The Thin End

New hope comes today for those with familial hypercholesterolemia (FH). Familial hypercholesterolemia (FH) is a genetic disorder characterized by high cholesterol levels, specifically very high levels of low-density lipoprotein (LDL, "bad cholesterol"), in the blood and early cardiovascular disease. Without treatment, the life expectancy of those with familial hypercholesterolemia can be reduced by approximately 15-30 years. However, in people with homozygous familial hypercholesterolemia, life expectancy may only be 20 years or less. Homologous chromosomes come in pairs. One homologous chromosome is inherited from the mother; the other is inherited from the father.  Homozygous refers to a gene that has identical alleles on both homologous chromosomes.   This is why the homozygous condition is particularly rare and can be more severe. HoFH is a rare and more severe form of familial hypercholesterolemia (FH), an inherited condition characterized by very hi...

The good news is that interventions and social distancing are working.   An analysis by researchers at Imperial College London has found that, across 11 countries, since the beginning of the epidemic, 59,000 [21,000-120,000] deaths have been averted due to interventions.  Keeping up the interventions is estimated to save in the long term up to 40.6 million people who would have died but for restricting the spread.  Whilst we might be critical of the tardiness of some governments in their response to the pandemic, the message is clear; intervention works.  More needs to be done.  In the United Kingdom there is an urgent need to ensure that front-line health workeres get the protective equipment they need.   It is also vitally urgent that testing kits are rolled out as promised, not just for health and social care workers but for the population.  Many more lives can be saved if this is done.  With testing for immunity, we can get...

The coronavirus shut down has made us all more aware of the problems of loneliness.  Loneliness itself can be a cause of mental health problems, of morbidity and of premature death.   A new study in the United States shows the impact of loneliness on the end of life experience.  In a study of Americans over age 50 years who died between 2004 and 2014, individuals who were characterized as lonely based on survey results were burdened by more symptoms and received more intense end-of-life care compared with non-lonely people. In the 2,896-participant study, which is published in the Journal of the American Geriatrics Society, one-third of adults were lonely. In addition to having an increased likelihood of experiencing troublesome symptoms at the end of life, isolated individuals were more likely to use life support in the last 2 years of life (35.5% versus 29.4%) and more likely to die in a nursing home (18.4% versus 14.2%) than non-lonely individuals. Dr Nauz...

Who should lead on the response to a public health crisis such as the COVID-19 pandemic?   In a commentary in The American Journal of Medicine noted public health experts have said that appropriate concerns – not fear – should play a significant role in the emerging pandemic, and political leaders should empower public health officials to drive the response. Our political leaders are quick enough to say they are 'being led by the science', but this is to a large extend disingenuous.  Science cannot tell politicians what to do.  It can only advise and given assessments of the probable consequences of decisions.  But those decisions must be taken by politicians.   The decisions are based on balancing different objectives - the economy, social impact, the effectiveness of any course of action, public attitudes and compliance - there is no one set of expertise on these.  Psychologists, sociologists, public health experts, epidemiologists, clini...

It was heartwarming to see the applause for our health care workers on the frontline in the fight against COVID-19.  But praise isn't enough, particularly from the government.   They need the resources to do the job.  In particular, they need protective equipment. In a survey conducted by Medscape UK ,  7 out of 10 respondents on the frontline said that the supplies of the protective equipment they need to do their job. Some staff are having to purchase their own protective clothing. This is a shocking state of affairs.  We are asking our doctors and nurses to work with one hand tied behind their back and to put their own lives and the lives of members of their families at risk. A few days ago, thousands of frontline NHS staff  signed a letter to the prime minister calling urgently for action to provide the protective kit they need. We need more than applause for our frontline NHS staff.  We need to give them the kit they need to do ...

Many people will be affected COVID-19 beyond those directly infected by it.  Lives will be lost as a result of the efforts to save lives from the virus.  This is a sad reality of the response to the pandemic. As we focus on the potential loss of life through the virus, we need also to consider why so many others have had to put off possible life-saving treatments, or had operations cancelled. We must also consider that the long term impact of the economic consequences will be considerable. The problems we face are due to a decade of austerity, which made preparations for a pandemic almost impossible to achieve. Of course, resources are always going to be stretched in such circumstances.   But it would be wrong to assume that such a pandemic was unforeseen.   On the contrary, all NHS Trusts have made some contingency plans for such a virus. It would be easy enough to imagine that a decade of underfunding of the NHS has had no significant impact.  Bu...

