Unit.

His team found that taking low dose daily aspirin for between three and five years reduced the chance of being diagnosed with cancer at that time by 19 per cent. Five years or more after starting taking aspirin, the reduction rose to 30 per cent.

He said: “These data do push the argument in favour of taking daily low-dose aspirin, particularly if you have a family history of heart disease or cancer.

“We showed previously that daily aspirin substantially reduces the long-term risk of some cancers, particularly colorectal cancer and oesophageal cancer, but that these effects don’t appear until about eight to 10 years after starting treatment.

“The delay is because aspirin is preventing the very early development of cancers and there is a long delay between this early stage and the eventual clinical presentation with a cancer.

“What we have now shown is that aspirin also has short-term effects, which are manifest after only two to three years.”

The effect was just as marked in those who started taking it after they had turned 60.

The short-term effect appeared to be caused by aspirin slowing the progression of cancer. Another new study showed aspirin almost halved the chances of diagnosed cancer spreading to other organs, over 6.5 years.

Prof Rothwell said: “This is important because it is this process of spread of cancer, or ‘metastasis’, which most commonly kills people with cancer.”

After five years, the chance of having died from cancer if on aspirin was 37 per cent lower.

The findings also raised “the distinct possibility that aspirin will be effective as an additional treatment for cancer – to prevent distant spread of the disease”, he said.

Aspirin has long been hailed for its blood-thinning properties, leading some to argue that it should be prescribed to those who are at a higher risk of heart attack or stroke, even if they have never had one.

However, researchers have been increasingly worried that the benefits of reduced heart attacks and strokes are cancelled out by the raised risk of stomach bleeds, which are occasionally fatal.

But Prof Rothwell said the new research showed that aspirin had a far greater effect on reducing cancer than reducing heart attacks and strokes. Nine out of 10 deaths it prevented were “non-vascular”, according to one of the studies.

Critics of widespread aspirin use point out that it triggers stomach bleeding in some people, which can occasionally be fatal. Even advocates concede it should be used with caution in over 75s.

Prof Rothwell said their studies showed that while aspiring doubled the risk of bleeds in the first three years, after that the risk fell so there was no difference to not taking it. Aspirin also did not increase the risk of fatal bleeds, he said.

Cooling stroke victims brains could save as many lives as drugs

Cooling the brains of people who have just had a stroke could have as dramatic effect on reducing deaths and long term disability as ‘clot-busting’ drugs new reserach has found.Cooling stroke victims brains could save as many lives as drugsReducing a patient’s body temperature to 35C induces a kind of hibernation in the brain that helps protect it from damage, pilot studies indicate.

The technique – which can involve introducing cold saline solution into the veins, and putting ice-packs on the body – is already used for patients with traumatic head injuries and for some babies hurt during birth.

Now academics across Europe are setting up a £9 million study, funded largely by the EU, to test the theory in 1,500 volunteers.

Dr Malcolm Macleod, head of experimental neuroscience at the Centre for Clinical Brain Sciences at Edinburgh University, said: “Our estimates are that hypothermia might improve the outcome for more than 40,000 Europeans every year.”

Pilot studies indicate at least seven or eight per cent of stroke patients will benefit from the cooling therapy, he said- similar to the proportion helped by thrombolysis.

Dr Macleod noted cooling appeared to work for up to six hours after the stroke, compared to about 4.5 hours for thrombolysism. He also said it could also be used in the vast majority of stroke patients, which is not the case for clot-busting drugs, which can only be used for about one in five.

He continued: “It’s a treatment that might in time be available to give in the back of ambulances.”

The larger study is needed to verify the pilot study results, he said.

Dr Clare Walton from The Stroke Association said: “Cooling is a particularly promising area of stroke research because we know body temperature often increases following a stroke and patients with very high temperatures tend to make poorer recoveries.

