Doctors call for debate on ‘rationing’ of NHS services

A recent British Medical Association poll of more than 220 doctors found that nearly 40% believe that NHS services should be ‘rationed’ – potentially denying treatments to those leading unhealthy lifestyles, such as smokers, excessive drinkers and the obese. Furthermore, almost all of the respondents (96%) would like an open debate on service rationing in an attempt to resolve any confusion after the National Institute for Health and Clinical Excellence said last year that patients could be denied treatment if lifestyle factors made it ineffective.

The survey followed cost-cutting action taken by primary care trusts in Suffolk last November to prevent obese people from receiving joint-replacement surgery. The risks of operating on obese people are thought to be higher, with the joints wearing out sooner, compared with surgery on people of normal weight.

While many of the doctors did not believe in service rationing, many were aware of the difficult questions it raises. ITN News quoted Dr Ikechuku Anya, a specialist registrar in public health medicine in Bristol, as saying: ‘Deciding how best to distribute the finite resources available to the NHS to meet the infinite demands made on it is very difficult. It is made even worse when, as is often the case, any attempt to discuss the financial implications of funding any treatment is drowned in a chorus of “how callous, how heartless”.’
ITN News, 3 February 2006

Could leptin injections signal the end of yo-yo dieting?
Injections of the naturally occurring hormone leptin could help people retain their weight loss after dieting, according to a recent report in The Times.

So-called ‘yo-yo dieting’, where dieters quickly put back on the weight they lose, is a significant problem, affecting as many as 85% of slimmers. Now, a team of investigators from Columbia University in New York has found that leptin injections can prevent the physiological response that encourages the body to put on additional weight to conserve fat levels.

In a small trial of ten volunteers, the team found that leptin injections completely reversed the metabolic changes observed with dieting (e.g. in energy consumption, muscle efficiency and thyroxine levels).
The Times, 2 December 2005

Enzyme suppression by Western diet may cause type 2 diabetes
A research team in San Diego says it has discovered how a fatty diet could predispose to type 2 diabetes. According to a BBC News report, the investigators discovered that insulin production in mice can be prevented by knocking out a single gene controlling the production of the enzyme
GnT-4a. They went on to show that expression of the same gene can be inhibited by a diet with high fat content.

The researchers also hypothesised that inherited predisposition to type 2 diabetes could be due to variations in GnT-4a.
BBC News, 29 December 2005

One in eight New Yorkers have diabetes
New York is in the midst of a diabetes epidemic, reports The Guardian, with over an estimated 800000 people affected – more than one in eight of the city’s population. The problem is so severe that doctors have warned that the condition could overwhelm the city’s health service and cause major problems in schools.

The New York Times has conducted a year-long study on the condition and reports that the city meets the requirements for a continued epidemic – including high levels of poverty and large populations of Latino and Asian people, who are more likely to develop diabetes than people of other ethnic backgrounds.

Thomas Freiden, Commissioner for the city’s Department of Health and Mental Hygiene said: ‘Either we fall apart or we stop this.’

Diabetes is a big problem in the USA, with the American Diabetes Association saying that the condition could cause life expectancy in the country to fall for the first time in over 100 years. Children are now increasingly being diagnosed with type 2 diabetes – a situation that was unheard of two decades ago. The problem has reached such a level that one in three children born within the last 5 years is now expected to develop the condition.

Despite the countrywide scale of the problem, New York has diabetes prevalence rates one-third higher than the rest of the USA.
The Guardian, 10 January 2006

Health spending freeze hits school fruit and vegetable scheme
An embargo on all new Department of Health (DoH) project expenditure introduced last November has had severe implications for the Government’s national programme to promote fruit and vegetable consumption in schools. Furthermore, an official evaluation of the scheme suggests it has not had a sizeable effect on children’s eating patterns.

According to a report in The Guardian, many of the scheme’s administrative staff have quite their jobs after the spending freeze left them uncertain about the programme’s future. The DoH itself said: ‘In the short-term, coordinators’ contracts will be extended for at least 3months beyond the end of this financial year while long-term plans for this important scheme are put in place.’

The scheme, which provides a free piece of fruit or vegetable every day to nearly 2million school children between the ages of 4 and 6, is part of the DoH’s strategy to tackle conditions such as obesity, heart disease and cancer.

