"Controversial Lightning Process 'helps children with chronic fatigue syndrome'," reports The Guardian.

The story is based on a UK study investigating whether a treatment called the Lightning Process helped teenagers being treated for chronic fatigue syndrome (CFS), also known as ME (myalgic encephalomyelitis).

The study randomly split 100 young participants into two groups: those who received standard CFS/ME treatment and those who received the standard treatment plus the Lightning Process (LP).

LP treatment involved an intensive three-day group-therapy course aiming to teach participants how to use their brain to improve their body's health.

Researchers found those who received the LP were more active, less tired and less anxious after six months. At 12 months, they also had improved depression scores and school attendance.

However, this therapy is not recommended by the NHS, which currently suggests behavioural and exercise therapy for people with CFS/ME.

There are an estimated 250,000 people affected by chronic fatigue syndrome in Britain, according to the ME Association charity.

It's not known what causes CFS/ME, but there are a number of theories, such as it being triggered by an infection.

Living with the condition can be difficult, with extreme tiredness and other symptoms making everyday activities challenging.

As well as support from family and friends, it might also be useful for people with CFS/ME to talk to others with the condition and perhaps find a local support group.

Where did the story come from?

The study was carried out by researchers from the University of Bristol and the University of Nottingham in the UK. It was funded by the National Institute for Health Research and two charitable trusts: The Linbury Trust and The Ashden Trust.

The study was published in the peer-reviewed medical journal Archives of Disease in Childhood, part of BMJ Journals, and is free to read online.

The media reporting of this study was generally accurate, but the Daily Telegraph's suggestion that the therapy helps children get back to school cannot be certain – there are a range of possible explanations for why children in the LP therapy group had better school attendance.

What kind of research was this?

This was a randomised controlled trial involving teenagers who had been diagnosed with CFS/ME. They were randomised to receive either usual care, or usual care plus the LP.

The LP is a therapy developed from osteopathy, life coaching and neurolinguistic programming (a behavioural psychotherapy that "retrains the brain"), and is used for a variety of conditions.

CFS/ME is a long-term illness with a wide range of symptoms, the most common being extreme tiredness.

It can also cause sleep problems, concentration problems, muscle or joint pain, headaches, a sore throat, flu-like symptoms, feeling dizzy or sick, or a fast or irregular heartbeat.

Current accepted treatments in the UK health service include cognitive behavioural therapy (CBT); a structured exercise programme called graded exercise therapy; and medication to control pain, nausea and sleep problems.

What did the research involve?

The researchers randomised 100 children aged 12 to 18 with diagnosed CFS/ME to receive either specialist medical care (SMC) or SMC plus the LP, and followed them up at 3, 6 and 12 months.

There were 51 participants in the SMC-only group. The SMC focused on improving sleep, and using activity management to establish a baseline level of activity (including school attendance, exercise and social activity) that was then gradually increased.

Sessions were delivered by professionals such as doctors, psychologists and physiotherapists. The number and timing of sessions were agreed with the teenager and their family.

There were 49 participants in the SMC-plus-LP group. In addition to the same SMC, they attended an LP course consisting of three different sessions, lasting four hours each, on consecutive days. They attended in groups of two to five.

The first was a theory session looking at:

• stress response
• how the mind and body interact
• how thought processes can be positive or negative

This was followed by a group session in which participants were asked to think about what they could take responsibility for and change.

The third was a practical session in which participants were asked to choose a goal they wished to achieve, such as being able to stand for a longer period of time. They were given different thinking strategies to perform before and during attempting to achieve the goal. They also chose a further goal, to be attempted at home.

Each participant was offered two follow-up phone calls.

Outcomes assessed were:

• physical function, measured using the 36-Item Short-Form Health Survey Physical Function Subscale (SF-36-PFS)
• quality of life using quality-adjusted life years (QALYs), measured using the EQ-5D-Y standardised instrument
• fatigue, using the Chalder Fatigue Scale
• pain, using the Visual Analogue Scale (VAS)
• anxiety and depression, using the Hospital Anxiety and Depression Scale (HADS)
• school attendance (days per week)
• child's use of health services, educational services or health-related travel, and other family costs, using a questionnaire

What were the basic results?

