Meningitis B vaccine gets European licence

But isn’t there already a vaccine for meningitis? Yes, there are many vaccinations against bacterial meningitis however a vaccine for meningitis B has not been available. Until now...

The ‘Bexsero’ vaccine is the first to cover meningococcal B meningitis

To begin with here are some facts and figures about meningitis B in particular:

• About 1870 people contract the infection each year and one in ten die as a result
• However around a quarter of all survivors are left with life altering side effects such as brain damage or limb loss
• This is caused by inflammation of the cell membranes of cells in the brain and spinal cord caused by the bacterial infection.

Secondly some more information about the ‘Bexsero’ vaccine itself:

• Developing a vaccine against meningitis B has been particularly challenging as it is caused by thousands of subtly different strains of bacteria. This consequently makes it very difficult to find a single jab that could cover them all.
• As a result the genetic structures of the varying strains were analysed in search of a common shared feature which could be targeted
• The product is a jab likely to be effective against 73% of the different variations of meningitis B

Finally when (and even if) the vaccine will be introduced in the UK is unknown, however now the vaccine has obtained a licence a decision may be made to introduce the vaccine into the childhood vaccination schedule in the UK. Meningitis Trust feel it should be introduced as quickly as possible but we will have to wait and see what happens

(Source: NHS Choices)

Clever bacteria

I plan to write very briefly this week as I am in the middle of exams and should be revising! I hope everyone else’s exams have/are going well.

Infectious bacteria have for the first time been caught performing "biological alchemy" to transform parts of a host body into those more suited to their purposes, by a team in Edinburgh.

The study showed leprosy-causing bacteria turning nerve cells into stem cells and muscle cells.

Essentially these bacteria are transforming nerve cells, which are static, into something which is more valuable to them. These stem cells can then be grown and transported around the body. 

Furthermore as these stem cells are “self” they can reach their desired location undetected by the immune system.

It is hoped that findings such as these could lead to new ways of developing stem cells in humans and/or improve the treatment of bacterial disease. However views on the clinical relevance of these findings are mixed.

Nonetheless the finding is very interesting and shows just how complex the interactions between humans and bacteria can be! You can read the full article here…

(Alchemy: The medieval forerunner of chemistry, based on the supposed transformation of matter, esp. that of base metals into gold.)

The Social Care Question

Evidence suggests around three quarters of us will need some form of support in our old age, combine this statistic with the fact that our population is “ageing” and it is clear that care of the elderly is a very important issue.

Unlike NHS care, such help and support is not free - there is simply not enough money for it to be free..

So, how much should such care cost an individual? And how is it/how should it be regulated?
Well, essentially that is 'the social care question'...! The degree of care needed (part time/full time), savings and the availability of care home spaces/carers are all considered. To see a more interesting and detailed breakdown of how the system works click here (Source: BBC)

For one in 10 people these care costs could amount to more than £100,000 over a lifetime. Costs like these mean that some people are forced to sell their homes or use up their life savings to pay for help in their old age.

The government’s intention is to cap the costs - at £75,000 - however this is more than double the £35,000 suggested cap based on careful consideration and calculation by an independent commission two years ago.

Although still a considerable amount, it is believed that at £35,000 people would engage and begin to plan for old age however at £75,000 there is a danger that the public might not do so as the figure is simply too high and they’re better off running the risk of not investing.

If people began to invest the insurance industry would follow suit, developing policies knowing that any catastrophic costs would be covered by the government.

To conclude, the economics is over my head in truth but I think the problem in question is very simple - how are we going to provide care and support for the elderly in the future? The current government hopes to address this growing problem and I am interested to see what their final suggestions will be. It is thought that a plan will be mapped out properly in the next month.

Tackling unhealthy eating

In my previous post I mentioned that the coalition government will target ‘unhealthy habits’ in this new year to try and improve health nationally and this would consequently lead to treatment savings within the NHS.

