What the papers say – weekly digest (05/01/24)

Your weekly digest of the top healthcare stories, covering news published from 01/01/2024 – 05/01/2024.

The Daily Telegraph

The rate of cancer diagnosis in Britain will reach one person a minute within a generation, experts predict, as they warn that the country could lose its status as a research ‘’superpower’’ in the disease. Michelle Mitchell, chief executive of Cancer Research UK, has said that even as the burden of cancer is increasing, investment in stopping it is failing to keep pace. ‘’We are at an inflection point,’’ she said. ‘’There are worrying signs on the horizon. And now is the time to act to retain a globally leading position over the future decades.’’ The charity has projected that by 2040 the number of cancers diagnosed in the UK will have risen by a fifth, to one a minute. Its analysis also found that on its present trajectory Britain risked creating a £1 billion gap in research funding. Compounding future problems for patients, the NHS faces a record six-day walkout by junior doctors, which officials say will make for one of the most difficult starts to the year ever and cause disruption for weeks. Ministers have pledged to make the UK a science superpower, building on its leading position in the life sciences in particular, including cancer. An estimated 419,935 cancer cases a year are diagnosed in the UK, and by 2040 this will rise to 505,565 on present trends. Deaths would rise by almost a fifth from 176,376 to 208,022. The projected figure is an increase of a fifth compared with today and comes from Cancer Research UK analysis. If middle-aged adults drop unhealthy habits such as smoking, drinking too much alcohol and poor diets that could lead to obesity, thousands of cases could be prevented, the charity said.

People struggling to speak after a stroke can make progress even years later with intensive therapy, a groundbreaking programme has shown. Patients taking part in a study went through a ‘’boot camp’’ offering 100 hours of personalised speech and language therapy, compared with an NHS average of 12 hours. Stroke survivors regained their ability to perform tasks such as chatting on the phone, ordering coffee in a cafe or reading bedtime stories to their children. Some were able to return to work. Results from two years of the intensive comprehensive aphasia programme at the National Hospital for Neurology and Neurosurgery in central London, funded by The National Brain Appeal, have been published online in the journal Aphasiology. Aphasia is an acquired communication disorder most commonly caused by strokes. It is estimated that more than 350,000 people in Britain have the condition, with numbers likely to increase, particularly as cases of dementia – another cause – rise. The frustration of knowing what they want to say, but struggling to say it, can make sufferers feel depressed and isolated. In October, the National Institute for Clinical Excellence (Nice) said stroke patients should be offered ‘’needs-based rehabilitation for at least three hours a day on at least five days of the week covering a range of multidisciplinary therapy including physiotherapy, occupational therapy and speech and language therapy.’’

The number of appointments and operations cancelled because of strikes by junior doctors is expected to top a million this week, during an unprecedented 6-day walkout. More than 200,000 cancellations are likely, prompting warnings that the action is making it harder to bring down waiting lists and is putting people off seeking care. NHS leaders have also said that in order to keep patients safe it is vital that the British Medical Association (BMA) responds swiftly to any requests for doctors to leave picket lines and return to work in the event that services come under too much pressure. A total walkout beginning today (Wednesday) will involve thousands of BMA members and staff from the smaller Hospital Consultants and Specialists Association, stopping working until next Tuesday. There have been 28 days of industrial action by junior doctors during the pay dispute, with a total of 973,565 cancellations – an average of almost 35,000 per day. Hospital leaders say the true number of patients affected could be far higher as they now avoid scheduling clinics to begin on expected strike dates. The BMA has not agreed any national exemptions to strike action, despite requests from the NHS to keep doctors working in areas such as fast-progressing cancers, corneal transplant eye surgery and deliveries by time-critical caesarean sections. Instead, trusts can request that doctors return to work if there are ‘’unpredictable events, major incidents or unexpected and extreme circumstances’’.

The NHS will have ‘’one of the most difficult starts to the year’’, officials said, with a doctors’ strike likely to have an impact for weeks. Tomorrow (Wednesday) at 7am, thousands of junior doctors walk out of A&E and off wards for six consecutive days, the longest strike in the 75-year history of the NHS. Sir Stephen Powis, NHS England medical director, said: ‘’This January could be one of the most difficult starts to the year the NHS has ever faced.’’ He said the strike came on top of seasonal pressures ‘’such as COVID, flu and staff absences due to sickness’’. But he said people should not be put off seeking the care they needed and should ‘’come forward as they usually would – using 999 and A&E in life threatening emergencies and 111 online for everything else’’. The NHS Confederation said the service would be put at ‘’serious risk’’ and reiterated its plea for the strike to be called off. Junior doctors want ‘’pay restoration’’ to 2008 levels, which they calculate as equivalent to a 35% pay increase. Talks with the government broke down last month after ministers offered the doctors 3% on top of an average 8.8% rise already implemented. A pay deal was reached with nurses and other NHS staff such as paramedics last summer, while consultants are voting on an offer. Victoria Atkins, the health secretary, has said if strikes are called off ‘’we will be back round the table in 20 minutes’’. The British Medical Association said ministers’ refusal to talk if strikes were scheduled was ‘’blocking progress’’.