At six months after randomisation, data from 81 participants showed that those in the SMC-plus-LP group were:

More active

They had better physical function compared with the SMC-only group according to the SF-36-PFS scale of 0 to 100, where lower scores indicate worse physical function. The SMC-plus-LP group's average increased from a baseline of 53 to 81.7, and the SMC-only group's increased from 56 to 70.2 (adjusted difference in means 12.5, 95% confidence interval [CI] 4.5 to 20.5).

Less fatigued

They had less fatigue, scoring 14.4 compared with 19.8 in the SMC-only group on a scale of 0 to 33, where higher scores indicate more fatigue (adjusted difference in means 4.7, 95% CI 7.9 to 1.6).

Less anxious

They had greater improvement in anxiety symptoms as measured by the HADS (scored from 0 to 21, with higher scores indicating worse symptoms) than the SMC-only group. The SMC-plus-LP average score was 6.1, compared with 9.0 for the SMC-only group (adjusted difference in means 3.3, 95% CI 5.6 to 1).

At 12 months after randomisation, data from 79 participants showed that the SMC-plus-LP-group were:

More active, less fatigued and less anxious

They still had better physical function, less fatigue and improved anxiety symptoms compared with the SMC-only group.

Feeling better

The SMC-plus-LP group also had greater improvement in depression symptoms on the HADS – scored from 0 to 21, with higher scores indicating more-severe symptoms (adjusted difference in means -1.7, 95% CI -3.3 to -0.2).

Attending school more often

School attendance, as measured by attendance in the previous week, was better for the SMC-plus-LP group, at 4.1 days on average, than the SMC-only group's 3.1 days (adjusted difference in means 0.9, 95% CI 0.2 to 1.6).

How did the researchers interpret the results?

The researchers concluded: "This is the first randomised trial investigating the effectiveness of the LP for any condition. It is the first trial that has demonstrated the effectiveness of an intervention other than CBT for paediatric CFS/ME.

"The addition of the LP to SMC improved physical function at 6 and 12 months in adolescents with CFS/ME and this difference increased at 12 months."

Conclusion

The results from this very small randomised controlled trial showed that people having LP therapy in addition to usual CFS/ME care had improved physical function, fatigue and anxiety symptoms at six months, and improved school attendance and depressive symptoms at 12 months.

However, there are a number of limitations to this research that need to be considered:

• Participants in both groups improved, so both treatments were effective to some extent.
• This was a very small trial, and the results analysis involved fewer than the 100 people recruited. It would need to be repeated in a much larger group to demonstrate more robust findings.
• A number of outcomes were looked at, so it was very likely that some of them would return positive findings by chance – the improvements might not have been due to the LP therapy.
• Participants were not blinded – they were aware of the group they were in; therefore, their self-reported outcomes might have been biased. They may have been more likely to report positive outcomes because they knew they were getting additional therapy in the LP group.
• Of all those eligible to participate in the trial, fewer than 30% agreed to take part. The reason why the majority didn't want to is unknown.

As the LP therapy was given in addition to the usual CFS/ME care, it certainly cannot be suggested as a replacement for the current usual care.

There's no single way of managing CFS/ME that works for everyone and, if you have the condition, you should be offered a treatment plan based on your symptoms. Your doctor should discuss all options with you and make you aware of any benefits and risks.

Links To The Headlines

Chronic fatigue therapy 'could help teenagers', study says. BBC News, September 21 2017

Controversial 'light' treatment for young ME patients - endorsed by celebrities - DOES work despite being labelled as 'quack medicine'. Mail Online, September 21 2017

Controversial Lightning Process 'helps children with chronic fatigue syndrome'. The Guardian, September 20 2017

M.E. 'Lightning Process' trains the brain to ward off tired thoughts. The Daily Telegraph, September 20 2017

Links To Science

Crawley EM, Gaunt DM, Garfield K, et al. Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomised controlled trial. Archives of Disease in Childhood. Published online September 20 2017

Summary

"One in four British girls hit by depression at 14 as experts blame increase in cyber bullying and academic pressure," says the Sun after a large study found 24% of 14-year-old girls in the UK report symptoms of depression.