For many years I served on NHS research ethics committees.  One aspect of clinical trials that always concerned us was how representative any trial was of the population.  This matters a great deal, as biased samples may give erroneous results or miss results that are of crucial importance   Now, new research has revealed bias and stereotyping among clinical and research professionals who recruit patients to enrol in cancer clinical trials. The findings are published online in CANCER , a peer-reviewed journal of the American Cancer Society (ACS). It is important to include diverse patients in clinical trials to ensure that the results will apply to patients in the general population. One form of bias is in the selection of those on the trail.  The proportion of racial and ethnic minorities participating in cancer clinical trials is persistently lower than the proportion of minorities in the U.S. population at large.  This has the potential for g...

Conspiracy theories tend to go viral on social media.  No surprise, then, that this would be so for COVID-19.  Support for the conspiracy theories comes, not from an evidence base, but mostly from people's instinct to think that the crisis created by the current pandemic is inexplicable.  From the title, you might expect an exposure of a major conspiracy to either cover-up of manufacture the COVID-19 virus.  There is no need for such theories.  The only conspiracy is that between our immune systems and the virus, and our trying to find a way to deal with the current crisis.    A pandemic was expected at some time because it is like such viruses that they will mutate and find ways to bypass our defences.   It is a constant game between viral agents and our immune systems.  Each, as it were, biologically trying to outwit the other.   So viral mutations are not rare.  A virus might also transfer across speci...

The new restrictions announced by the UK Prime Minister, Boris Johnson, are thought to be vital.  But is it going to be a case of too little, too late? The prospect, unless more is done to protect those in the population who are vulnerable to the virus, is a catastrophic number of cases that would overwhelm the NHS. An  analysis by researchers at University College London,  Cambridge University, and Health Data Research, suggests that the mitigation measures already in place would not be sufficient to avoid tens of thousands of deaths caused by COVID-19 virus. Using data on underlying conditions and age in the population, the analysis suggests that without stringent measures to prevent spread, the virus will bring about between 35,000 to 70,000 deaths. These are shocking figures to contemplate - a picture of health services being overwhelmed, itself leading to further non-COVID-19 deaths. The government have identified just 1.5 million with particular under...

The incidence of liver cancer is rising worldwide.  Now new research suggests this is being driven by the rise in obesity.  The new research reveals rising rates of liver cancer around the world, despite advances aimed at preventing the disease. The findings are published,   CANCER , the journal of the American Cancer Society.  To obtain trends and estimates of liver cancer by age, sex, region, and cause,  Dr Xingdong Chen,  of Fudan University in China, and his colleagues examined 1990–2017 data from the Global Burden of Disease Study covering 195 countries and territories. Globally, liver cancer cases diagnosed before the age of 30 years decreased from 17,381 in 1990 to 14,661 in 2017, but they increased in people aged 30–59 years and 60 years and older from 216,561 and 241,189 in 1990 to 359,770 and 578,344 in 2017, respectively. When applying age adjustments (to allow populations to be compared when the age profiles of the populations are ...

Tory scourge of the unemployed,  Iain Duncan-Smith is at it again. Now he urges the government not to bring in a universal income during the pandemic because it would 'be a disincentive to work'.   One really does wonder which bit of the planet he lives on! But he has form with this.  His view of those on benefits is that they are mostly shirkers.  He was one of the Tories that relished the prospect of cutting benefits to the 'workshy' poorest. A clue to his attitude came many years ago from a comment made by Duncan-Smith in an interview with Nick Robinson on the BBC. Speaking of people on benefits, he said "I want to change your life..to be a better person'.  This clearly reflects a view held about those on benefits: they are not 'good' people. At best it represents an inadvertent viewpoint 'look we want to help you back to work'. At worst it reflects a deep-seated attitude that stigmatises those on benefits as 'work...

