What the papers say – weekly digest (01/03/24)

Your weekly digest of the top healthcare stories, covering news published from 26/02/2024 – 01/03/2024.

Daily Express

Poor mental health can harm chances of a good education and can lead to people being out of work or in low paying roles, research shows. A study by Resolution Foundation found that 79% of people aged 18-24 who are out of work due to their mental health are only qualified to GCSE level or below. This compares with 34% of all in that age group. Those aged 11-14 who are struggling are three times more likely to not pass five GCSEs, including maths and English. And young people are more likely to be out of work due to poor mental health than those aged in their 40s. In 2021-22, 34% of people aged 18-24 reported symptoms of mental disorders, while in 2000, it stood at 24%. The study concluded that efforts to tackle Britain’s epidemic of poor mental health should focus on lower-qualified young people. The Foundation’s Louise Murphy said better support will mean ‘’everyone has qualifications to build on’’. Jo Bibby, of the Health Foundation which funded the research, said without concerted cross-government action, we ‘’risk creating a ‘lost generation’ due to ill health’’.

A new method of squeezing apples to produce juice may boost health benefits, scientists claim. The method results in four times as many polyphenols – antioxidants found in fruit, red wine and cocoa. They are thought to have health advantages for the heart and brain, and may protect against disease. Experts said you can maximise these compounds in the juice by using a vacuum-driven spiral filter press, which takes out oxygen. Study co-researcher Stefan Dussling, from Geisenheim University in Germany, said: ‘’Nutrient losses are commonly due to the presence of oxygen, which quickly degrades some of the nutrients in apple juice. ‘’We hope the new juicing method will be used more widely to help people get more of these beneficial natural compounds.’’

Parkinson’s sufferers are struggling to afford the basics as the benefits system  is failing them, a charity has claimed. Many patients are ‘’poorer than they should be’’ amid the cost-of-living crisis, Parkinson’s UK said. The group’s latest report is backed by former BBC presenter Mark Mardell, who has spoken about living with the condition. He said that it is ‘’shameful that due to the broken benefits system, people with Parkinson’s who are eligible for support are being denied the help they so badly need’’. Mr Mardell, who hosted The World at One on Radio 4, said he was ‘’pleased to add my voice to Parkinson’s UK’s calls for change’’. The charity found people with Parkinson’s are 10% more likely to be inaccurately assessed for a personal independence payment (PIP) than other claimants. Its research suggested half of those who had experience of benefits claimed the person assessing how Parkinson’s affects their daily lives did not have a good knowledge of the condition. The latest report has called on the Government to scrap the rule around symptoms having to affect someone  for 50% of the time if they are to be taken into account for PIP. The charity’s survey found 24% of 3,016 respondents are struggling to cover costs. Many said that they did not have enough money to cover basic needs such as food. Sue Christoforou, of Parkinson’s UK, said: ‘’It’s appalling that due to a lack of support from the Government, people with Parkinson’s eligible for the benefits designed to support them are poorer than they should be.’’ A spokesman for the Department for Work and Pensions said: ‘’All our assessors are qualified health professionals who have access to condition-specific information on Parkinson’s.’’

Hospital emergency departments have been urged to make infection control a top priority or risk patient lives. A report warned they had let standards slip since the pandemic. It said staff and patients are still in danger of contracting Covid and called on healthcare workers to get vaccinated against the virus and flu. The Royal College of Emergency Medicine probed the level of patient screening including tests for Covid. It found the national average of patients screened when attending A&E was 17% last year, down from 25% in 2022. RCEM president Dr Adrian Boyle added: ‘’It is unconscionable that directly after a terrible pandemic the system is not providing the standards that staff and patients need.’’