The Millenium Cohort Study followed more than 19,000 children born in the UK in 2000 to 2001. Parents completed surveys when the children were aged 3, 5, 7, 11 and 14 about any emotional difficulties they were having. At age 14, the children also completed a short questionnaire about their mental health.

Levels of anxiety and depressive symptoms were similar for girls and boys up to the age of 11. At age 14, parents reported 12% of boys and 18% of girls had emotional problems. But when the 14-year-olds themselves were asked about their mental health, 9% of boys and 24% of girls reported depressive symptoms.

Though the statistics are worrying, it is important to note that these were responses to questionnaires and not formal diagnoses of depression so the real figures are likely to be lower. However, it is still of concern that so many children are struggling with emotional problems.

If you have concerns about yourself or a child, see your GP as there are many effective treatments available including talking therapies.

Find more information and advice for young people on mental health problems.

Where did the story come from?

The study was carried out by researchers from University College London, and was funded by the Economic and Social Research Council and the Government.

It was published by the Centre for Longitudinal Studies, an Economic and Social Research Council resource centre based at University College London and is free to read online (PDF, 554kb).

In general, the media reported the research accurately, although few explained that the children had not been formally diagnosed with depression and had only reported some symptoms in a questionnaire.

What kind of research was this?

This was a cohort study in which children born in the millennium were followed up over 14 years through questionnaires given to both parents and the children themselves.

This type of observational study is good for looking at patterns of illness in the population. However, it relies on people agreeing to take part so can be subject to selection bias whereby only people with an interest in the topic complete the survey.

What did the research involve?

The Millenium Cohort Study recruited the parents of 19,517 children born in 2000 to 2001 from England, Scotland, Wales and Northern Ireland.

When the children were aged 9 months, 3, 5, 7, 11 and 14 years, the parents answered questionnaires about their physical, emotional, social, cognitive and behavioural development. They also provided details about their family relationships, economic status and family life.

When the children were aged 3 and above, the questionnaires included the Strengths and Difficulties Questionnaire which includes parental concerns about behaviour problems, hyperactivity and bullying, and gives a score out of 10, with higher scores indicating greater problems.

When the children were aged 14, they completed the Short Mood and Feelings Questionnaire. This consists of 13 statements. Children are asked if they felt the statements were true, sometimes true or not true reflections of how they felt in the previous two weeks:

• I felt miserable or unhappy.
• I didn't enjoy anything at all.
• I felt so tired I just sat around and did nothing.
• I was very restless.
• I felt I was no good anymore.
• I cried a lot.
• I found it hard to think properly or concentrate.
• I hated myself.
• I was a bad person.
• I felt lonely.
• I thought nobody really loved me.
• I thought I could never be as good as other kids.
• I did everything wrong.

What were the basic results?

Average scores on the Strengths and Difficulties Questionnaire (0 to 10) completed by parents were low overall (a lower score indicating lesser problems):

• Behaviour problems were more likely at the age of 3, with a score of just below 3, which then reduced and stayed around 1.
• Emotional symptoms gradually increased from 1 to just over 2 by the age of 14.
• Hyperactivity was the biggest problem, scoring around 3 at all ages.
• Peer problems scored between 1 and 2 at all ages.

The proportion of children reported to have emotional problems by their parents increased with age:

• at the age of 3, it was 8%
• by 11, this had risen to 12%
• at 14, it was still 12% for boys but had increased to 18% for girls

The proportion of children reported to have behaviour problems varied with age:

• at the age of 3, 20% of boys and 17% of girls
• at 5, 11% of boys and 7% of girls – at 14, 15% of boys and 11% of girls

According to the Short Mood and Feelings Questionnaire completed by 14-year-old children:

• 24% of girls reported high levels of depressive symptoms
• 9% of boys reported high levels of depressive symptoms

Ethnicity and household income results indicate that children from all backgrounds and socioeconomic status can suffer from symptoms of depression:

• Prevalence for girls ranged from 9% of Black African and 15% of Bangladeshi background to 25% of white and 27% of mixed race.
• Mixed-race boys were also more likely to have symptoms of depression, at 13% compared to 3% of those of Indian ethnicity.
• 18% of girls from the highest income bracket, 23% from the lowest and up to 27% of those from the second lowest bracket had symptoms of depression.
• 12% of boys in the second lowest bracket going down to 6% in the highest bracket had depression symptoms.