Prime Minister Boris Johnson was surprisingly upbeat at his news conference in saying effectively that the United Kingdom will see the Covid-19 crisis through in twelve weeks, or as he put it 'turn the tide'.   Was he right to be so optimistic? It is always good for leaders to offer hope and maintain morale, but where is Boris getting his twelve-week estimate from? Boris' twelve weeks probably comes from the modelling.   The models predict that 50% of cases will come in the first three weeks and 90% over nine weeks.  Currently, we see cases doubling about every four days, which is very much in line with the modelling. The governments objective is to delay the peak, pulling it out so that the burden on the NHS is reduced.  It is a strategy to buy time.   If it works, it might save lives because it will free up resources to deal with the severity of cases. Nonetheless, challenging life and death decisions will have to be taken by clinicians about who ...

There are still too many avoidable stillbirths, baby deaths and brain injuries that occur during term labour in the United Kingdom finds the latest report from Each Baby Counts . Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, says of the report: “There are still too many avoidable baby deaths and brain injuries occurring during term birth in the UK – even one preventable case is one too many. We owe it to each and every one affected to find out why these deaths and harms occur, in order to prevent future cases where possible." Launched in 2014 by the Royal College of Obstetricians and Gynaecologists, Each Baby Counts is a national quality improvement programme that aims to reduce the number of babies who die or are left severely disabled as a result of incidents that happen during term labour. The programme brings together the results of local maternity investigations into stillbirths, neonatal deaths and brain injuries to understand ...

There are good reasons why the UK government needs to do more to roll out testing for coronavirus. First, because without doing so, we are working in the dark about the spread of the virus in the population.  Second, because those who have been infected with the virus and recovered would have built up immunity, and it would prevent unnecessary confinement. The more we get a grip on that kind of knowledge, the more people we can get back to work. The WHO was right at the outset to call for widespread testing: test, test, test.   We should not be making plans in the dark. Testing played a vital role in South Korea in their apparently successful attempts to gain control of the virus. The South Koreans introduced testing tents in the streets.   Testing wasn't an add on.  It was a vital plank of the Korean strategy. Testing can save lives.  If people are sure they are infected with the virus, then they could get treatment at an early stage and increase ...

So much now depends on developing a vaccine against COVID-19, but how long could that take? The best estimate is that it would take at least twelve months. The best chance currently is one being developed in the United States. One way to generate a vaccine is to replicate the bit of the virus that causes the immune system to react, but without the virus' potential for taking over the cells of the body that host it. It is a bit like finding a key that fits a lock but doesn't allow the thief to enter. The estimate is that a vaccine for Covid-19 is at least 12 months away. A trial of a vaccine has begun in the United States. The group based in Seattle, Washington, had been working on a similar virus and so have been able to switch to Covid-19. They have reproduced a bit of RNA that acts as a template for a bit of the virus that would be recognised by the immune system.  It is an ingenious trick they are using, which is to use a bit of RNA to get cells of our bod...

Shocked into action by the potential mortality from the coronavirus pandemic, governments around the world are acting to release huge sums of money into their economies.  Today, the UK chancellor announced that he was making available over £330 bn to support businesses during the crisis.  This is by far the biggest ever peace-time intervention in the economy.  It is right that governments should respond.  Millions of lives depend on them doing so.  But it should make us think about whether we have been getting our priorities right in the past, and whether we are now doing so.   Poverty kills just as relentlessly as does the coronavirus.  It attacks the most vulnerable.  Yet, the government invests too little in preventing it.  This has been particularly so over the last decade, where both child poverty and pensioner poverty have increased.  Poverty comes in different ways.  A report two years ago showed...

For the first time since WW2, we are reminded of how facing a major crisis we must pull together as a society. The coronavirus pandemic has exposed how fragile our social infrastructure has become after a decade of austerity.  Whilst not making the response to COVID-19 party political, the Tory government must acknowledge the need to invest in our communities, in social care, and other key services.  These are just as vital to our economic well-being as any factory. But this requires the government to ensure there is support for our key services.  We must never again allow our social support system to become so fragile. Just as bridges and roads, rail-links and ports are vital to our economy, so also is the fabric of our health and care system.  The government must once again start investing in people and communities. Much will be done by volunteer support groups, and that is a wonderful thing.  Indeed, we must all consider what it is we are doing fo...

During this Coronavirus pandemic, We often hear it said that we should 'follow the science'.  That, of course, is better than simply dipping your finger in the air to test the humidity!  But can the science work fast enough to inform debate when it comes to the difficult decisions to be made by politicians?  The answer is that it cannot.   The problem is that science works through a long process of experimentation or data acquisition, writing of papers, which then go through a peer review before being published. Cutting short any of this process weakens the strength of the science.  With the Covid-19 pandemic, events are occurring faster than science can function. What then happens is mostly speculation based on judgement, whether by specialists or not. Epidemiologists, virologists etc. are called upon to give their view on what is likely to happen. Few of them stress the problem that science doesn't work that way.  We all either feel ...

