What the papers say – weekly digest (03/05/24)

Your weekly digest of the top healthcare stories, covering news published from 29/04/2024 – 03/05/2024.

The Guardian

People with type 1 diabetes are being forced to endure the ‘’stress and anxiety’’ of insulin shortages, patients, pharmacists and health campaigners have warned. The drugs scarcity, the latest to affect the UK, is sowing uncertainty for the 400,000 people with the condition, with some products not available again until 2025 amid global manufacturing and supply problems. Britain is already contending with record numbers of medicines becoming hard or impossible to obtain, including those for attention deficit hyperactivity disorder and epilepsy. The Juvenile Diabetes Research Foundation (JDRF) said a ‘’regular and reliable supply of insulin is essential for life’’ for people with type 1 diabetes. That is because their disease – an autoimmune condition unrelated to type 2 diabetes – means they cannot make insulin naturally and must inject it every day or get it through a pump. ‘’People with type 1 diabetes must regulate their own insulin injections and dose, so it’s imperative that they have confidence in the supply of their regular type of insulin,’’ said Hilary Nathan, the JDRF’s director of policy. ‘’The news of any shortages could cause significant anxiety.’’ The Department of Health and Social Care (DHSC) confirmed there were ‘’supply issues with a limited number of insulin products’’ that patients might find ‘’distressing’’. One patient said ‘’I spent the last two days trying to get hold of insulin to treat my type 1 diabetes. I was terrified when my usual, very reliable pharmacist told me he couldn’t get hold of my insulin. I had no idea that insulin could go out of stock. Type 1 diabetics fall ill and will die within a few days without insulin. I’m worried for fellow diabetics, not only to access the supply to stay alive but the stress and anxiety this causes.’’ She had to ring a large number of pharmacies in her town before eventually finding one that still had stocks of vials of Humalog, her usual form of insulin, and getting a fresh supply. Eli Lilly, the US firm that makes Humalog, said last month that it and another form of the drug were temporarily out of stock. Nathan said any shortage of vials ‘’is of particular concern as people who use pumps to deliver their insulin rely on these forms of the drug’’. Having to switch instead to an insulin pen, because vials are unavailable, ‘’could be enormously disruptive and distressing to (a patient’s) everyday life.’’ Two other insulin formulations – Flasp FlexTouch pre-filled injecting pens and Tresiba FlexTouch pens – are also in short supply. Neither is expected to become available again until early next year. Two other forms of insulin have been discontinued. In a report published earlier this month, the Nuffield Trust warned that drug shortages were a ‘’new normal’’ in Britain and that Brexit was worsening the situation. The NHS has sought to reassure people with type 1 diabetes that they can use other formulations when their usual product is unavailable. But a small number have encountered difficulties as a result of being given ‘’inappropriate dosing’’ advice when they switched. They included one who was hospitalised with ketoacidosis – a potentially life-threatening side-effect of type 1 diabetes – according to a national patient safety alert issued in December. ‘’The impact of medicine shortages on patients and our community pharmacies continues to be a deep concern. It is a battle to keep up with the large number of medicine supply issues’’, said Mike Dent, the director of pharmacy funding at Community Pharmacy England.

People aged over 70 and those with long-term health conditions would have access to the same named GP for every appointment under plans announced by the LIberal Democrats, as polling reveals that almost half of Britons rarely or never see the same family doctor. The Lib Dems’ leader, Ed Davey, said the policy would require 8,000 more GPs and take at least four years to implement at an extra £1bn a year, with the money coming from taxing big banks. Older people and those with long-term conditions, including mental health conditions, had been found to benefit the most from access to the same GP, the Lib Dems said. They pointed to a study that found people who had kept the same GP for more than 15 years had a 25% lower chance of dying within a year than those with a new GP. Polling commissioned by the party found almost half (47%) of UK adults who had seen a GP more than once in the past couple years said they rarely or never saw the same doctor for each appointment, with almost one in five (18%) saying that they never did. This latter number rose to 27% among people aged over 65. Davey said: ‘’It is a scandal that under this government’s watch the family GP has become a thing of the past. Pensioners are not receiving the care they need because doctor surgeries are swamped, leaving waiting times spiralling out of control. We need a return to the family GP, starting with older people and those with long-term health conditions. We want to see the return of the named GP, so patients with complex needs see the same GP and don’t have to waste time going over the same details every time they see a doctor. This would provide vital personalised care for those who need it most, helping people lead healthier lives, independently in their own homes wherever possible.’’ The region with the highest incidence of people never seeing the same GP for every appointment was the south-east of England (25%). The polling also found almost half (46%) of adults said the wait to see the same GP was now considerably longer, with the figure rising to 55% for over-65s. Davey told BBC’s Sunday with Laura Kuenssberg programme: ‘’All the evidence shows (having a named GP) improves their health outcomes. It actually saves the NHS money because people don’t go into hospital so often.’’ Asked how it would be funded, he replied: ‘’We have said that the tax cuts that the Conservatives have given to the big banks since 2015, they should be reversed. That’s worth £4bn a year, not just to pay for this part of our policy but for many other parts of our healthcare policy.’’