How did the researchers interpret the results?

The researchers concluded that "children's perspectives about their mental health may be different from their parents". They say this "highlights the importance of obtaining young people's own perspective of their mental ill-health, alongside other perspectives".

Conclusion

This large cohort study highlights high levels of depressive symptoms in children and adolescents.

It is however important to note that these are symptoms – we don't know how many of the children would be diagnosed with depression.

When parents complete the Short Mood and Feelings Questionnaire, it is estimated that it will accurately identify 75% of children with depression and 73% of children without depression. But it is less accurate when children complete it. Recent research suggests that it can identify 60% of children with depression and 61% of children without depression.

Despite these limitations, the fact that so many children report symptoms is of concern. Various experts in the media have suggested reasons, ranging from greater awareness of mental health issues and therefore increased reporting, to greater pressure from social media. Further research is needed to identify the causes.

It is important to seek help early for children with emotional problems and your GP is the best place to start. You can also contact the charity Young Minds that offers information and help to both young people and their parents or carers.

Links To The Headlines

Quarter of 14-year-old girls 'have signs of depression' BBC News, September 20 2017

How a quarter of girls are hit by depression: Shocking figures show teenagers are struggling to cope with school, stress and pressures of social media Mail Online, September 20 2017

Teenage Blues One in four British girls hit by depression at 14 as experts blame increase in cyber bullying and academic pressure The Sun, September 20 2017

One in four teenage girls are depressed, by their own accounts The Daily Telegraph, September 20 2017

One in four girls have depression by the time they hit 14, study reveals The Guardian, September 20 2017

A quarter of all 14-year-old girls are depressed, research shows The Independent, September 20 2017

Quarter of girls are depressed at 14 in mental health crisis The Times, September 20 2017

Links To Science

Patalay P, Fitzsimons E. Mental ill-health among children of the new century (PDF, 554kb) Briefing paper from Centre for Longitudinal Studies, UCL Institute of Education. Published online September 20 2017.

"Scientists invent injection that could deliver every childhood vaccine in one go," reports The Independent. Various media sources have run stories on a new injection they claim could allow multiple childhood vaccines to be delivered in a single jab.

This follows the development in the US of a method of making a tiny, multilayered biodegradable device, or microstructure, that can be given via injection. The device has several compartments that can be filled with solutions to be released at different points in time.

For the study, mice were given a single injection of the microstructure, which had been loaded with two fluorescently labelled sugar solutions. The researchers showed that the device could release the solutions at different times and that the delivery seemed to be better than in mice who received the solutions via two separate injections.

This device could have great medical potential, but it's important to realise that this is very early research.

More stages of testing in mice would be needed before we could think about human trials. There may be many as-yet-unknown obstacles in terms of safety and effectiveness when considering using the device for human immunisation.

Where did the story come from?

The study was carried out by researchers from the Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology (MIT) in the US and was funded by the Bill & Melinda Gates Foundation. Individual researchers received various additional funding grants.

The study was published in the peer-reviewed journal Science and is free to read online.

The media reporting was generally representative of the study and discussed the potential applications of such a device, as well as some of the hurdles that still remain.

What sort of research was this?

This was laboratory research describing the manufacture of a 3D microstructure that could be used for pulsed delivery of a drug or vaccine in a single injection.

The authors explained how 3D microdevices could be used for tissue engineering and drug delivery. Depending on size, shape and composition, the internal architecture of 3D microdevices offers greater potential than single-layer devices.

However, this research is still at the early experimental stage.

What did the research involve?

The researchers fully described the technique they used to create the microdevice. The methods are complex and only described in brief here.

The device was made of lactide-glycolide copolymers, the most widely used biodegradable polymers for human applications. The fabrication technique ("StampEd Assembly of polymer Layers" or SEAL) involves the technology used to produce computer chips.

The first layer of the microstructure is created using heated polymers in a silicone mould. This is then repeated, using microscopic alignment, to add layer upon layer to create structures smaller than 400 micrometres.

The process was tested by creating a number of different microstructures, including a 3D star, table and chair.

The researchers' main aim was to produce a microstructure that could be injected into the body and deliver timed pulses of different vaccines or drugs. They made a microstructure with hollow bases, filled these with a test solution and then carried out various experiments.