This is something which has featured in the news this week (week one of the new year!), the ‘unhealthy habit’ being unhealthy eating, one of the main causes of obesity. “Obesity costs the NHS £5bn each year and the latest figures from the Department of Health show that the number of children who are overweight or obese doubles during their time at primary school.”

‘Healthy’ food can often be the more expensive option and therefore access to such food in certain areas or certain families can be difficult and limited. As a result certain food firms are involved in a recent scheme by ‘Change4Life’ and offers on their food products will be available at more than 1000 Asda, Aldi and Co-Operative food stores across the UK.

Although a “responsibility deal” is currently in place (as well as schemes such as Change4life) and has managed to improve food content and labelling, a labour representative has asked whether a legal limit on the amount of fat, sugar and salt should be established. Especially in foods aimed at children given the statistic above for example. Essentially, is the current voluntary approach doing enough to regulate what our food contains or is it time for the introduction of legislation?

Here are five potential food 'targets' that could be affected by such legislation if it were introduced:

1.) Breakfast cereals - reduce sugar content

2.) Fruit juice - not pure fruit juice but the ones which are not pure fruit juice and can have large           amounts of sugar added

3.) Ready meals - stop the addition of too much salt in certain brands

4.) Crisps - reduce salt levels

5.) Biscuits, cookies and cakes - rethink with regards to fat levels

To give a more detailed example, the party says measures could include a 30% cap on sugar content in cereals aimed at children – significantly lower than in several well-known brands.

To give an example of legislation elsewhere, in French schools all food and drink is controlled, following the introduction of these measures studies have shown that the number of overweight children have decreased from 18.1% in 2000 to 15.5% in 2007. How telling is this statistic? Is the decrease really that significant and what changes have occurred since 2007...

Finally a few thoughts on the idea, for example is such a scheme realistically controllable? Would legislation have its desired effect, just because the healthy food is more readily available does not mean it will be purchased by families and would the products be affordable for all families? Could the money be invested elsewhere, perhaps education or accessible exercise facilities? Compulsory education on healthy eating with examples of which meals are 'healthy' in all secondary schools in the UK?

Source: BBC Health News

Things to look out for in 2013

Given the time of year the BBC health page looks to year the ahead this week and I thought I would do the same. So here is a list of three things (all hyperlinked) to look out for:

1.) The report of the public enquiry into the treatments of patients at Stafford Hospital and the trust involved. Preliminary data suggest that between 2005 and 2008 four hundred patients died unnecessarily because of poor care. Even more extreme is the data suggesting that thirsty patients had to resort to drinking from vases and receptionists were left to assess patients in A&E. What will the outcome of the enquiry be, will legislation be put in place to stop such mismanagement happening again?

2.) Public health initiatives to tackle unhealthy habits, for example will banning the display of tobacco products in shops in England occur and later be followed by the introduction of plain packaging for cigarettes? Australia are the only country to have taken this step so far.

-- A minimum price for alcohol, 45p/unit? Before the decision is made campaigns are taking place to increase the suggested price to 50p/unit as agreed in Scotland already as research suggests this relatively small increase in price can save a more significant number of lives.

3.) 1st April 2013: the NHS Commissioning Board will take over the day-day running of the health service (some of their targets can be seen in a previous post) and the majority of the budget will come under the control of GPs. Although these structures have been operating in the shadows for sometime next year they will be properly introduced. Will the transition go unnoticed with small changes here and there over time or will significant changes take place immediately?

To conclude, keep your eyes peeled and Happy New Year!

Radiotherapy court case

A very brief post given the time of year, and consequently the travelling and present exchanging that is going on! Despite this I felt I could not ignore the recent  court case involving seven year old Neon Roberts.

The case is unusual for a number of reasons. The fact that Neon's mother is refusing treatment for her son itself but also the fact that the identity of the boy has been revealed. Under normal circumstances names would not be given in order to protect the identity of the youngsters involved. However in this particular case the mother went into hiding which was delaying both the court case and important medical treatment so the police felt it was necessary to release names and photos to try and speed up the relocating process!