The number of young people receiving their MMR jab is up nearly a quarter from last year, official figures show. A national campaign to boost uptake was launched in January amid concern over measles rates in England, when the UK Health Security Agency (UKHSA) declared a national incident after a major outbreak in the West Midlands. The latest NHS England data shows more than 360,000 MMR jabs were administered in the 12 weeks to 24 March 2024, a 23% rise. The biggest rise in vaccination numbers were in London and the West Midlands. The first dose of the measles, mumps and rubella vaccine is typically given to one-year-olds, with the second coming between the ages of three and a half and five. Measles is highly infectious and can lead to serious illness, lifelong disability or even death. In pregnant women, it can cause stillbirth, miscarriage and low birth weight. The new campaign encourages parents and carers of children aged from six to 11 to make an appointment with their child’s GP practice so they can receive missed MMR vaccinations, and just over 1 million people aged 11 to 25 in London and the West Midlands have also been encouraged to catch up on missed jabs. In order to keep measles at bay, more than 95% of children should be vaccinated, but NHS figures from December suggest England is only at about 85%. With an estimated 3.4 million under-16s at risk of getting the virus, the campaign sent more than a million parents letters and emails inviting them to get their child vaccinated. Pop-up MMR clinics have been held in wellbeing buses, at libraries, schools and pharmacies, and outside supermarkets. But measles cases continue to rise. According to UKHSA figures released last week, there were 103 new cases in the past week. The number of laboratory-confirmed cases since 1 October 2023 rose to 1,212, up from March’s figure of 868. In October 2023, there were just 17. Nearly two-thirds (64%) of the cases were in children under 10. Steve Russell, NHS national director for vaccinations and screening, welcomed the encouraging vaccination figures, but urged those yet to have their MMR jab to come forward: ‘’Measles is a very serious illness and, with data showing cases are still being reported around the country, it is vital that everyone who is still unprotected comes forward.’’

Transgender people will be treated in single rooms in hospitals in England under new government plans to update the NHS constitution. The proposal follows a pledge last year by the then health secretary Steve Barclay to prevent people who have changed their gender identity from being treated on male- or female-only wards. The new plan is included in proposed changes to the NHS constitution, which sets out what rights patients have in terms of the care they can expect to receive from the NHS. Hospital managers responded by accusing ministers of ignoring much more pressing issues, such as long waits for care. The proposals also include a reaffirmation of patients’ existing rights to ask to receive ‘’intimate care’’ – such as an examination of their breasts, genitalia or rectum – only from staff of the same sex as them and to stay on a single-sex ward. The Department of Health and Social Care said the aim was to enhance the privacy, dignity and safety of all patients, including transgender people. But Matthew Taylor, the chief executive of the NHS Confederation, which represents hospital trusts, told ministers it was important that ‘’the NHS is not dragged into a pre-election culture wars debate’’. The debate around changing the constitution ‘’should not be about grabbing headlines’’, he said. Ministers would be better bringing forward plans to improve NHS funding, improve the state of health facilities and get waiting time for A&E care and planned surgery back to the levels that existed when the constitution was first published in 2012, he said. Dr Emma Runswick, the deputy leader of the British Medical Association, also criticised the plans for how the NHS should manage hospital inpatients who are transgender. ‘’Some of the proposed changes to the NHS constitution run the risk of causing more harm than good, with the potential to incite further discrimination, harassment and ostracisation of an already marginalised group,’’ she said. ‘’If these proposed changes come into effect, transgender and non-binary patients will potentially find their access to vital NHS services limited.’’ Taylor described the proposed guidance as ‘’ambiguous’. It does not explicitly tell hospitals they should routinely put a transgender person in a single room. But it appears to presume that this will generally happen. Wes Streeting, the shadow health secretary, highlighted that NHS figures show that ‘’the use of mixed-sex wards has exploded under the Tories’’.