What were the basic results?

The researchers created a device that could give a controlled release of a substance. It delivered a fluorescently labelled test solution in a separate pulsed release, with no leakage prior to the set release time.

The sealed structures, filled with two labelled sugar solutions set to be delivered in separate pulsed releases, were then injected into a group of mice.

This group was then compared with mice that received the solutions via two separate injections timed to match the release from the microstructures. When tested after one week and then again after one month, levels of the test solutions were higher in the blood of the mice that received the single injection.

The microstructure and its pulse-release capacity were also stable under variations of temperature and acidity.

How did the researchers interpret the results?

The researchers said: "These experiments demonstrate that one injection of core-shell particles can induce a long-term antibody response, outperform multiple time-matched injections, and achieve twofold dose sparing."

Conclusion

Injection of a microstructure device that can give time-delayed release of a vaccine or drug could have great potential in medicine.

As the researchers noted, the structures are tiny and fully biodegradable, so they shouldn't cause a foreign-body reaction.

But they also mentioned the size – the lightweight device could only hold a small amount of solution. However, the researchers suggested that varying the wall thickness to create larger cores could greatly increase the device's capacity.

At this stage, the device has only been tested in a single experiment in mice. Further research in mice would be needed to see whether you could move on to testing it in humans. It's very difficult to stay at this stage which human vaccines the device could potentially be used for or what obstacles there could in terms of safety and effectiveness.

Various experts have given their response to the findings.

Dr Anita Milicic, senior scientist at the University of Oxford's Jenner Institute, said: "Single-dose vaccination has been a long-standing goal of the WHO [World Health Organization]: since the early 1990s researchers have been trying to create a vaccine formulation that is capable of delivering the equivalent of two or three prime-boost vaccinations with a single immunisation.

"Achieving this would circumvent many obstacles that immunisation coverage faces today: non-compliance, missed or delayed doses, logistical problems of vaccine storage and administration in hard to reach parts of the world, wastage of expired/unused doses, and so on."

Dr Kevin Pollock, honorary lecturer in infection, immunity and inflammation at the University of Glasgow, cautioned: "It may be as long as 15 to 20 years before such delivery systems could be used in vaccines.

"It is not yet well understood how the human immune system would respond as it is much more used to receiving a single dose, being allowed to recover and then being immunised again.

"This demonstrates the difficulty of going from in vitro or in vivo systems using mice to a vaccine ready to be rolled out in the NHS. This group are not even at this point. Therefore, there is much work to be done to consider the safety of these vaccines."

Find out more about the current childhood vaccination schedule in England.

Links To The Headlines

Scientists invent jab that could deliver every childhood vaccine in one go. The Independent, September 16 2017

New technology could allow multiple vaccines to be delivered in single jab. The Guardian, September 14 2017

Links To Science

McHugh KJ, Nguyen TD, Linehan AR, et al. Fabrication of fillable microparticles and other complex 3D microstructures Science. Published online September 15 2017

"Women get bored of having sex with their partner after just a year together, a new study suggests," is the rather crass story in the Mail Online.

The news is based on research that actually found multiple factors increased the likelihood of both men and women reporting a lack of interest in sex.

The findings come from interviews with more than 10,000 men and women in the UK about their sex lives.

Lack of interest in sex was associated with being in poor health, being in longer relationships (for women), and living with your partner – and varied with age.

Those who found it easier to talk about sex were less likely to report a lack of interest.

Where did the story come from?

The study was carried out by researchers from the University of Southampton, University College London, the London School of Hygiene and Tropical Medicine, and the University of Glasgow.

It was funded by the Medical Research Council, the Wellcome Trust, the Economic and Social Research Council, the Department of Health, and the Scottish Government Chief Scientist Office.

The study was published in the peer-reviewed journal BMJ Open on an open access basis and is free to read online.

As you'd expect, the study was covered widely in the UK media. The reporting was generally accurate, though statements like "how women get bored of having sex with their partner after just 12 months" in the Mail Online generalise the findings somewhat.

We don't know why some people lack interest in sex – boredom isn't mentioned in the study, and the majority of women in relationships lasting longer than a year didn't actually report a loss of interest in sex.