Britain's first budget since leaving the EU shows little to no Brexit dividend.  Digesting the UK Chancellor's budget will take a bit of time...just a bit.  But it is already clear that there is little of the trumpeted Brexit bonanza.  There is no windfall from Brexit. Of course, some will argue that there was never going to be any. Instead, the government has abandoned its economic principles, planning now to increase borrowing to spend on big infrastructure projects and cope with the coronavirus pandemic.   It is a crisis budget. We saw none of the £350 million a week for the NHS that adorned Boris Johnson's Leave campaign bus.  We did get an extra £6 bn for the NHS, which is woefully short of the £18 billion that was suggested as a bonus from Brexit! Of course, nobody believed the battle bus figure in any event.  It was a porky pie.  Not only did it get the number wrong for our payments into the EU, but it was also a sleight of hand to s...

There seems to be a worrying trend in the incidence of colorectal cancer in young people.  A population-based analysis from England indicates that the incidence of colorectal cancer is increasing rapidly in young adults. The findings, which are published in BJS (British Journal of Surgery), suggest that colorectal cancer should no longer be considered a disease of older people. For the analysis, investigators examined information on adults who were diagnosed with colorectal cancer in England between 1974 and 2015. Of the 1,145,639 new cases of colorectal cancer diagnosed between 1974 and 2015 in adults aged over 20 years, there were 2,594 in 20–29 year olds, 11,406 among 30–39 year olds and 42,134 in 40–49 year olds. The most sustained increase in incidence rates was seen in adults aged 20–29 years. The magnitude of increases was similar in both sexes and across income levels. The most pronounced increases in incidence occurred in the southern regions of England. Anothe...

We might feel that with the massive borrowing to spend in the UK chancellor's budget sees the end of austerity.   Not long ago, the Tories were attacking Labour for their spending plans.  Now, this Tory government is set for the biggest spending spree in decades. Of course, much of this is because of the coronavirus pandemic.   The NHS will get a boost in spending because, without such an injection of new cash, it will be unable to cope. The government is responding to crises.  At last, it is putting in the much-needed funds to strengthen flood defences. But does all this mean the end to austerity?  The answer to the poorest is that it does not.   There is little in the budget to address the problem of social care.  There is little to solve the issue of high rents and poor standard of housing. There is little to address the crisis in children's services, and little to address the crumbling school infrastructure. It is a spending budget, b...

Social media is full of pitfalls, where understanding is concerned.  Face to face encounters with others involves a great deal of facial expression, hand gestures, body language. In short, emotion matters.   Our body language tells much more than the words we utter. Of course, we can use emojis in our messages -  or we can add kisses, xx, after our abrupt response, softening the impact of, say, a disagreement.   There are a hundred and one ways of saying 'sorry', but how do you say it 'as if you mean it'? See what I mean :) ?   I wasn't rude :) Do take care :) Beware of negative emojis?  Negative emojis are more likely to be poorly processed. A new study , published in the journal Computers in Human Behaviour,  now shows that men and women process emojis differently.  On the whole, it seems that women rate negative emojis to be more negative than do men  :(.  While positive emojis :) are about equally interpreted. Some...

Labour Party leadership candidate, Rebecca Long-Bailey, wants to reopen the debate about Clause 4 in the party's constitution. At a time when the party should be seeking to unite, this candidate is bent on opening old wounds and potentially devoting months if not years of wrangling about its constitution. It is, of course, a pitch to the Corbyn wing of the party.   They have never forgiven Tony Blair for pushing through reform of the old Clause 4 section 4, which enshrined public ownership as an objective. It was and will remain a source of contention in the party ever since it was written in 1918, but mainly since the former leader in the 1950s, Hugh Gaitskell, tried to ditch it. The clause, which has sweeping nationalisation in it, was always far removed from what a Labour government would do.   But for years the party carried the burden of its intent written in stone. For many on the left, it is a shibboleth.  To moderates, it is was an unnecessary handic...