The Telegraph

The chairman of the Covid Inquiry has been urged to ‘’do the right thing’’ and assess the impact the pandemic had on the mental health of the general public as a priority. Mind, a leading mental health charity, has accused Baroness Hallett of ignoring reality by deciding to exclude the issue from hearings later this year. In a ruling published earlier in April, Lady Hallett rejected pleas from Mind and other charities to include adult mental health and well-being in its investigation into healthcare systems at hearings starting in September. The inquiry’s third module will include children’s and young people’s mental health services as well as the well-being of those working within the NHS and other parts of the healthcare system, but not the impact on the general public. Numerous studies have shown the harm caused to mental health, with previous research by Mind finding that about a third of adults and young people said their symptoms had become much worse since March 2020. The charity found one in five adults did not seek support because they did not believe their problem was serious enough. Mind had argued at a preliminary hearing earlier this month that Lady Hallett should consider the wider impact on adult mental health and support services during hearings in the autumn. The decision not to include it later this month means the issue may not be examined properly until 2025.  Lady Hallett’s decision comes after almost 30 organisations warned that she risked letting down millions of people if the inquiry did not adequately consider the impact Covid, and its multiple lockdowns, had on the public’s mental health. Those who followed the pandemic restrictions most closely are the most likely to be suffering from stress, anxiety and depression, according to a study by Bangor University published last year. Children were also affected, with one in nine reported to have some form of disability, following a post-pandemic surge in mental health conditions and behavioural disorders.

Victims who were given the Oxford-AstraZeneca vaccine have accused the Health Secretary of snubbing them over their pleas for a better compensation deal. Victoria Atkins has told those injured after receiving the vaccine and grieving relatives of those who died that she did not have time to meet them because of her ‘’already hectic parliamentary and diary commitments’’. AstraZeneca, the pharmaceutical giant, is being sued in a class action by 51 alleged victims of the vaccine, developed in conjunction with the University of Oxford and rolled out in 2021. For the first time it has accepted in court documents that the vaccine ‘’can, in very rare cases, cause’’ blood clots and low blood platelet counts that can be fatal. As part of the vaccine rollout, the Government agreed to underwrite any legal fees and damages in the event the pharmaceutical firms faced legal action caused by adverse reactions. It also runs a Vaccine Damage Payment Scheme but victims argue that its one-off payment of £120,000 is inadequate and has been frozen at that level since 2007. Official figures suggest at least 81 people died and hundreds more were left injured from the side effect called thrombosis with thrombocytopenia syndrome or vaccine-induced immune thrombocytopenia and thrombosis. AstraZeneca said: ‘’Our sympathy goes out to anyone who has lost loved ones or reported health problems. Patient safety is our highest priority and regulatory authorities have clear and stringent standards to ensure the safe use of all medicines’’.

A healthy lifestyle could add five years to the lives of people who are genetically predisposed to die young, a study has found. Experts analysed more than 350,000 people in the UK and found that healthy habits such as regular exercise, not smoking and eating well could help off-set the negative impact of genetics on life expectancy. The researchers said that 20 per cent of the Britons studied had a high genetic risk of a premature death, defined as before the age of 75, but they could add five years and three months to their life with healthy interventions. About 60 per cent of participants had genetics likely to give them an ‘’intermediate’’ life expectancy, while the remaining 20 per cent had genes linked to a longer than average lifespan. Life expectancy in the UK has stalled in the past decade and is now lower than it was pre-pandemic at about 78 and a half years for men and 82 and a half years for women. Those with genes predisposing them to a shorter lifespan were 21 per cent more likely to die before the age of 75 than those predisposed to a longer lifespan, the experts found. The researchers also split the 353,742 participants from the UK Biobank into three groups depending on how healthy their lifestyles were: 23.1 per cent had favourable lifestyles, 55.6 per cent were considered intermediate and 21.3 per cent  had unfavourable lifestyles. Over 13 years, about 25,000 people died and the scientists used polygenic risk scores to determine a person’s overall genetic predisposition to a longer or shorter life. The scientists also scored them on the lifestyle across key areas including smoking, alcohol use, exercise, diet, sleep and body shape. They concluded the genetic risk of a shorter lifespan or premature death could be offset by about 62 per cent if these people followed a healthy lifestyle by ‘’never smoking, regular physical activity, adequate sleep and healthy diet’’. The researchers from the Zhejiang University School of Medicine and the University of Edinburgh published findings in the BMJ Evidence Based Medicine Journal.

