Meet the medical experts who will be guiding Spectator Health online

This article was published by Spectator Health on 19 February 2016.

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The media’s coverage of health matters. It affects what foods we buy, what pills we take, whether or not we get our children vaccinated. Yet health reporting is confusing at the best of times. Sometimes the experts don’t agree. More often, the media goes with a fresh angle because it is interesting, and the true picture is obscured.

These days it’s not just the journalists who get blamed. The new scapegoat is the university press office, which can hype up research in a way that distorts the actual findings.

That’s why Spectator Health has assembled a panel of medical experts to cut through dodgy press releases and offer a reliable verdict about the value and robustness of each piece of research that we report on.

Our reports (as in today’s here) will contain a ‘sniff test’ from one of our medical experts which will point out if the conclusion is new, long established or obviously wrong, and, if relevant, draw attention to more robust research in the same area. Each paper will get a score out of five — zero for meaningless PR guff, five for gold-standard research.

The medics and academics who are lending their expertise are GPs Dr Chris Hall, Dr Roger Henderson, Dr Michael Banna and Dr Ryan Maginn, cardiology registrar Dr David Warriner, cardiologist Prof Robin Choudhury, obstetrician-gynaecologist Dr Tarek S Arab and pharmacologist Prof David Colquhoun — all of whom can spot a dodgy Daily Mail headline from a mile off.

That way we can combine the virtues of good journalism with proper medical rigour. And, the next time you are baffled by claims that beetroot juice prevents dementia or that bacon will give you cancer, you know where to find a bit of sense.

Does a tan really raise your risk of skin cancer?

This article was published at Spectator Health on 12 February 2016.

‘No safe way to suntan, new NICE guidance warns.’ The BBC headline was repeated by most of the media and reflected some alarming new advice on skin cancer. The nub of it was that people should expose their arms and legs to short busts of sunlight only — long enough to get a hit of vitamin D, but not long enough to change the colour of your skin.

The guidelines aren’t based on any new evidence and don’t represent a change in thinking. Instead they are an attempt to reflect current consensus among the experts. I have to admit I was shocked that a bit of sunbathing is actually considered risky behaviour. But is it true — and how much does it raise your risk of skin cancer?

The truth is the experts don’t know. The clear evidence relates to sunburn, not tanning. A meta-analysis published in the Annals of Epidemiology in 2008 found that getting a painful sunburn every two years of your life triples your chance of a melanoma.

Another study found that if you had 26 or more ‘painful’ or ‘severe’ sunburns in your lifetime your risk would double or triple.

To put this into perspective, the lifetime risk of developing a malignant melanoma is one in 52 for men and one in 54 for women.

As a rough estimate, then, getting sunburnt frequently will raise your risk to slightly less than three in 52 (for men) or slightly less than three in 54 (for women) — slightly less, that is, because the original lifetime risk figures encompass everyone, including the perennially sunburnt, so to simply triple the figure would be to overstate the risk.

Another key factor is your skin type. People with very fair skin (classed as ‘type 1’) have double the risk of a melanoma compared to people with dark skin (‘type 6’).

When it comes to skin cancer risk and tanning, the picture is hideously complex. Many skin cancers are caused by exposure to ultraviolet light (either through sunshine or sun beds). Ultraviolet light also causes skin to darken. So a tan is evidence of exposure to a carcinogen — it is the skin ‘trying to protect itself’. But that’s a good thing, too: a tan will protect against future exposure to UV. That is why people with naturally dark skin are at lower risk. There is some evidence that outdoor workers, who spend a lifetime in the sun, are at lower risk too.

Mark Elwood, professor of cancer epidemiology at the University of Auckland, explained:

Epidemiological evidence shows that ‘intermittent sun exposure (from holidays, etc) is more of a risk factor for most melanoma than continuous sun exposure (from long-term outdoor employment): maybe in the latter situation, the protective mechanisms outweigh the initial carcinogenic dose.

He stressed that, for most people, these ‘protective mechanisms’ will not apply, and the NICE guidance is ‘probably a reasonable, if over-simplified, statement’.