What kind of research was this?

This cross-sectional survey looked at factors associated with reporting a lack of interest in sex and examined if – and how – these differ by gender.

This type of research is good for looking at the attitudes and behaviours of a large number of people, but only investigates them at a single point in time, so trends over time and longer term outcomes can't be assessed.

And it also doesn't show cause and effect – in other words, it can't show that any one of the factors investigated can on its own lead to a lack of interest in sex.

There may be many personal reasons for a lack of interest that weren't investigated in this study.

What did the research involve?

The research used data taken from the third UK National Survey of Sexual Attitudes and Lifestyles (Natsal-3).

The survey involved 4,839 male and 6,669 female respondents aged 16 to 74 who reported having one or more sexual partners in the past year.

This study looked at factors associated with a lack of interest in sex.

The computer-assisted interviews took place in participants' homes with professional interviewers. Computer-assisted self-interviews were used for more sensitive questions.

Participants who'd had one or more sexual partners in the past year were asked: "In the last year, have you experienced any of the following for a period of three or more months?". They were given a list of difficulties, including "lacked interest in having sex".

Those reporting lacking interest in sex for at least three months were then asked how they felt about this, from "not at all distressed" to "very distressed".

Those answering a little, fairly or very distressed were defined as lacking interest in sex and having distress about it respectively.

The researchers then looked at the likelihood that reporting a lack of interest in sex lasting three or more months was associated with a range of factors, including:

• leaving school at 16
• unemployment
• poor health
• current depression
• frequency of sexual activity
• recent masturbation
• relationship status
• ease of communication about sex
• pregnant or having children
• previous sexually transmitted infection diagnosis

Analyses were then broken down by gender and age groups.

What were the basic results?

Overall, 15% of sexually active men and 34.2% of sexually active women reported lacking interest in sex for at least three months before the interview.

Having sex five or more times compared with not at all in the past four weeks reduced the likelihood of reporting a lack of interest in sex by 61% in men (odds ratio 0.39, 95% confidence interval 0.30 to 0.51) and 59% in women (OR 0.41, 95% CI 0.34 to 0.49).

Compared with women who'd been in a relationship for less than a year, women in a relationship for 1 to 5 years were 45% more likely to lack interest in sex (OR 1.45, 95% CI 1.2 to 1.76), and those in relationships for 5 to 15 years were almost 2.5 times more likely to lack interest in sex (OR 2.37, 95% CI 1.96 to 2.86).

These findings were only true for women, with no significant increase in likelihood found for men.

Women in a steady relationship but not living with their partner were 41% less likely to lack interest in sex compared with those living with their partner (OR 0.59, 95% CI 0.49 to 0.71). There was no significant difference for men.

Men were most likely to lack interest in sex between the ages of 35 and 44, with 17.2% reporting a lack of interest (95% CI 14.5% to 20.4%), and women were most likely to lack interest between the ages of 55 and 64, at 38.8% (95% CI 34.5% to 43.2%).

Finding it difficult to talk about sex, having depressive symptoms, being in "fair" or "bad" health, and not feeling emotionally close when having sex all increased the likelihood of a lack of interest in sex for both men and women.

How did the researchers interpret the results?

The researchers concluded: "Both gender similarities and differences were found in factors associated with lacking interest in sex, with the most marked differences in relation to some relationship variables.

"Findings highlight the need to assess and, if appropriate, treat lacking interest in sex in a holistic and relationship-specific way."

Conclusion

This study appears to suggest that many factors increase the likelihood of both men and women reporting a lack of interest in sex. Overall, women seem to be more likely to lose interest than men.

While this large study provides some insight into the possible reasons behind having a lack of interest in sex, it has a few limitations:

As so many factors were considered, there were bound to be some that showed statistical significance – this could just be by chance.

The cross-sectional nature of the study means we can't be sure if the specific factors reported on caused the lack of interest, or vice versa.

People self-reported their sexual activity – this might lead to biased reporting, as people might under- or over-report certain factors.

If your sex life isn't fulfilling, there are steps you can take to make it better.

A good start is talking to your partner about how you feel about your current sex life in an honest and open way.

Read more advice about improving your sex life.