Gender-neutral lavatories carry the most germs, research suggests. The UK study examined the bacteria – including multi-drug resistant superbugs – in a wealth of hospital settings. Lavatories for women were found to carry far fewer microbes than those for men. When staff facilities were compared, door handles for men were around eight times as dirty as those for women. However, unisex lavatories were the worst of all, researchers found, in the study presented at the ESCMID Global Congress in Barcelona, Spain, held on April 27 to 30. Scientists said the findings about gender-neutral lavatories, which also included disabled facilities, might reflect heavier overall use, on top of different attitudes to cleanliness between men and women. The study examined three general hospitals in Lanarkshire, Scotland.

Men on a popular hair-loss drug have been warned of its potential serious sexual and psychiatric side effects by the drug regulator. The Medicines and Healthcare products Regulatory Agency (MHRA) said men should be aware that finasteride has been linked in depression, suicidal behaviour and sexual dysfunction that in some cases continued beyond the treatment. It has also ordered suppliers of finasteride to include a patient alert card in packs to raise awareness. Finasteride is used to treat benign enlarged prostate and male pattern baldness but is only available on the NHS for the former.

The Times

Millions on disability benefits face the biggest welfare reforms ‘’in a generation’’ that could mean those with depression and anxiety lose payments. Sickness benefits should cease for ‘’many, many people’’ with the condition, ministers will argue. Instead they will propose ‘’meaningful support’’, such as talking therapies and social care packages. Mel Stride, the work and pensions secretary, said the system should not be paying people to deal with the ordinary difficulties of life, as he prepared to publish plans that would overhaul benefits. They are likely to stop regular payments for a swathe of mental health problems and other conditions. Welfare reform will be a key dividing line in the general election. Stride said it was ‘’extraordinary’’ that Labour leaders were refusing to say whether they supported his changes, and argued that many voters ‘’deep down’’ agreed with him. ‘’Here I am, bringing forward probably the most fundamental reforms in a generation and Labour have had really nothing to say about whether they fundamentally support or oppose them,’’ he said. Referring to the Beveridge Report that laid the foundations for the welfare state in the 1940s, Stride called for a ‘’Beveridge reset moment’’ and said that the over-labelling of everyday worries was ‘’definitely a factor’’ in the increase in long-term sickness to a record 2.8 million people. He said tax-payers would not accept the ‘’huge amounts of money’’ needed to pay for a projected two million rise in the numbers receiving disability benefits before the end of the decade. ‘’There are those that have perhaps milder mental health conditions, or where perhaps there have been too great a move towards labelling certain behaviours as having certain (medical) conditions attached to them, where actually work is the answer or part of the answer, ‘’ Stride told The Times. ‘’What we’ve got to avoid is being in a situation where we too readily say, ‘well, actually, we need you to be on benefits’’’. This month (April) the prime minister said that he was on a ‘’moral mission’’ to reform welfare as he warned that too many people were being ‘’parked’’ on benefits leading to ‘’unsustainable’’ rises in cost, with the £50 billion bill for working-age sickness benefits due to rise by another £20 billion before the end of the decade. Today (Monday) Stride will publish a green paper centering on the main disability benefit, personal independence payments (PIP), which are paid to 3.5 million people irrespective of whether they can work. Saying that he had ‘’concerns about how well targeted PIP is’’, he said that people did not necessarily need ‘’ongoing payments of thousands of pounds a year’’ for their conditions. Some with mobility problems might only need ‘’some small number of inexpensive adaptations,’’ Stride suggested. The biggest change being proposed is for those with mental health difficulties. Stride said it could be ‘’where you have mild depression or anxiety, that the best thing to do is not so much a cash transfer, but actually some kind of meaningful support that helps get that person into a position where they’re having a much better life , where work is at the centre of their life’’, he said. He suggested that talking therapies, social care packages, respite care and a ‘’whole plethora of things’’ could be alternatives. Stride said it was an ‘’open question’’ as to whether people with conditions such as ADHD or learning disabilities should also be paid disability benefits given ‘’they come in all sorts of different forms of scales of severity’’. Critics have questioned where this support will come from at a time when there are 1.9 million on NHS mental health waiting lists, but Stride insisted that offering more help was a ‘’key area of focus for the government’’. There are 360,000 people claiming PIP for anxiety and depression, double the figure five years ago. Stride said ‘’the growth in milder mental health conditions and that leading to people not working is an issue’’. But as part of efforts to make the system ‘’better targeted’’, he said there were degenerative or permanent conditions ranging from Parkinson’s to Down’s syndrome where ‘’it’s absolutely clear that PIP should be provided’’. He said: ‘’There are perhaps some people that need more support than the current system is giving them. But equally there are many, many people for whom support could potentially come in a different form’’. Stride insisted that the ‘’fundamental impetus’’ for the changes was to provide better help, rather than cost cutting. But he acknowledged that the cost ‘’has to be one of the considerations’’. He said: ‘’It’s difficult to describe as sustainable when we’re looking at a 63 per cent increase in PIP spend, about £13 billion, over the next few years. These are huge amounts of money’.