The evaluation of the scheme found that children eligible for the programme increased their fruit and vegetable consumption by one-third of a portion per day on average – not meeting the DoH’s five portions per day recommendation. The Guardian quoted a DoH spokesman who said: ‘Children participating in the scheme ate more fruit and vegetables than those not in the scheme, plus there was an increased awareness and knowledge of the five-a-day message. We know more work needs to be done to continue raising awareness of the importance of healthy eating but changing behaviour can take time.’
The Guardian, 28 January 2006

Cameron criticises cut-price chocolate at the checkout
Conservative Party leader David Cameron has criticised retailer WHSmith for promoting chocolate at reduced prices to customers queueing at checkouts. However, other retailers have already begun ensuring their checkouts are sweet-free, reports The Times.

Marks & Spencer says it is currently trialling a scheme in 12 stores where sweets and chocolate at the checkout have been replaced with healthier snacks, such as fruit and nuts. Asda, which does sell chocolate at the checkout, says it also has healthier options available to queueing customers. 

The Co-op claims that it does not sell sweets or chocolate at its checkouts and says it has a policy of not advertising unhealthy foods on children’s television.

The Times report follows a publication from the National Consumer Council in November 2005, which found that supermarket chains are guilty of promoting unhealthy foods in favour of fruit or vegetables. 
The Times, 6 January 2006

Diabetes link with pancreatic cancer
Researchers from the US National Cancer Institute have confirmed previous studies linking type 2 diabetes to pancreatic cancer. In a study published in the Journal of the American Medical Association, the researchers reported that cancer risk is associated with raised insulin levels and insulin resistance – phenomena observed prior to the onset of type 2 diabetes.

The team reviewed 16-year follow-up data for more than 21000 male smokers from Finland, and found that pancreatic cancer was more common in those with the highest levels of blood glucose, insulin and insulin resistance.

The researchers acknowledged that follow-up studies are required to confirm their findings. A spokesperson for charity Cancer Research UK said: ‘This paper supports the idea that having type 2 diabetes makes you slightly more likely to develop pancreatic cancer. But it’s important to stress that this is a very small increase in risk.’
BBC News, 14 December 2005

Strong link between obesity and major diseases of the eye
Obesity may increase the likelihood of developing blindness-causing eye disease, reports telegraph.co.uk. While obesity is already well established as a risk factor for conditions such as heart attack, high blood pressure, cancer and diabetes, researchers from Israel found a consistent and strong link between obesity and four major diseases of the eye in a review of 20 studies from around the world.

The linked conditions are age-related macular degeneration, glaucoma, diabetic retinopathy and cataracts. While the link between obesity and the first three of these is explained by vascular damage, the connection between weight and cataracts is not clear.

‘This review was to acquaint physicians and lay people with the dangers of being fat as related to ophthalmology,’ said Michael Belkin, Professor of Ophthalmology at Tel Aviv University.
telegraph.co.uk, 
29 December 2005

Snickers pie doesn’t really satisfy
Celebrity chef Antony Worrall Thompson’s latest culinary creation has failed to impress the Food Commission’s Food Magazine. The magazine labelled the chef’s Snickers pie – containing five Snickers bars, eggs, sugar, mascarpone, soft cheese and puff pastry – as ‘one of the most unhealthy recipes ever published’. 

Worral Thompson, also the author of the popular recipe book Healthy Eating for Diabetes, said the pie is intended as a treat for children to eat on special occasions. He said: ‘Kids have to be allowed to be kids from time to time.’

With the equivalent of 22 teaspoons of fat and 11 teaspoons of sugar in a single serving, kids may need to run a marathon to work off the 1250 calories in each slice!
The Guardian, 6 February 2006

On shaky ground: Ticklish solution to a common problem
Researchers from Boston University, USA, have reported on a potential new treatment for improving balance in patients with stroke or diabetic neuropathy: vibrating insoles.

The team, led by Dr James J Collins, tested the effects of the insoles on 15 people with stroke and 15 people with diabetic neuropathy in a study published in Annals of Neurology. Five traditional sway parameters and three derived from random-walk analysis showed improvement with the insoles, which contain three vibrating elements.

The sub-sensory vibration is thought to make neurones more sensitive to the stimuli present during standing. Further studies are planned: a prospect likely to tickle the fancy of healthcare professionals worldwide!
Reuters, 24 January 2006

Oat cuisine: Haggis off the menu for Scottish children
The battle against obesity has gained a new casualty in Scotland, reports The Times, with the traditional haggis being classified as a ‘restricted food’ in nutritional guidelines for pre-school children released by the Scottish Executive.

The guidelines state that haggis should be eaten no more than once a week by children under 5years of age, due to its fat and salt content.

Manufacturers of the food are reported as being disappointed with the move. A spokesperson for MacSweens is quoted as saying: ‘Haggis has been around for centuries and has high quantities of protein, carbohydrates and fibre.’
The Times, 25 January 2006