“We already know that cooling is effective in reducing the amount of brain damage in patients who have acquired brain injuries from accidents. We look forward to finding out whether it has the same positive effect in stroke patients.”

Low staffing levels harms elderly care nurses warn

The care of the elderly is being compromised in UK hospitals because there are too few nurses, according to the Royal College of Nursing.Low staffing levels harms elderly care nurses warnResearch by the union suggested everything from basic communication to care for the dying was suffering.

And it called for minimum staffing levels to ensure standards improved, arguing one nurse for every seven patients was needed.

The intervention by the Royal College of Nursing (RCN) comes after a series of damning reports about the services the elderly are receiving.

The Patients Association and Care Quality Commission have both recently published studies detailing “shocking” levels of care.

Ministers have promised to give more powers to nurses as well as improving monitoring to drive up standards.

But the union said it was now time to insist on strict staffing levels and stop relying on health care assistants to fill the gaps.

It polled nearly 1,700 nurses – 240 of whom were working on wards with older patients.

The survey showed that while older people’s wards only had one nurse for every nine patients on average, general wards, at 6.7 patients per nurse, and children’s wards, at 4.2, were much better staffed.

Respondents said low staffing meant care suffered in a variety of ways.

Eight in 10 said basic support, such as talking and comforting patients, was compromised, while a third said they did not have time to help people properly with eating and drinking.

Nearly one in five also said care for dying patients was neglected.

The research looked at the use of guaranteed staffing rules in places such as Australia and the US and concluded they were needed in the UK.

It recommended there should be one registered nurse for every five to seven patients in the NHS.

Peter Carter, the RCN’s general secretary, said: “Patients on older people’s wards are being let down by systemic failings in our hospitals.

“Despite working tirelessly to provide patients with high quality care, nurses in these settings have repeatedly told us that they are unable to do this because of pressures caused by short staffing.”

A scandalous waste of money in the National Health Service

The public want taxes to be spent on patient care, not paper-shuffling- Telegraph Editorial.A scandalous waste of money in the National Health ServiceThe astonishing levels of pay for agency doctors employed by the NHS, revealed in our investigation, provide further evidence of how dysfunctional the health service bureaucracy has become.

Nor do these findings suggest that the EU Working Time Directive, limiting doctors’ working hours, is operating to good effect.

Although there were strong objections from the medical profession when this directive was imposed, there was also a recognition that doctors’ hours needed to be regulated to some degree: there is an obvious risk to patients being seen by an exhausted doctor, panda-eyed from lack of sleep.

The revelation, however, that in the two years since the directive came into force, NHS hospitals have spent more than £2 billion on temporary clinical staff makes it clear that something is very wrong.

One problem has been highlighted by Professor Norman Williams, President of the Royal College of Surgeons, who has expressed concern about hospitals attempting to economise by leaving vacant the posts of retired consultants, only to spend large sums employing locum staff.

That is sheer incompetence and evidence of the urgent need to rationalise NHS bureaucracy.

Doctors perform a vital service; but it is neither reasonable nor necessary to pay rates of £20,000 a week (equivalent to £1 million a year), especially when many of the payments to on-call doctors include hours when they are asleep.

This scandalous situation has all the classic ingredients: European diktat, bureaucratic incoherence and abuse of taxpayers’ money.

The public agency on which taxpayers least begrudge their involuntary contributions being spent is the NHS; but that generosity is predicated on the money being spent at the “sharp end” of patient care, not dissipated in the black hole of public sector paper-shuffling.

Doctors must not work excessive hours, but both the directive and NHS administration should be searchingly reappraised.


NHS reforms approved by Parliament

The bitter 14 month parliamentary battle over the NHS finally came to an end last night after the Government comfortably fended off a last desperate attempt by Labour to delay the health legislation.NHS reforms approved by ParliamentMPs have approved the last amendments to the Health and Social Care Bill – leaving the way clear for Royal Assent to be granted before Parliament starts its Easter recess next week.