A ‘’storm of pressure’’ is bearing down on the NHS, its top doctor has warned, with winter viruses surging before the longest junior doctors’ strike on record. Next week thousands of medics will walk off wards and out of A&E for six days as part of a pay dispute that has led to almost 974,000 appointments and operations being cancelled. Figures released by NHS England showed rising numbers of patients were being treated in hospital for flu, COVID-19 and norovirus. In the week leading up to Christmas Eve there were an average of 942 patients with flu in hospital each day, including 48 in critical care. That is almost six times higher than the figure of 160 four weeks ago. Meanwhile 452 hospital patients on average were there because of norovirus symptoms, which include diarrhoea and vomiting, and 3,620 patients had COVID – up by more than half from a month before. An average of 2,597 members of staff were off work due to COVID every day last week, compared with 1,715 people off at the end of November. Ambulance chiefs had raised concerns about rising levels of handover delays. Paramedic crews should be able to pass patients on to hospital staff within 15 minutes, freeing them for new calls. However, delays of more than 10 hours have been reported at some hospitals. In the week leading up to December 17 NHS data showed 30% of patients in England waiting 30 minutes and 12% waiting more than 60 minutes. Last week showed some improvement, with 23% waiting 30 minutes and 7% more than 60 minutes. There were 14,262 hours lost to handover delays, down from 28,966 a week earlier.

The Guardian

An NHS illness prevention service should scour medical records to identify and seek out those who need pre-emptive treatment, health advice and weight-loss drugs, Sir Tony Blair says. The NHS app must be revamped to alert people to treatments and tests they should be having, the former prime minister’s think tank says. The proposals align closely with plans by Wes Streeting, the shadow health secretary, to turn people’s phones into an increasingly personalised form of health advice. The Tony Blair Institute argues that a dedicated prevention organisation could save the NHS billions of pounds a year and boost the economy by reducing record levels of illness absence. The present NHS bodies fail to make preventing ill health a priority as they struggle with urgent patients and the next government must build on the COVID vaccine programme by creating a system to target those at risk, it argues. Britain is increasingly becoming older and sicker, with about 40% of the NHS budget spent on treating preventable conditions. Last month the institute estimated that obesity cost the health service £19 billion a year, far higher than previously thought. Now it is arguing for a separate organisation, Protect Britain, to work alongside the NHS and be responsible for ‘’identifying patients who are at risk from or suffering from preventable diseases and conditions.’’

Persuading cancer patients to take exercise classes, improve their diet and talk about their problems can improve their survival rates, according to pioneering research. Experts say ‘’prehabilitation’’ should become part of routine cancer care protocols to boost UK patients’ chances. An increasing body of evidence shows the important role fitness can play in how cancer patients fare after surgery and other treatments. A team at University Hospital Southampton found that a programme of high-intensity exercise during the six-week gap between chemotherapy and surgery could return patients’ physical fitness to pre-chemo levels before going under the knife. Professor Mike Grocott, head of the university’s critical care research group, said: ‘’We know that in major surgery, physical fitness has a big impact on how fast you recover, your chances of complications and your long-term outcomes. Not only have we shown this improvement in pre-surgery fitness, evidence of reduced complications and improved quality of life, we’ve also published data showing that this kind of exercise results in the tumour itself shrinking ahead of surgery.’’ Separate research from the same group showed that a patient’s level of physical fitness before surgery for certain cancers was an indicator of how well they would recover.