The Guardian

Ultra-processed food (UPF) is directly linked to 32 harmful effects to health, including a higher risk of heart disease, cancer, type 2 diabetes, adverse mental health and early death, according to the world’s largest review of its kind. The findings from the first comprehensive umbrella review of evidence come amid rapidly rising global consumption of UPF such as cereals, protein bars, fizzy drinks, ready meals and fast food. In the UK and US, more than half the average diet now consists of ultra-processed food. For some, especially people who are younger or poorer, a diet comprising as much as 80% UPF is typical. The findings published in the BMJ suggest diets high in UPF may be harmful to many elements of health. The results of the review involving almost 10 million people uncovered a need for measures to target and reduce exposure to UPF, the researchers said. The review involved experts from a number of leading institutions, including Johns Hopkins Bloomberg school of public health in the US, the University of Sydney and Sorbonne University in France. Writing in the BMJ, they concluded: ‘’Overall, direct associations were found between exposure to ultra-processed foods and 32 health parameters spanning mortality, cancer, and mental, respiratory, cardiovascular, gastrointestinal, and metabolic health outcomes.’’ They added: ‘’Greater exposure to ultra-processed food was associated with a higher risk of adverse health outcomes, especially cardiometabolic, common mental disorders and mortality outcomes. These findings provide a rationale to develop and evaluate the effectiveness of using population-based  and public health measures to target and reduce dietary exposure to ultra-processed foods for improved human health.’’ Ultra-processed foods, including packaged baked goods and snacks, fizzy drinks, sugary cereals and ready-to-eat or ready meals , undergo industrial processes and often contain colours, emulsifiers, flavours and other additives. They also tend to be high in added sugar, fat, and/or salt, but low in vitamins and fibre. Previous studies have linked UPF to poor health, but no comprehensive review had yet provided a broad assessment of the evidence. To bridge this gap, researchers carried out an umbrella review, a high-level evidence summary, of 45 distinct pooled meta-analyses from 14 review articles associating UPF with adverse health outcomes. The review articles have all been published in the past three years and involved 9.9 million people. None was funded by companies involved in the production of UPF. Estimates of exposure to ultra-processed foods were obtained from a combination of food frequency questionnaires, 24-hour dietary recalls and dietary history, and were measured as higher versus lower consumption, additional servings per day, or a 10% increment. The researchers graded evidence as convincing, highly suggestive, suggestive, weak, or no evidence. They also assessed the quality of evidence as high, moderate, low or very low. Overall, the results show that higher exposure to UPF was consistently associated with an increased risk of 32 adverse health outcomes, the BMI reported. Convincing evidence showed that higher UPF intake was associated with about a 50% increased risk of cardiovascular disease-related death, a 48-53% higher risk of anxiety and common mental disorders, and a 12% greater risk of type 2 diabetes. Highly suggestive evidence also indicated higher intake was associated with a 21% greater risk of premature death from any cause, a 40-66% increased risk of heart disease-related death, obesity, type 2 diabetes and sleep problems, and a 22% increased risk of depression. There was also evidence for associations between UPF and asthma, gastrointestinal health, some cancers and cardiometabolic risk factors, such as high blood fats and low levels of ‘’good’’ cholesterol, though the researchers said the evidence for these links was limited.

The NHS hospital waiting list will be falling ‘’consistently’’ by the time of the general election but will remain even larger than it was before Covid until 2030, a report predicts. In potentially good news for Rishi Sunak, the Institute for Fiscal Studies (IFS) said the waiting list for operations in England was set to ‘’start to fall consistently but slowly from the middle of 2024’’, during the months leading up to the election that is widely expected in November. However, in sobering news for the Conservatives and Labour, the think tank also warned that whoever forms the next government will not get the waiting list back down to pre-pandemic levels by the end of the next parliament, which is likely to run until the end of 2029. In addition, the length of time patients are forced to wait for an array of treatment, such as A&E care, diagnostic tests and cancer treatment as well as planned surgery – already the worst on record – is also likely to remain frustratingly long. In January last year, the prime minister’s promise that ‘’NHS waiting lists will fall and people will get the care they need more quickly’’ was one of the five pledges he asked voters to judge him by. However, Sunak admitted recently that he had not fulfilled that pledge. The waiting list stood at 7.2m when he made the pledge but by December it had risen to 7.6m. Sunak has laid the blame on strikes by NHS staff since December 2022, which have forced hospitals to rearrange 1.4m operations and outpatient appointments. The size of the waiting list, which covers procedures patients are waiting for under the NHS’s referral-to-treatment scheme, has fallen in each of the last three months, from 7.8m to 7.6m. That is primarily because hospitals have made efforts to tackle the backlog – for example by putting on extra sessions of surgery in the evenings and at weekends. Many of the 6.5 million people on the list are waiting for a hip or knee replacement or cataract removal. The waiting list stood at 4.6m when Covid struck. But by the IFS’s calculations it is on course to still be as high as 6.5m in December 2027. Five of the six waiting list targets set out since 2022 intended to reduce long waits and boost the number of operations hospitals perform, including three Sunak outlined, have either been missed already or are ‘’unlikely’’ or ‘’very unlikely’’ to be achieved on time, the IFS said.