The NHS shake-up has threatened to drive a wedge between the coalition partners ever since it was unveiled by Tory Health Secretary Andrew Lansley.

It is intended to give GPs greater control over NHS budgets, reduce bureaucracy, and increase patient choice.

But while there was jubilation among Tory and Liberal Democrat ministers, opponents have warned that the problems are only just beginning.

RCN chief executive and general secretary Dr Peter Carter described the reforms as “deeply flawed”.

He said: “We have achieved some concessions which make the Bill a different piece of legislation from that which first appeared, but our real concerns about the future of the NHS have not been heeded.

“It is now our responsibility to patients to do everything we can to ensure that the health service runs as best as it can despite the massive upheaval that this Bill will bring.

“We intend to work with trusts, regulators and other bodies but our fear is that in the fullness of time this Bill will be a cause of significant regret.

“Perhaps most importantly we will be supporting nurses who are going to have to pick up the pieces and still deliver the best care they can for patients through this extremely difficult time of change.”

Furious opposition from professional bodies and Lib Dem activists led David Cameron and Nick Clegg to take the highly unusual step of “pausing” the legislation last year.

Despite accepting more than a thousand amendments – including limits on competition and private sector involvement – the Government has failed to win over many health workers.

Lib Dems embarrassed Mr Clegg at the party’s spring conference this month by again refusing to back the measures in a vote.

And there is speculation that the controversy could yet cost Mr Lansley his job in a reshuffle expected over the coming months.

When the Cabinet met yesterday, ministers from both parties banged the table to celebrate news that the reforms had finally cleared the House of Lords.

An emergency debate called by Labour had the potential to delay the Bill until an internal assessment of risks had been published.

Shadow health secretary Andy Burnham demanded that the Government publish the risk register, insisting: “People outside will struggle to understand how Members of this House could make such momentous decisions without having carefully considered all of the facts and all of the evidence.”

But Mr Lansley accused Labour of “political opportunism”, saying civil servants needed “safe space” in which to advise ministers.

The Commons defeated the motion by 328 to 246 – a majority of 82. No Lib Dem MPs sided with the opposition, with the most vocal critics choosing to abstain.

After the House agreed more than 370 amendments to formally pass the Bill later, Mr Burnham insisted the “fight will go on” and promised to repeal the measures if Labour returned to power.

“We have given this fight everything that we had,” he said. “All I can say is our fight will go on to protect and restore this party’s finest achievement.”


MS sufferers have new drug hope by quango

The first pill for MS sufferers is set to be approved for use on the NHS.MS sufferers have new drug hope by quangoThe National Institute for Curbing Expendtiture (NICE) has overturned previous draft guidance on the drug Fingolimod after the price was discounted and has now ruled that a proportion of people with multiple sclerosis should be treated with it.

MS is a neurological condition that can cause symptoms from dizziness and fatigue to tremors, memory and speech problems. Some patients lose mobility and are wheelchair-bound.

It is often characterised by periods of stability followed be relapses.

Nice has recommended in new draft guidance that people with highly active relapsing remitting MS be treated with fingolimod, also known as Gilenya, made by Novartis.

Studies have shown it can reduce relapses by between 50 and 60 per cent.

It costs around £20,000 per patient per year and thousands of people may benefit.

The qualify patients will have to have unchanged or increased relapse rate or ongoing severe relapses compared to the previous year, despite them taking other drugs such as beta interferons.

Professor Carole Longson, Director of the Health Technology Evaluation Centre at NICE said: “The latest draft guidance from our committee recommends the NHS-use of fingolimod for a specific group of adults who have highly active relapsing-remitting multiple sclerosis.

“Following new information provided during the consultation, the analyses show that for these people, treatment with fingolimod will be a cost effective option for the NHS in this group of people with multiple sclerosis, if Novartis provides the drug at a discounted price, as proposed in its patient access scheme.