Cases of scabies have written dramatically this winter and experts fear that a resurgence of the Dickensian disease is being driven by real or ‘’pseudo’’ resistance to treatment. In November, the rate of scabies was double the seasonal average, with three cases per 100,000 people, according to data from the Royal College of General Practitioners. In 2018-19 there were 1.4 cases per 100,000 people. In the week beginning November 27 there were 484 cases recorded by the 500 GP practices in England and Wales. In the same week in 2021 there were 56, and in 2022 there were 94. Michael Marks, an epidemiologist who is chairman of the International Alliance for the Control of Scabies, said the recent rise in cases ‘’feels like a real phenomenon. It’s not UK specific’’. Scabies is an itchy rash caused by mites under the skin, called Sarcoptes scabiei. The disease spreads as thin tunnels of blisters that spread across the body. It is more likely to appear in areas of deprivation. Where it is endemic it can lead to renal and heart disease. Experts are still looking into why cases are rising. In September, the British Association of Dermatologists urged manufacturers to increase production of Permethrin, the first-line treatment, because low stocks had contributed to a ‘’major public health issue’’. The Times spoke to dermatologists who said shortages seemed to have eased but cases were still rising, which suggests other factors are at play. European researchers are assessing whether drug resistance could be a factor or whether ‘’pseudo resistance’’ caused by patients who struggle to treat themselves properly, is to blame. Permethrin cream is difficult to use because patients have to cover their entire body for 24 hours. There are other drugs that can be used, with Ivermectin considered one of the best.

Scientists have discovered a protein that plays a key role in stopping ‘’zombie’’ cells from forming in our bodies, paving the way for treatments to slow down ageing and stave off disease. As we age, a process called cellular senescence causes some cells to live longer than they should. Instead of dying and being cleared away, they linger and can increase the risk of cancer, Alzheimer’s and other diseases. A study has identified a protein called HKDCI that plays a central role in keeping two of the key organs within cells, the organelles, tidy. The protein helps to clear damaged mitochondria, which act like tiny batteries to produce energy within cells, in a process called mitophagy, helping to keep the cells healthy. A release from the journal Proceedings of the National Academy of Sciences said that the HKDCI protein effectively ‘’helps to take out the mitochondrial trash’’. The protein also helps to repair damage to lysosomes, an organelle that helps to break down and clear away worn-out cell parts.

Every hour that teenagers spend in front of a screen during the day leads to an extra 10 minutes spent trying to get to sleep, a study has found. Teenagers’ sleep is more disrupted by interactive screen use than by watching television, research suggests. The effect of screen time on sleep has been documented previously, with experts recommending that devices are not used in the hours before bed. Now academics suggest that the type of screen also matters. Interactive engagement such as texting friends or playing video games, delays sleep more than simply watching a screen. The research, conducted by a team at Pennsylvania State University and published in the Journal of Adolescent Health, analysed the screen use and sleep patterns of 15-year-olds. They said adolescents who used screens to communicate with friends or play video games in the hour before bed took 30 minutes longer to fall asleep. Such online activity also had an effect if it took place earlier, but was not as pronounced. Each hour spent playing video games on top of their usual amount, for example if a new game had come out, led to delay in sleep that night of roughly ten minutes. The team assessed the daytime screen-based activities of 475 adolescents using daily surveys. David Reichenberger, lead author on the study, said: ‘’Without adequate sleep, kids are at increased risk of obesity, as well as impaired cognition, emotion regulation and mental health.’’

The Times

Jobcentres and bosses will refer people to therapy or running and gardening clubs to keep them well enough to work in an attempt to tackle long-term sickness in the benefit system. In the first steps towards the creation of a national occupational health service, pilot schemes will begin in the new year to ‘’swoop in’’ on the sick and focus their treatment on staying in work. Work coaches, physiotherapy and mental health treatment will be offered to people in danger of falling out of the workforce, as well as debt advice, therapeutic recreation and workplace adjustments. Mel Stride, the work and pensions secretary, has expressed frustration that the NHS is not doing enough to deal with record levels of sickness absence and wants his department to be involved in treatment plans. Reforms making it easier for doctors to refer people to occupational health schemes will be tested to reduce the number that GPs sign off from work. In an article for The Times, Stride and Victoria Atkins, the health secretary, say the government “is on a mission to get people back to work” as they set out plans to scale up occupational health services. A record 2.6 million people are off work because of long-term sickness, adding billions to the welfare bill. Stability benefits are projected to rise by 75% to £93 billion a year by the end of the decade. Rishi Sunak has promised to tackle the ‘’national scandal’’ of the growing number of those too ill to work, with reforms designed to force more people to look for work and a ‘’Universal Support’’ service offering intensive personal coaching to help people get jobs. Key elements of the plan, however, will not take effect until 2025. Since Sunak became Prime Minister, the number of people on benefits with no requirement to look for work has risen by about half a million. There are now 2.2 million people claiming Universal Credit with no work requirements, representing 36% of total claimants, up from 24% four years ago.