Laws to allow assisted dying may pass in Scotland, Jersey and the Isle of Man in the next few years, leading to a divergence between different parts of the UK and the crown dependencies, MPs have warned. The government must consider the repercussions of this, a parliamentary inquiry into assisted dying has said. Jersey, the Isle of Man and Scotland are all considering the legalisation of assisted dying, although in each case only permanent residents would be eligible. ‘’It looks increasingly likely that at least one jurisdiction among the UK and crown dependencies will allow (assisted dying) in the near future and ministers should be actively involved in discussions about how to approach the divergence in legislation,’’ said a report from the health and social care committee. It also recommends doctors be given clear guidance on how to respond to requests for medical reports from terminally ill patients considering travelling abroad for an assisted death. Although it is not illegal to provide medical reports to facilitate assisted dying abroad, the British Medical Association (BMA) advises doctors not to do so, while the General Medical Council (GMC) says providing access to patient’s records should not be considered encouragement or assistance. ‘’It does not seem to be entirely clear to doctors what they are allowed to do,’’ the report says. Revised guidance from the GMC and BMA was needed, it adds. The report urges the government to commit to increased financial support for hospices and ‘’ensure universal coverage of palliative and end-of-life services’’. The inquiry considered more than 68,000 responses from members of the public and 380 pieces of written evidence during the course of its inquiry into assisted dying. Opinion polls have shown that between 73% and 84% of the public support legalisation within strict guidelines. Between 1998 and 2022, 531 Britons travelled to Dignitas in Switzerland for an assisted death, the report says. It is not illegal for a British citizen to travel abroad for an assisted death but anyone accompanying or helping the person may be subject to investigation and prosecution.

People experiencing long Covid have measurable memory and cognitive deficits equivalent to a difference of about six IQ points, a study suggests. A score of 100 is regarded as average. The study, which assessed more than 140,000 people in the summer of 2022, revealed that Covid-19 may have an impact on cognitive and memory abilities that lasts a year or more following infection. People with unresolved symptoms that persisted for more than 12 weeks had more significant deficits in performance in tasks involving memory, reasoning and executive function. Prof Adam Hampshire, a cognitive neuroscientist at Imperial College London, and first author of the study, said: ‘’What our study shows is that brain fog can correlate with objectively measurable deficits.’’ Last year, the Office for National Statistics estimated that about two million people in Britain were experiencing self-reported long Covid and a previous Imperial College analysis suggested that tens of thousands in England could have symptoms lasting a year or more after infection. The study took more than 140,000 participants from the React cohort, begun in April 2020 as one of the world’s largest Covid surveillance studies. They were given online cognitive tests to test memory, attention, reasoning and other functions. About 3.5% of the cohort had symptoms persisting

Daily Telegraph

Therapy and meditation help to combat menopause symptoms, a study has shown. Anxiety, depression and memory issues are common signs of menopause, and University College London (UCL) scientists have found that mindfulness and cognitive behavioural therapy are effective at alleviating suffering. It comes after criticism of government plans to provide talking therapy as a treatment for the menopause on the NHS. Authors of the study say doctors and patients should consider using the treatments in addition to medicines such as hormone replacement therapy (HRT). A meta-analysis of 30 studies included more than 3,5000 women around the world and found small to moderate benefits among menopausal women who underwent either therapy or mindfulness. ‘’The message we want to be really clear about is that we are not in any sense suggesting this as an alternative to HRT, or recommending this instead of HRT,’’ said Prof Aimee Spector, the author of the study, from UCL. Scientists said the findings offered hope for women ineligible to have HRT, such as breast cancer survivors, and people with other conditions including diabetes, epilepsy or asthma. The study, which is published in the Journal of Affective Disorders, focused on medical interventions with professional clinicians but it says practising mindfulness or meditation at home could also help. The National Institute for Health and Care Excellence recently recommended the use of cognitive behavioural therapy for menopause symptoms in draft guidance. This led critics to accuse the body of being patronising and too negative about HRT.