“We have published the latest version of our draft guidance on our website so that interested parties can highlight any factual errors or appeal against our final draft recommendations.”

In MS the body’s own immune system attacks the protective coating around nerve fibres which carry signals between the brain and the rest of the body.

The drug prevents the immune cells from attacking the nerve coating.

The Scottish equivalent of Nice, the Scottish Medicines Consortium has not approved the drug.

Nick Rijke, Director of Policy & Research at the MS Society, said: “We are delighted; this decision signifies a major step forward in the treatment of this devastating condition.

“Gilenya has been found to be highly effective in trials and taking a daily tablet will come as welcome relief from frequent, often unpleasant, injections.

“Making this new treatment available will increase patient choice for thousands of people with MS across England and Wales, but we’re deeply disappointed by the SMC’s decision in Scotland – and urge them to reconsider.”


PIP breast implants- the latest news and information

Worries about the breast implants made by PIP have emerged since news of a major investigation into the France firm.PIP breast implants- the latest news and informationInitially it was thought that around 40,000 women in the UK had the implants but yesterday the Department of Health said new evidence meant a further 7,000 women in the UK might have them. About 95% of the implants were provided privately for purely cosmetic reasons.

The French implants caused global concern after it was revealed they contained industrial silicone rather than medical-grade fillers and that they may be more prone to rupture and leakage.

Initially reports also linked the implants to a rare form of cancer known as ALCL. This cancer link has been now been firmly discounted by medical experts here and in Europe.

It isn’t currently known whether the rupture rate for PIPs is higher than for other types of implant.

From the implants that have been tested, there appears to be no risk of dangerous toxic effects in the event of a rupture.

The implants involved are called Poly Implant Prosthèse (PIP) and were made by a French company of the same name.

In a Medical Device Alert in March 2010, the Medical and Healthcare products Regulatory Agency (MHRA) said: ” … most breast implants manufactured by the company since 2001 have been filled with a silicone gel with a composition different from that approved”.

That alert was based on advice from French regulators. However, after an investigation by the MHRA, the French authorities reported in March 2012 that PIP implants made before 2001 may also contain unauthorised silicone gel.

PIP gained approval to market its silicone implants in 1997 but it is not clear when it began using a cheap type of silicone gel intended for making mattresses.

The marketing, distribution and use of the PIP implants was suspended in March 2010.

About one breast implant in five needs replacing within 10 years, whatever the make, so it is unlikely that all the 7,000 women who had PIP implants before 2001 still have the same implants.

An expert committee was set up recently to examine the specific risks associated with PIP implants. It concluded that there was not enough evidence to recommend their early removal. That advice has not changed.

However, the committee said the NHS would remove and replace the implants without charge if patients that the NHS had operated on remained concerned. The government expects the private sector to follow suit.

Women who received a PIP implant from the NHS will be contacted to let them know they have one. If you are worried, you should book a consultation with your specialist or GP.

Some private clinics have said they will replace PIP implants free if clinically necessary.

The expert committee has commissioned further work on the health risks and will meet again in May 2012 to review the findings and update its earlier advice as needed.

Also, the Department of Health has set up two reviews to look at how the PIP situation occurred and the issue of regulating the cosmetic surgery industry as a whole.

The first report is due to be submitted to the health secretary by the end of March 2012.

New Alzheimer’s drug Donepezil slows progression

More than 100,000 people in the UK suffering the “savage” effects of advanced Alzheimer’s disease could benefit from drug treatment to slow its progression. New Alzheimer's drug Donepezil slows progressionScientists have shown for the first time that drugs used to slow the disease in its early stages also work when the condition is advanced, greatly extending the population who could be treated.

Advanced Alzheimer’s is marked by the progressive loss of cognitive skills and physical control and leaves individuals stripped of their dignity and personality.

The finding could double the number of patients currently on treatment from 50,000 to over 100,000 in the UK and extend treatment to millions more worldwide.