Can genetically modified ‘killer mosquitoes’ stop the Zika virus?

This article was published at Spectator Health on 26 January 2016.

The forecast for the Zika virus outbreak seems dire. There is no vaccine, and no hope of one for at least a year, probably longer. And, according to the World Health Organisation, it is likely to spread to every country in the Americas apart from Canada and Chile.

Women in El Salvador have already been told to leave off getting pregnant until 2018, as it seems likely the virus causes brain damage in infants. Of course, this does not seem very realistic.

While North and South Americans wait for a vaccine, the best hope may lie in targeting the Zika carriers: the mosquitoes. And scientists in Oxford have developed an extraordinarily deadly means of doing so.

A company called Oxitec, set up by scientists from Oxford University, has produced a form of genetically modified mosquito whose offspring do not survive. By releasing millions of these GM males into an area to mate with potentially virus-carrying females they can lower the mosquito population by nine-tenths in a matter of months. (The GM males die quickly too, having been programmed to survive on a special diet in a lab.)

Trials on the Aedes aegypti mosquito — the mosquito transmitting the Zika virus – have already been carried out in Brazil. The target of the trial was not Zika, but dengue fever, and in Eldorado, Sao Paolo, where the GM mosquitoes were released, the number of dengue cases dropped from 133 to just one in a year.

The Oxitec mosquitoes are still being reviewed by the US Food and Drug Administration and a plan to use them in Florida met fierce opposition following headlines about ‘genetically modified killer mosquitoes’.

If taken up by the governments of the Americas they could be a key weapon against the Zika virus, alongside more routine methods of mosquito-avoidance. The challenge will be to scale up their production quickly enough to make a difference.

In the longer term they may well be crucial in efforts to combat other mosquito-borne disease — dengue fever, chikungunya, yellow fever, malaria — by keeping the mosquito population at a very low level. It tentatively raises hopes that the mosquito may one day no longer be such a deadly enemy for humans.

Type-2 diabetes has a secret: it’s perfectly reversible

This article was published at Spectator Health on 6 January 2016.

Carlos Cervantes used to suffer from severe diabetes. His low point was 2011, when he had a heart attack, his kidneys started failing him and he was facing a foot amputation because of a toe-to-ankle ulcer. ‘I had pretty much figured that my time was up,’ he says.

Then he stumbled on a news clip about a study at Newcastle University. In it all 11 subjects had their type-2 diabetes reversed after following a very low-calorie diet — that is, just 600 calories a day for eight weeks. So Cervantes gave the diet a try. His blood sugar dropped to a normal level, his symptoms vanished and he was returned to good health.

The mechanism is simple. Type-2 diabetes is caused by a build-up of fat stopping the pancreas from producing the insulin we need. Restricting calories to a very low level means we can burn off this fat, allowing the pancreas to start working normally again.

Cervantes’s success story is one of many. Professor Roy Taylor, who led the Newcastle trial, says ‘over 100’ people around the world have contacted him to say they have tried the diet and got rid of their own type-2 diabetes.

Now, together, with Professor Mike Lean, he is leading a five-year study to determine whether such a diet might become routine NHS treatment (for type-2 diabetes, but not for type-1, which is caused by a reaction of the immune system, not fat). The results will begin to trickle in next year and be published in 2018.

Official guidelines may change after that. Until then, there’s nothing to stop people trying the diet themselves (though if you are on medication it’s best to check with a doctor first).

Fortunately, you don’t have to drop down to 600 calories a day. Subjects in the latest trial have a daily intake of 800. This seems to make a big difference. The earlier trial was gruelling. The journalist Richard Doughty, a subject on the trial, recalled feeling tired, hungry, and ‘detached from colleagues’. Even though it was July his fingertips went white with cold and he had to wear a coat.

On 800 calories it’s not nearly so horrible. ‘The first 24 or 48 hours are tough,’ says Professor Taylor. But then the body adjusts and ‘you rapidly lose the sensation of hunger’. In fact, he says, most of the subjects so far have carried on with the diet for longer than the 12-week minimum.