The medical regulator failed to sound the alarm over Covid vaccine side effects and should be investigated, MPs have said. The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for approving drugs and devices and monitors side effects caused by treatments. But the all-party parliamentary group (APPG) on pandemic response and recovery, an influential group of MPs, has raised ‘’serious patient safety concerns’’. It has claimed that ‘’far from protecting patients’’. The regulator operates in a way that ‘’puts them at serious risk’’. Some 25 MPs across four parties have written to the health select committee asking for an urgent investigation. In reply, Steve Brine, the health committee chairman, has said an inquiry into patient safety is ‘’very likely’’. In a letter to Mr Brine, the APPG said there was reason to believe that the MHRA had been aware of post-vaccination heart and clotting issues as early as February 2021, but did not highlight the problems for several months. Denmark and several other European countries suspended the AstraZeneca vaccine over clotting fears in March 2021, but the MHRA only published safety advice on April 7, by which time 24 million people had been vaccinated. The watchdog also saw a ‘’signal’’ for the heart problems myocarditis and pericarditis in February 2021, but did not include the conditions in safety updates until June 2021, MPs said. The APPG wrote: ‘’In effect, the MHRA licences medical products as safe knowing it lacks the processes to properly monitor adverse events. In the case of Covid-19 vaccines, given the comparatively novel technology and record manufacturing speed, could the MHRA have even properly scrutinised the licensing data or known the short term safety? Historically, trust and confidence in vaccines and vaccine safety has been high in the UK, but it seems that the experience of the Covid-19 vaccines has undermined this and by association trust in the regulator and the pharmaceutical industry. Now more than ever, a wide-reaching and in-depth review is needed.’’

Meal deals are to be stripped of crisps and fizzy drinks in Scotland under SNP plans to tackle the obesity crisis. Proposals unveiled yesterday (Tuesday) state that the supermarket offers, as well as temporary price reductions on unhealthy food and drink, will fall within the scope of a new junk food crackdown north of the border. Options in a consultation for ‘’rebalancing meal deals towards healthier options’’ include banning any food or drink classed as being high in fat, sugar or salt from the promotions in meal deals. These typically consist of a sandwich, snack and drink for a set price. Alternatively, customers may be allowed to purchase one unhealthy item, such as a bag of crisps, or a sugary drink, but not both. The plans are a significant departure from rules in England, where only multibuy junk food promotions, such as buy-one-get-one-free deals, face being banned from October next year. However, there are warnings that if the proposed ban on temporary price reductions on all junk food in Scotland goes ahead, it will cause confusion for cross-border business and drive up food bills for struggling families. South of the border, there are no plans to restrict meal deals or end temporary price reductions. Supermarkets said that meal deals should not fall within the scope of the crackdown, as they were not ‘’impulse’’ purchases of unhealthy items.