Ministers have been urged to scrap plans to dispose of a £1 billion megalab built during the pandemic to respond to future disease outbreaks but is now up for sale. The Commons science, innovation and technology committee suggests in a report that the Rosalind Franklin Laboratory in Leamington Spa, Warwickshire, should be kept in public ownership. It wants the facility to be used to develop ‘’phage therapies’’ – treatments that many scientists believe could potentially replace antibiotics and reduce the threat of drug-resistant superbugs. The laboratory opened in June 2021 and was used to process COVID tests. At the time, it was described by the government as a ‘’state-of-the-art facility’’ that marked ‘’an investment in our scientific capabilities for the future’’. Potential buyers would include biotech companies. However, the asking price has not been disclosed and MPs on the science committee believe any sale will fall short of recouping the estimated 1.1 billion pounds investment in the site. The science committee wants it to become a government-backed production plant for bacteriophages, a type of virus that can destroy bacteria responsible for many infections. Phages have been used for decades to treat conditions ranging from eye and urinary infections to neonatal sepsis and to heal surgical wounds. Interest in using them has grown alongside concerns that widespread use of antibiotics is increasing the resistance of bugs to even the most effective conventional drugs.

Relatives of people who chose to end their lives at Dignitas have described their delight at Dame Esther Rantzen ‘s announcement that she has enrolled at the Swiss clinic. They believe the broadcaster’s wish to arrange her own death rather than wait to die from stage-four lung cancer could open the door to MPs voting to legalise assisted dying. Two relatives who spoke to The Times said that although Dignitas would provide a dignified end for their mother and husband, the threat of prosecution had blighted their final weeks together. Dignity in Dying, which lobbies for assisted dying to be allowed in Britain, said that 531 British people have died at Dignitas since 2002 and estimated that an additional 101 have ended their lives at smaller Swiss clinics. Tom Beagly-Spicer, 39, accompanied his mother, Susan Spicer to Dignitas when she was 57 after she decided that she could not face multiple sclerosis and the return of her breast cancer. The part they resented was the need to lie. Whenever they needed documents, they had to disguise that it was for a Dignitas application, Beagly-Spicer said Rantzen’s endorsement could give MPs the final push they needed. He has already worked with Dame Prue Leith, who became patron of Dignity in Dying because of her brother’s agony with bone cancer before his death in 2012. Ann Whaley, 81, travelled to Dignitas with her husband Geoff in 2019 after his body was wasted by motor neuron disease. Their decision not to lie led to her being interrogated by police. The intervention meant an additional £12,000 in legal costs on top of £11,000 paid to Dignitas and a further £3000 for expenses. She stressed that Dignitas doctors were thorough in obtaining proof that relatives were terminally ill and were not being pressured to die. Whaley added that Rantzen’s support would be ‘’enormously useful’’. ‘’I worked at the BBC when Esther was doing her campaigns. She’s a well-known name and that makes an enormous difference,’’ she said.

Five million children have missed out on seeing an NHS dentist in the past year as the worsening crisis puts thousands of youngsters in hospital. Only one in seven children received their recommended annual checkup in some parts of the country, an investigation by The Times into the collapse of NHS dentistry has revealed. The majority of High Street dentists have now shut their doors to new adult and child NHS patients making it impossible for millions to get an appointment. Dental leaders said they were particularly concerned about the long-term impact on children, some of whom are having to miss school in pain. More than 26,000 were admitted to hospital last year to have teeth pulled out under general anaesthetic due to ‘’wholly preventable’’ decay. In England, 52% of children have seen an NHS dentist in the past year. Only 40% of adults have seen an NHS dentist in the past two years. Analysis of data from the 338 local authorities shows stark regional disparities. Parts of Lincolnshire, Devon and Norfolk are now ‘’dental deserts’’ with almost no NHS access, leaving some patients with no option but to go to A&E with agonising toothache or to try pulling out their own teeth.

The little blue pill could be replaced by a V-shaped gadget used at home to treat erectile dysfunction using radiofrequency technology. The new device, called Vertica, improved matters for 85% of participants in a clinical study and helped 50% reach normal levels of performance. It uses radiofrequency energy to gently warm the inner tissues of the penis, triggering a collagen remodelling process that can improve how blood flows to and from the organ. The Vertica device, which costs £1,500, is designed to restore collagen fibres in the penis, a problem potentially affecting around 40% of men globally. It resembles a V-shaped games console controller, with handles on each side and a hole in the centre where the user inserts their penis. It is used at home, with three 30-minute treatments per week for the first month and then two a week for another month. The early trial, published in the peer-reviewed International Journal of Impotence Research, involved 28 men receiving 12 treatments with the device. Daniel Lischinsky, founder of OhhMed Medical, the manufacturer of the device, said: ‘’Vertica is a safe and easy-to-use, non-invasive medical device, designed to improve erectile dysfunction in the long term. It is not a medication; no prescription is required and there are no side-effects. Vertica is safe and is driven by scientific data.’’