But, from the point of view of burning fat, 800 calories works as well as 600 — both are well below the daily requirement of 2,500 (men) or 2,000 (women). On either diet we get most of our energy from our fat rather than the calories we consume.

One problem, according to Taylor, is boredom. The diet involves nothing but nutritional shakes and water for 12 weeks. The shakes, made by Cambridge Weight Plan, don’t come in all that many varieties. (An alternative 700-calorie diet that includes actual food can be found here.)

Another issue is you can always put the weight back on. You might reverse the diabetes only for it to come back later. ‘One of the most difficult things is not getting the weight down, but adapting long-term habits,’ says Taylor.

Type-2 diabetes is still widely seen as a progressive condition that will only ever get worse. One biscuit too many, you think, and you are doomed. The good news is there is a way out and it doesn’t even involve a pill or a doctor — just a diet.

Spotting lung cancer early is crucial. Here’s what you should know

This article was first published at Spectator Health on 17 December 2015.

Britain tends to lag behind other European countries in terms of its cancer survival rates. A few years ago this was most definitely the case with lung cancer. In 2005 only nine per cent of patients survived for five years after diagnosis. Now, after a remarkable jump in progress, it is predicted that for those diagnosed in 2013 the rate will be 16 per cent — still low, but actually only slightly behind world-leading rates such as Sweden’s or North America’s.

The reason, says Dr Mick Peake, clinical lead for the National Cancer Intelligence Network, is a massive increase in specialist surgeons — up from 40 to more than 80. Previously about half of lung operations had been performed by heart surgeons.

This greater expertise means that surgery is much more commonly a treatment. And, for lung cancer patients, surgery is by far the best option. If caught early enough the tumour can simply be cut out — vastly preferable to gruelling rounds of chemo and radiotherapy.

Dr Peake cites two other factors in the improvement in Britain’s rates. One is data. From 2004 data was collected on hospitals’ performance on lung cancer. (Some hospitals’ results were alarmingly poor, says Dr Peake.) The other is more surgeons joining multidisciplinary teams to assess patients’ treatment. An expert surgeon is then well-placed to decide if surgery might be possible.

For lung cancer, even more so than for most other cancers, early diagnosis is crucial. Four in 10 cases are spotted during some sort of emergency hospital admission. In these cases the survival rate is very low – 12 or 13 per cent are alive after a year. But if you are diagnosed after a GP referral your chances of surviving go up to nearly 50 per cent.

These figures are undeniably bleak. But to improve our odds of beating lung cancer, and to lower the death rate generally, there are two things we should know — what the early symptoms are and whether we are likely to be at risk.

So, risk. About 85 per cent of cases are caused by smoking. The other biggest cause is a natural gas called radon, which is present in higher levels in Cornwall, Wales and the north of England. (An interactive map is here.) A small percentage of cases is explained by second-hand smoking and air pollution.

Symptoms, unfortunately, aren’t easy to spot. An advertising campaign had the line: ‘Been coughing for three weeks? Tell your doctor.’ Actually, says Dr Peake, it’s not that simple. Most smokers have some kind of permanent cough — so often the warning sign is when that cough changes.

Dr Peake explains: ‘It becomes more persistent, or more frequent, and it might start disturbing your sleep. You often produce more phlegm or the phlegm alters in some way, becomes slightly discoloured or green or has blood in it. Or sometimes it might hurt a bit when you cough, or you have might chest pain.’

Most people, Dr Peake suggests, are aware that something has changed. ‘They might say “I had a cough for six weeks” – actually they had a cough for five years,’ he says, but its character altered six weeks ago.

For some, though, there is not even a cough. In that case, what to look out for is ‘any new symptoms — breathlessness, weight loss, chest pain — that do not go away’.

The threshold for concern should be very low, Dr Peake says. ‘A lot of people are very reticent about disturbing their GP,’ he says. But most lung cancers will be picked up by a single chest X-ray, so there is no downside to a check-up.

The latest figures have been compiled by the UK Lung Cancer Coalition, an alliance set up to raise survival rates. They were released in its report Ten Years On: The Changing Landscape of the UK’s Biggest Cancer Killer.