The Times

Britain has fallen behind the rest of the world on cancer survival because of a systemic failure to provide lifesaving treatment to older patients, new research shows. The use of chemotherapy and radiotherapy is significantly lower in the NHS than in comparable nations., particularly for older patients. Someone aged over 85 is four times more likely to get chemotherapy in Australia compared with the UK, according to a study in the Lancet Oncology. One in three UK cancer patients are over 75 and campaigners say ‘’systemic ageism’’ means they are missing out on treatment to extend their lives or manage symptoms.  Researchers at University College London looked at data on treatment and survival rates from 780,000 cancer patients in the UK, Norway, Australia and Canada over a five-year period. Only 32 per cent of UK patients received chemotherapy, compared with 39 per cent in Norway and Canada and 42 per cent in Australia. Meanwhile, 20 per cent of UK patients received radiotherapy, compared with 23 per cent in Norway, 26 per cent in Canada and 24 per cent in Australia. Across all age groups patients in the UK were less likely to get treatment, but this disparity widened as patients got older. Only 2 per cent of those aged over 85 received chemotherapy in the UK, compared with 8 per cent in Australia and Canada. For radiotherapy, 9 per cent of over-85s received the treatment in the UK, compared with 15 per cent in Australia. The UK was also found to have much lower survival chances for lung, pancreatic, bowl, stomach and ovarian cancers. Only 63 per cent of UK bowel cancer patients survived five years, compared with 70 per cent in Canada and Australia. Dr John Butler of the International Cancer Benchmarking Partnership, which led the study, said: ‘’Lower use of chemotherapy and radiotherapy in the UK could impact people’s chances of survival, especially for older patients. Although we have made progress, the last benchmark showed that cancer survival in the UK is still around ten to 15 years behind leading countries.’’ The study looked at eight different types of cancer. It used data from 2012 to 2017, which is the most up-to-date international data available, and researchers said that clinical practice was unlikely to have changed since then. NHS data shows that last year was the worst on record for delays in cancer treatment. More than one in three patients are having to wait beyond the two-month target to start treatment such as chemotherapy following diagnosis.

Death threats, physical abuse and racist slurs aimed at NHS workers have prompted a hospital to make it easier for staff to ‘’red card’’ patients. Aggressive patients or visitors could be banned from Barking, Havering and Redbridge University Hospitals NHS Trust for up to 12 months. Cases of aggression against staff at the east London trust have doubled in three years, from 36 in January 2021 to 75 in January this year. Hospital bosses have begun a campaign, ‘’No Abuse, No Excuse’’, in response. It includes 60 body cameras for staff, policies to make it easier to ban patients or visitors, increased visibility of security staff and a ‘’de-escalation’’ course for employees. Under the old rules, only one person had been banned in five years. Staff who have faced abuse are promoting the campaign. Yvonne Ihekwoakba, a nurse, said she was punched in the stomach and knocked to the floor when she tried to give a patient his medication. Mohammed Islam, a security officer, was kicked in the jaw and had teeth broken. Theo Kayode-Osiyemi, from the appointments team, recalled being told to ‘’go to the jungle where I belong’’. Figures from the 2022 NHS staff survey showed that, across England, 28 per cent of staff had been abused at work.

More than 8,000 children have had operations and appointments cancelled because of strikes by junior doctors, figures show. Members of the British Medical Association (BMA) are holding a five-day walkout, which began at 7am on Saturday (24th February), in their tenth round of strikes over the past year. NHS leaders are concerned about the mounting toll of industrial action on patients, including severely ill children and those needing cancer surgery. Analysis by The Times shows that the three biggest NHS children’s hospitals in England have had to cancel 8,478 appointments because of junior doctors’ strikes. This includes 3,857 cancellations at Great Ormond Street Hospital in London, the country’s biggest NHS children’s hospital, which said it could not overestimate the impact strikes have had on its young patients. At Alder Hey Children’s Hospital in Liverpool there have been 2,852 cancellations and at Sheffield Children’s Hospital there have been 1,769. Hospitals were affected by industrial action on one in every ten days over the past year, causing 1.3 million appointments and operations to be cancelled. There appears to be little hope of an end to the dispute, with ministers and BMA leaders continuing their public spat over pay yesterday (Monday) as thousands of doctors took to picket lines. Rishi Sunak told BBC Radio York that he did not want to ‘’run down’’ the NHS and that strikes by junior doctors were to blame for the lack of significant progress on NHS waiting lists which stand at 7.6 million. He said: ‘’When it comes to the waiting lists, in the last few months actually we’ve seen the waiting lists start to fall. And that’s because we haven’t had as much industrial action. Obviously there is once again industrial action, but at the end of last year we had no industrial action in October or November and the waiting list fell by about 150,000.’’