The next generation of weight-loss pills will contain no drugs but will vibrate in your stomach to trigger a feeling of fullness, scientists believe. The pills work by stimulating the stomach’s ‘’stretch’’ receptors, making the body believe it is full of food, according to researchers from the Massachusetts Institute of Technology and Harvard Medical school. Scientists found that the pills could reduce food intake by 40% after testing them in pigs. They chose the animals because their digestive system, with a single stomach, is similar in size and arrangement to that of humans. The study found that the pill passed through the pigs’ digestive system safely after about four days. The researchers chose a vibration frequency of 80 Hz, finding that a higher frequency would have been audible to human ears and created a buzzing sound from the stomach. They designed the pill with ridges, dots and spirals to increase its ability to stimulate the stomach lining.

If you’re considering changes to your diet as part of a ‘’new you’’ this New Year, be careful where you seek advice. Dieticians have warned that a host of potentially harmful eating patterns that are promoted on social media could lead to medical problems and eating disorders. The British Dietetic Association (BDA) said that people this year have been asked by its members about eating trends such as carbohydrate avoidance, weight-loss gummies, a ‘’raw cleansing diet’’ and products aimed at those going through the menopause. Other queries made to members of the professional organisation concerned the ‘’carnivore diet’’, which has been followed by the psychologist Jordan Peterson, as well as pureeing food, juice diets, cider vinegar for weight loss, and the fruit, egg and water fasting diet. Caroline Bovey, the chairwoman of the BDA, said: ‘’Most of us wouldn’t take a drug to deal with a medical condition without seeking medical advice or being confident that it had been properly tested. And yet, some of us are persuaded to completely change what we eat, often overnight, based on something someone with very little, if any, nutritional expertise says worked for them. Positive, healthy messages around food can often get lost at this time of year in favour of quick fixes.’’ The BDA said that having thousands or millions of followers on social media was ‘’not a reflection on knowledge or expertise, especially where nutrition is concerned.’’

Young people are the biggest consumers of low and no-alcohol drinks, with almost half of 18- to 24-year-olds now occasionally or regularly choosing them, a survey has suggested. 44% of the youngest group of drinkers now consider themselves occasional or regular drinkers of alternatives to alcohol, up from 31% in 2022, according to a study by the Portman Group, an industry body. The research also suggested that the younger generation was now the most sober age group overall, with 39% of them not drinking alcohol at all. Those who had cut their alcohol consumption as a result of low and no-alcohol products had increased to 23% compared with 21% in 2022, and 35% now considered themselves an occasional or regular drinker of alcohol alternatives, up from 29% in 2022. 75% of UK drinkers had at least tried a low or no-alcohol alternative, compared with 33% of non-drinkers, the survey found. For the sixth year in a row, the most popular reasons to drink alternatives were to avoid drinking excessively at social events and being able to drive. Consumers most often drank the products in alternation with alcohol, or on drink-free days, while 83% first tried an alcohol alternative through a product that shared branding with an alcoholic product. YouGov surveyed 2,197 UK adults online between November 16 and 17.

A medicine to prevent serious respiratory disease developed by AstraZeneca has been approved in China, an increasingly important market for Britain’s biggest pharmaceuticals group. Beyfortus, a long-acting monoclonal antibody, has been authorised by Beijing for the prevention of lower respiratory tract infection caused by respiratory syncytial virus (RSV) in infants. The medicine, a partnership between the Anglo-Swedish company and Sanofi of France, was previously approved in the European Union in October 2022 and by the US Food and Drug Administration last July. RSV, a common and highly contagious seasonal virus, is the main cause of lower respiratory tract infection in infants, including bronchiolitis and pneumonia. AstraZeneca has been investing in the RSV market, having last month agreed to acquire Icosavax, a Nasdaq-quoted company that owns a vaccine in late-stage development for older adults, in a deal worth up to $1.1 billion. China has become a major market for the FTSE 100 company under SIr Pascal Soriot, its chief executive since 2012, becoming the largest multinational drug group in the country.