Women are 40 per cent more likely to suffer from depression while they are going through the menopause, research has revealed. The University College London study found that rates of depression increase significantly in the three to five years before a woman’s periods stop, which typically occurs between the ages of 49 and 52. This extra risk disappears once women have been through the menopause, defined as when they have had their final period. Levels of two hormones, oestrogen and progesterone, begin to fluctuate several years before this in a phase known as perimenopause, associated with the main ‘’menopausal’’ symptoms including mood changes, hot flushes and irregular menstrual cycles. The new study looked at data from 9,141 women worldwide, examining how their risk of a diagnosis of depression changed according to different stages of the menopause. It concluded that perimenopausal women – who have symptoms of the menopause but whose periods have not stopped – were at 40 per cent higher risk of depression compared with women who had not yet begun menopause. The heightened risk of depression fell once women were postmenopausal, defined as when they had not had a period for more than a year. These women were at no greater risk of depression than younger women who had not yet begun the menopause. The study, published in the Journal of Affective Disorders, comes amid controversy over whether or not the menopause has been ‘’overmedicalised’’. Last month, a major study in The Lancet argued that there is ‘’no compelling evidence’’ to support the widely held view that menopause increases the risk of mental health conditions – which it said may reflect stressful life events affecting middle-aged women.

Young people with cancer struggle to get on clinical trials that could improve their chances of survival, the Teenage Cancer Trust says. It says there are fewer trials for patients aged between 13 and 24 who are more likely to have rare cancers. Verity Baker, 23, from Bristol, was diagnosed with a rare, incurable cancer, DSRCT sarcoma, when she was 17. She spent two years on a clinical trial at Royal Marsden Hospital, in Sutton, Surrey, and said that ‘’for that period my cancer didn’t spread’’. Even though her condition has since deteriorated she said: ‘’I have met other young people who haven’t had the chance to take part in a trial, which I think is unfair’’. The charity wants the government to implement recommendations from a review of commercial trials ‘’in a way that accounts for the unique needs of teenagers and young adults with cancer’’.

Children’s vaccines in the form of a patch could soon be sent in the post after a trial found that they were on a par with those traditionally delivered by injection. The landmark trial found that the patches, which are similar to sticking plasters and allow vaccines painlessly to permeate the skin, were as effective as conventional jabs against measles and rubella. Known as microarray patches, they deliver the vaccine using microscopic projections that penetrate the top layer of skin. Unlike traditional vaccines, the patches do not need to be refrigerated and need minimal training to apply. The trial in the Gambia involved 45 adults, 120 babies and 120 toddlers. The research, published in The Lancet, found that the patch produced a strong immune response, comparable to that of a needle injection. More than nine in ten infants were protected from measles and all were protected from rubella after a single dose. The trial was led by researchers from the Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine. The patch was developed by Micron Biomedical, which sponsored the trial. Funding came from the Bill and Melinda Gates Foundation.