Sight loss in some inherited eye diseases may be caused by gut bacteria and may be treatable with antibiotics, research suggests. A study in mice found gut bacteria was present in damaged areas of eyes where sight loss had occurred due to a genetic mutation. This mutation may relax the body’s defences and allow bacteria to reach the eye, causing irreversible blindness, the researchers said. The gut contains trillions of bacteria, many of which are key to healthy digestion. However, they can be harmful. Dr Richard Lee, of the UCL Institute of Ophthalmology and Moorfields Eye Hospital NHS Foundation Trust, the co-lead author of the study, said that the findings could have huge implications for treating eye diseases associated with a particular gene. ‘’We found an unexpected link between the gut and the eye which might be the cause of blindness in some patients,’’ he said. ‘’As we have revealed an entirely novel mechanism linking retinal degeneration to the gut, our findings may have implications for a broader spectrum of eye conditions, which we hope to continue to explore.’’ He added that he hoped clinical studies could determine whether the mechanism was indeed the cause of blindness in some cases and whether targeting bacteria could be a viable treatment. Researchers examined the impact of the CBRI gene, which is crucial to regulating what flows in and out of the eye. The gene is associated with inherited eye diseases such as Leber congenital amaurosis and retinitis pigmentosa. It is responsible for 10 per cent of Leber congenital amaurosis cases globally and 7 per cent of retinitis pigmentosa cases. Inherited eye diseases are the leading cause of blindness in working-age people in Britain. The study showed that in the lower gut the gene combated disease and harmful bacteria by regulating what passed between the contents of the gut and the rest of the body. Those barriers in the retina and the gut could be breached when the gene had a particular mutation that reduced its effect. This allowed bacteria in the gut to move through the body and into the eye, leading to lesions in the retina that caused sight loss. According to the study, treating those bacteria with antimicrobial medicines such as antibiotics was able to prevent sight loss in the mice, even though it did not rebuild the affected cell barriers in the eye. Further research will need to look at whether this applies in humans. Deterioration of one’s sight is irreversible and has lifelong implications. To date, the development of treatments has largely focused on gene therapies or stem cell therapies. The new study, jointly led by researchers in China, was published in the journal Cell.

A treatment for gonorrhoea discovered by scientists at GSK has achieved positive late-stage trial results, boosting a growing anti-infective portfolio that has blockbuster potential. The company said a phase III study for gepotidacin, a potential oral antibiotic for urogenital gonorrhoea, found it was not inferior to an existing combination treatment, which includes a jab. With cases of the sexually transmitted infection rising worldwide and concern growing about resistance to existing treatments, there is a need for new antibiotics. Caused by a bacteria called Neisseria gonorrhoeae, the disease affects men and women and there are an estimated 82 million new cases a year. If not treated, it can lead to infertility and other sexual and reproductive health problems. It also increases the risk of HIV infection. Some people find that the existing option of a course of antibiotics can be difficult to take, for example because of allergies, intolerances or the way in which they are administered. Gepotidacin was discovered by GSK’s scientists in Stevenage, Hertfordshire, one of its global research and development sites, and is in late-stage development to treat uncomplicated urinary tract infections. GSK’s emerging anti-infective portfolio will be one of at least a dozen significant new product launches from 2025. The FTSE 100 group, one of Britain’s two big drugs companies, is building confidence among investors in the long-running turnaround of its drug pipeline. Last month, it upgraded longer-term financial forecasts and its shares have risen by about 15 per cent over the past year. This month GSK secured a fast-track review in America of a potential blockbuster treatment for chronic hepatitis B. A blockbuster drug is usually defined as a medication with annual sales of more than $1 billion. Detailed results from the gonorrhoea trial would be presented at a scientific meeting and shared with global health authorities, GSK said. Chris Corsico, senior vice-president of development at GSK, said the ‘’positive headline results demonstrate the potential for gepotidacin to provide a novel oral treatment option in the face of rising resistance and for patients who can’t take other treatments due to allergies or intolerance’’. The result was based on a microbiological response three to seven days after treatment. GSK is also developing a vaccine for the prevention of gonorrhoea infections, which was granted a fast-track review by the US Food and Drug Administration in June and is in a second phase trial.