Only one in five of the 500,000 patients with Alzheimer’s in the UK, a third of whom have advanced disease, are currently receiving drug treatment because of a shortage of clinics to diagnose them.

Professor Robert Howard of the Institute of Psychiatry, Kings College, London, who led the study published in the New England Journal of Medicine, said: “For the first time we have robust and compelling evidence that treatment with these drugs can continue to help patients at the later, more severe stages of disease. Patients were better able to remember, understand, communicate and perform daily tasks for at least a year longer than those who stopped taking the drugs.”

The National Institute for Curbing Expenditure (NICE) came under fire when it initially refused to approve Donepezil, the commonest drug whose brand name is Aricept, and associated drugs on the ground that they were not cost effective. It said the drugs worked in 40 per cent of those treated. Later they were forced to review its decision and recommended the drugs in the early and moderate stages of the disease but not in the late stages.

Although Its current advice says the drugs should only be withdrawn when doctors consider they are no longer of benefit, the latest findings mean its default position – that the drugs do not work in the late stages of the disease – may now have to be reviewed.

Researchers led by Professor Howard  studied 295 patients with  severe Alzheimers over a year and found continued use of donepezil slowed the deterioration characteristic of the disease by one third, equivalent to four months of improved quality of life.

Those who took a second drug, memantine, in combination, did even better.

Professor Clive Ballard, director of research at the Alzheimer’s Society, which funded the study with the Medical Research Council, said the drug was not a cure but significantly relieved the symptoms: “If I had Alzheimers disease or my relative did I would want them to have [the combination].”

Donepezil came off patent in February and its cost has  plummeted. It is now priced at around 80 pence a day compared with £2.50 a day for the patented drug, Professor Ballard said. The next stage of the research would be to examine the cost effectiveness of the drug based on the reduced cost.

Professor Nick Fox of the Institute of Neurology, University College, London, said dementia cost Britain £20 billion a year and one third of the population would be affected at some point in their lives.

“We desperately need therapies that will slow the disease at a stage when we have most to retain. This is a savage disease with a self sustaining momentum of its own.”

Yogurt might prevent a heart attack

Recent research has investigated the human digestion system and found that the contents of the alimentary canal may be a matter of life or death.Yogurt might prevent a heart attackYour digestive system is home to roughly 100 trillion microbes – about 10 times the number of cells in the major organs.

A team co-led by Prof Jeroen Raes of the Flemish Institute of Biotechnology has discovered that we all have one of three basic ecosystems of bugs in our guts – but strangely, the type for each person is unrelated to their race, native country or diet.

They label these “enterotypes” the “bacteriodes”, “prevotella” and “ruminococcus”, to reflect the species of bug that dominate in each.

People with a bacteriodes ecosystem, for example, have a bias towards bacteria that get most of their energy from carbohydrates and proteins.

This revelation has prompted much interest, because it could explain differences in our ability to digest food.

A few years ago, Prof Jeffrey Gordon’s team at Washington University School of Medicine found that the intestines of obese people contain a slightly different repertoire of microbes when compared with slim people. In the Flemish study, researchers found a similar correlation between obesity and the abundance of bacteria that extract energy rapidly from food.

Prof Jeremy Nicholson, of Imperial College London, doubts that the latest find is of huge biological significance, since the three enterotypes probably have similar roles and capabilities. Yet he believes that one day, it might be possible to engineer enterotypes, which could be used (for example) to boost the number of calories extracted from poor diets by children in developing countries.

The human gut contains about 1,500 bacterial species, so tinkering with their ecology in a controlled way may be tricky. Although there are products that claim to manipulate bacteria, such as prebiotics, which fuel certain microbes, and probiotics (such as yogurts) that contain live bacteria, we still understand too little to do this reliably.

Yet recognition of the importance of the microbiome is growing.