It is a common complaint that the air conditioning in offices and public places is set with men in mind, leaving women shivering as they feel the cold more. Scientists have found, however, that women are not more susceptible than men to feeling cold, claiming there is ‘’no sex difference’’ in how temperature is perceived. Researchers from the National Institutes of Health in Maryland, in the United States, exposed 16 women and 12 men to temperatures between 17C and 31C for four hours, asking them how to report how comfortable they found the conditions and measuring how much they shivered as the temperature fell below the standard room temperature of about 22C. They reported: ‘’No sex difference was detected in shivering or reported thermal comfort’’. The study also measured the temperature at which shivering began and at which the body started to boost its metabolic rate to keep warm, and found ‘’no differences were detected in the coldest tolerable temperature…between women and men’’. The study, published in the journal Proceedings of the National Academy of Sciences, found that women seemed better able to tolerate cold because their body’s emergency heat-generation mechanism activated at a lower temperature than that of men. It suggested susceptibility to the cold is more closely linked to factors such as body fat and body shape, and encouraged further studies.

Collagen creams, detox teas and vitamin shots may be among the latest wellness trends on social media but it turns out they are mostly an expensive waste of money, according to Which?. The consumer group examined the ingredients, price and health claims made by six categories of product or supplement. It consulted experts and gave a verdict. Which? concluded that in many cases there is not robust evidence to justify the price or that people can just as easily get the same benefits elsewhere for less. Social media marketing has given a huge boost to the wellness industry in recent years, and the average person spends £487 a year on fitness, cosmetics and nutrition products, according to GlobalData, a research firm. The research said, for example, that vitamin shots usually cost £2 or more for just 60ml, the same price per litre as Moet & Chandon champagne, but the main ingredient is ‘’typically fruit juice’’. It said the shots, which claim to boost the immune system, are not necessary for people who eat a healthy, balanced diet and that the vitamins they contain, such as C and D, and zinc, could be cheaper elsewhere. It was even more dismissive of detox teas, stating that ‘’no herbal tea can detox your body’’. The research said: ‘’The wellness industry would have us believe that we all need to detox our bodies but this isn’t true. Our liver, kidneys and digestive systems do that for us already.’’ The study was also dismissive of ‘’targeted pain killers’’ saying that when you pay a premium for these products, such as Neurofen migraine relief, you are essentially ‘’paying for the packaging’’. It quoted Dr Andrew Moore, a pain specialist and former Oxford research fellow, who said that ‘’it’s impossible to formulate (tablets) for headache or joint pain or period pain’’. Moore said that it could be worth paying extra for ibuprofen lysine, which he says is a more effective formulation of the drug. Neurofen did not respond to the request to comment. Which? also looked at functional mushrooms which refers to mushrooms that are used as a form of alternative medicine, believed to have properties beyond their nutritional make-up that can be beneficial to health. It said that ‘’it’s hard to miss mushroom mania’’ but that while they do have potential benefits, there is not enough evidence to suggest they work and most products are not authorised to make health claims in the UK. It said: ‘’Brands are allowed to make some claims about reishi mushrooms, as this ingredient is currently under review (meaning the evidence for the claims are being assessed). But packaging claims for other types of mushroom are often based on different common proven ingredients, such as omega-3, and vitamins B12 and D, rather than the mushrooms themselves’’. Which? also looked at collagen creams and supplements, noting that while some studies support their effectiveness for healthy bones, joints and skin, the benefits are unproven by large-scale independent studies. It also said that when applied topically, collagen molecules are too big to penetrate the outer layer of skin and even when broken down into peptides ‘’it’s unlikely they can reach deep layers of skin to effect long-lasting change’’. The research said that the creams often include other ingredients, such as glycerin for hydration and retinol for rejuvenation, which may explain any visible cosmetic improvement. Which? also said that hair-loss shampoos were unlikely to work for most people. Natalie Hitchins, the head of home products and services at Which?, said: ‘’Our latest research has exposed unproven claims on some popular ‘health’ products and found consumers can end up paying a premium for health benefits that are either questionable or could be found more cheaply elsewhere. If you are thinking of buying a trending health product, don’t assume that expensive prices and slick advertising necessarily result in better quality products, and do your research as branded versions can cost considerably more than own-label ones – despite containing the same active ingredient. Also, be cautious of the cherry-picked positive reviews that some brands may use in their marketing’’. Which? will publish its findings in full next week.