Neon had previously undergone two operations to remove a cancerous brain tumour and nodule before the most recent hearing however his mother did not want him to have radiotherapy. Her reasoning for this was the potential side effects of the treatment including lowered IQ, infertility and shorter life span. Neon's father (who is separated from the mother) had agreed to his son having radiotherapy.

Perhaps there are alternatives that could be considered? If this was the case then both parties would have their needs met, Neon would receive treatment but not radiotherapy so his mothers fears would be put at ease. However the medical experts involved say there are no other realistic alternatives available, nothing has undergone rigorous clinical trials and shown similar positive outcomes. 

If Neon were to receive radiotherapy what would his prognosis be? Without further treatment there is a very strong chance that Neon will die. By contrast the survival rate for children with radiotherapy is between 80%-86%. As such the stressful treatment would not be an unnecessary 'gamble', there is a strong chance the treatment will work for Neon. 

It was both of these reasons as well as the risk-benefit balance being strongly in favour of treatment that the court ruled against the mothers wishes. Neon is to undergo radiotherapy to try and prevent the cancer from spreading and will live with his father for the duration of the treatment. 

Was the outcome of the trial ever in doubt, could the court of granted the mothers appeal? Probably not.  Before reaching such decisions I think a number of things should be/are considered: the prognosis of the patient, availability of alternative treatments, the reasoning of the patient/relative and finally the capacity of the person in question to make such a decision. Cases involving children are particularly tricky as the child may be too young to give consent or lack the capacity to give consent. What do you think of the situation? 

Finally it's all very well discussing the situation however I/we must not forget about how difficult these times must be for Neon's mother, having a child whom you love dearly suffer from a life threatening condition yet the only potential solution is aggressive and invasive treatment. 

Proposed changes to the NHS

'Everyone counts: Planning for patients 2013/2014' is the title of a document published by the NHS Commissioning Board yesterday outlining the incentives that will be used to improve NHS services from April 2013, the first year of the new NHS, where improvement will be driven by clinical commissioners.

The document includes a clear set of outcomes against which to measure such improvements and outlines five offers:

1. Move towards a seven-day a week working for routine NHS services
2. Greater transparency and choice for patients
3. More patient participation 
4. Better data to support the drive to improve services
5. Higher standards and safer care

I will now look at points one and two in more detail as these points in particular featured in the news over the weekend.

The idea of a seven day service follows research which suggests patients are more likely to die if they are admitted to hospital over the weekend. In fact the study showed that patients in England were 16% more likely to die if they were admitted on a Sunday rather than mid-week. 

Staffing - in particular the absence of senior doctors - has been highlighted as a key reason for this.

Although such a scheme would be ideal and may be successful there are obvious obstacles that must be overcome, for example a reluctance to work on the weekend due to family commitments. What incentives or schemes could there be to try and overcome this reluctance? Bearing in mind the NHS is trying to save money whenever possible so lucrative salaries are probably not the answer... Not only are there obstacles but solutions that work for one speciality may not work for another! 

Secondly the greater transparency and choice for patients, for example the provision of surgeons' data. Such data on heart surgeons is already available but the aim is to enable access to data belonging to a number of other specialities for example vascular and orthopaedic surgeons. 

As well as enhancing patient choice the data would allow surgeons to compare "performance" and consequently this might lead to competition and an incentive or pressure to improve performance. 

The primary concern amongst surgeons and other medical professionals with releasing this data is that it may give a misleading impression and may be misinterpreted. For example surgeons performing more difficult, high risk, complex surgery may look to be performing worse and labelled as "bad" surgeons when in fact they are the best surgeons but the nature of their work is extremely high risk.

To conclude Sir David Nicholson, the chief executive of the NHS Commissioning Board said the following about the proposed changes: “At the heart of our approach is local control over decision making. We want to put power in the hands of clinicians who know their patients best.  We want to give them the money, information and tools to do the job. And we want the public to have the information they need to make choices and participate fully in the development of their health services.”