It has already been linked to our understanding of obesity, allergies, diabetes and cancer – and in the past few days, a study has appeared by Prof John Baker at the Medical College of Wisconsin in Milwaukee that suggests that the types and levels of bacteria in a person’s gut may be used to predict the likelihood of their having a heart attack, too.

The find, Prof Baker believes, “is a revolutionary milestone” in the prevention and treatment of such attacks.

As part of his experiments, he and his colleagues induced heart attacks in three separate groups of rats.

The first was fed a standard diet. The second was given the antibiotic vancomycin and the third fed a probiotic supplement containing Lactobacillus plantarum, a bacterium that suppresses the production of a hormone called leptin, which is linked to appetite and metabolism.

It turned out that the group treated with the antibiotic also showed decreased levels of leptin – and that the two groups with lower leptin levels suffered less serious heart attacks, and recovered from them better. “We may not be ready to prescribe yogurt to prevent heart attacks, but this research does give us a much better understanding of how the microbiome affects our response to injury,” says Dr Gerald Weissmann, editor-in-chief of the journal in which the study appeared.

Prof Jeremy Pearson, associate medical director at the British Heart Foundation, stresses that more research will be required to show whether the dramatic changes in inflammatory molecules seen in the rats would apply to humans, too. But few doubt that, in the not too distant future, we will get dramatic new insights into our health by studying the shadow world of our microbial passengers.

Roger Highfield is the director of external affairs at the National Museum of Science and Industry


Diabetes amputation rates show huge regional variation

Amputation rates for diabetes patients are 10 times higher in some parts of England than in others, according to a study highlighting the postcode lottery in diabetic care.Diabetes amputation rates show huge regional variationResearchers say the figures highlight the importance of ensuring the right specialist care.

The findings coincide with an NHS report putting the annual cost of diabetes-related amputations at £120m.

The study Variation in the recorded incidence of amputation of the lower limb in England, published in the journal Diabetologia, compared lower leg amputation rates for local health trusts (PCTs) across England over three years.

The paper concluded that, compared with the general population, people with diabetes were over 20 times more likely to have an amputation.

It reports a huge variation in the rates of both major (above the ankle) and minor amputations for patients with diabetes – including Types 1 and 2.

For major amputations these range from just over two each year for every 10,000 patients to 22.

In England every year there are about 6,000 diabetes-related amputations.

One of the main authors, Prof William Jeffcoate, a consultant diabetologist at Nottingham City Hospital, is wary of pinning blame on the areas with the highest amputation rates, though he says the variations are “shocking”.

He thinks the problem lies in the way services are organised.

“Foot disease is very complicated and a single professional hasn’t necessarily got the skills to manage every aspect of it.

“And that’s why I believe that only if you can gather a multi-disciplinary team and make sure that people have rapid access to assessment by such a team, it’s only in that way that we think you can provide the best service.”

Many hospitals in England still do not have these teams – which also include podiatrists, surgeons and specialist nurses.

Prof Jeffcoate says a lot of health staff are not trained to recognise the risks of foot disease.

“Maybe it’s just that people don’t like feet. Maybe it’s related to the fact that footcare tends to occur in an older population. But for whatever reason doctors and nurses have also never had specialist training in foot disease and so it means that they don’t necessarily have the skills to assess a new condition when it arises.”

The findings complement previous research suggesting that up to 80% of diabetes-related amputations could be avoided.

They also coincide with new figures on the annual cost of foot ulcers and amputations in England, published in a report by NHS Diabetes.

Its overall estimate is £650 million per year, including £120 million per year for amputations. The paper also highlights additional costs to patients and carers through lost working days and reduced mobility.

The report author, Marion Kerr, says the savings from specialist footcare teams – by reducing amputations – are six or seven times greater than the costs of setting them up.

“We believe that if the NHS were to spend to save – to introduce teams of this kind – not only would they transform the lives of many patients, but actually save money in the process.”