The coronavirus is a nightmare for any government, and the UK Health Secretary has difficult choices to make.  The worst-case scenario is worrying.  The government should be preparing for the worst.  To date, the UK is in a containment phase of the crisis.  Other countries have already moved to measures to prevent the virus from spreading.  Managing the spread of the virus means drastic social and political action as evidenced in Italy. One wonders why the government is waiting.  There is no reason to suppose that the virus is not spreading in the UK just as it is in France, even if it has not reached the levels seen in Italy. Stopping the spread would mean taking strong measures that would impact adversely on the economy.  The government will also be mindful of the risks of panic in the population. Many experts are warning that the UK has only a few days if it is to take action that would prevent the virus spreading as it has done in Italy, ...

With Elizabeth Warren stepping out of the Democratic candidate race we are left with two tired old men who will probably now inflict untold damage on each other.  Neither is likely to come out of the race unscathed.   It is a battle between a 'socialist' left and a centrist.  Tired ideas headed up by tired old men. It is hardly inspirational stuff. American politics seems to be stuck in a time warp and neither the Republicans nor Democrats have ideas robust enough to face the critical challenge of climate change.   Climate change doesn't split neatly into a left-right division.    It really needs youthful leadership with new ideas.  Someone capable of projecting a vision of a new horizon.  Instead, we will have two potential leaders appealing to their separate camps of followers.  Those follow will entrench in their positions, and the risk is that it will alienate voters needed to win against Trump.   American politics is stu...

How much do we rely on partners to spot medical problems, and how important is this in prognosis? Psychological stress has been proposed as a risk factor for melanoma, but clinical evidence is limited. It is reasonable to consider that any kind of stress will affect the bodies defences, such as the immune system.  The stress of illness in a  partner or a close relative has its toll, and then there is the impact of loss if they die.  A recent British Journal of Dermatology study funded by the European Academy of Dermatology and Venereology looked for a potential link between the death of a partner, which is one of the most stressful life events, and melanoma. The research was carried out by the London School of Hygiene & Tropical Medicine and Aarhus University Hospital in Denmark. The result was rather curious. In the study, which included information from the UK Clinical Practice Research Datalink and Danish nationwide registries, investigator...

Hope for a better future for both the Palestinians and the Israelis appear have taken a knock with an analysis that shows young Israelis have shifted to the right, with 53.9% voting for right-wing parties. But is it the full story? Seventy per cent of Jewish Israelis define themselves as right-wing. And less than 30% support a two-state solution.   For those hoping for a generation shift that would give impetus to a peaceful solution that recognised the rights of Palestinians, it gets worse. Forty per cent of young Jewish Israelis according to the poll would support a complete annexation of the West Bank.   The poll shows little sympathy for the Palestinians. Those of us who had hoped for a generation shift can take some comfort from the reasons given by young Israelis for their position.   Many more would support a two-state solution if security for Israel could be guaranteed.  Security is the primary concern of voters, young and old.  Hope also lies else...

The UK government has published its position in trade talks with the United States.  At the outset, it makes clear that the NHS is not on the table, nor what the NHS pays for drugs.  "The NHS will not be on the table. The price the NHS pays for drugs will not be on the table. The services the NHS provides will not be on the table. The NHS is not, and never will be, for sale to the private sector, whether overseas or domestic. Any agreement will ensure high standards and protections for consumers and workers, and will not compromise on our high environmental protection, animal welfare and food standards." This is good news if they stick with those pledges. The government must resist giving under pressure, and pressure there will be.  The US will want concessions if it is to provide more favourable access to its markets. It is a market that the UK will increasingly depend upon unless it can strike a good deal with the EU. As with our relationship with the EU, ...

We often hear the expression 'on top of the detail'.  The forensic analysis of instant media more often will find politicians wanting when it comes to specifics.  An interviewer comes to the studio well briefed with a specific set of details, the politician comes having to anticipate what they might be asked.  It is a game of cat and mouse, chasing around the issues. Andrew Neil on the BBC uses the technique of catching politicians on detail, or on what they might have done or said at some time in the past, long or short.  "I put it to you that....", "No, no, this is what you said in 100 AD." Does it get us anywhere? We could say that politicians should know the detail.  But is that really sensible?  Good decisions may be influenced by details, or by what is called 'fact'.  Yet, decisions are often made on a balance of probabilities and not on 'facts'. Boris is a broad-sweep politician Boris Johnson is a broad sweep politician....