Links To The Headlines

Women 'more likely to lose interest in sex than men'. BBC News, September 14 2017

The one-year itch: How women get bored of having sex with their partner after just 12 months (but the interest in steamy nights doesn't fade for men). Mail Online, September 14 2017

Women are more likely to get bored of sex with a long-term partner, suggests new study. Metro, September 14 2017

Women are more likely to lose interest in sex if they move in with their boyfriend, expert warns. The Sun, September 14 2017

Women more likely to lose interest in sex in long-term relationships. The Daily Telegraph, September 14 2017

Women more likely to lose interest in sex after a year. The Times (subscription required), September 14 2017

Links To Science

Graham CA, Mercer CH, Tanton C, et al. What factors are associated with reporting lacking interest in sex and how do these vary by gender? Findings from the third British national survey of sexual attitudes and lifestyles. BMJ Open. Published online September 13 2017

"Tattoos could give you cancer, new research suggests," is the entirely unsupported claim from the Mail Online.

The news come from a study that found evidence particles from tattoo ink can spread into lymph nodes – but it hasn't been proven that tattoo ink causes cancer.

Researchers used samples of skin and adjacent lymph nodes taken from six donors after autopsy.

Four of the donors had tattoos and were more likely to have substances like titanium in the lymph nodes. Lymph nodes are part of the lymphatic system, which in turn is part of the immune system.

The problem is the researchers didn't include important information about whether any of the donors had cancer, or what caused their deaths. This means it's not possible to claim that the tattoo ink particles found in lymph nodes cause cancer.

Tattoos have become far more popular in recent years, leading to concerns about their safety. The ink used in tattoos includes a mixture of organic and metal-based pigments and preservatives.

There's been little study of their effects on human health. This is partly because animal experiments are thought to be unethical, as tattoos are a matter of choice, not medical necessity.

Most safety concerns have focused on the need to ensure tattoo artists use sterile needles to prevent the spread of blood-borne diseases, such as hepatitis C.

We don't know whether the spread of ink particles into lymph nodes would have any significant impact on human health, let alone cause cancer.

Where did the story come from?

Researchers were from the German Federal Institute for Risk Assessment, Physikalisch-Technische Bundesanstalt, and the Institute of Forensic Medicine in Germany, and the Department of X-ray Spectrometry European Synchrotron Radiation Facility in France.

The research was published in the peer-reviewed journal Scientific Reports on an open access basis, so it's free to read online.

The Guardian's reporting is balanced and accurate. But the Mail Online's coverage is less accurate, focusing on the "controversial" chemical titanium dioxide found in some tattoo inks, stating it's been "linked to cancer".

There's no evidence titanium dioxide is linked to cancer except possibly when inhaled, which would usually only be a risk for people who work in manufacturing.

What sort of research was this?

This post-mortem research was carried out on tissue samples from people with and without tattoos.

The researchers used a variety of techniques, including X-ray fluorescence imaging, to measure levels of dyes and metals in skin and lymph nodes.

Lymph nodes are part of the body's immune system, and are located in the neck, armpits and groin.

Tiny foreign bodies such as nanoparticles of pigment can be swept up by lymph fluid or blood cells and transported to the lymph nodes.

The research doesn't tell us what effect these findings might have on people's health.

What did the research involve?

Researchers took samples of tattooed skin and lymph nodes from four people with tattoos and two people without to act as a control sample.

They ran a series of experiments to identify the types of pigments and particles in the skin and lymph nodes to see whether ink particles travelled to the lymph nodes and persisted there.

They also looked at tissue surrounding ink particles to see whether it differed from tissue not close to ink particles.

Using a range of techniques, they set out to answer four questions:

• Do organic pigments travel from the skin to the lymph nodes?
• Do people with tattoos have more potentially toxic metals in their skin and lymph nodes?
• What size are particles from pigments, and what size are the particles that travel to lymph nodes?
• Do the particles affect surrounding tissue?

They used a number of advanced spectroscopy techniques to analyse the tissue.

Spectroscopy involves analysing a sample of organic matter by measuring the wavelength of the spectrum of light it produces – different elements produce distinct lines on the spectrum.

What were the basic results?

The researchers found:

• Organic pigments in both skin and lymph nodes from two of four tattooed donors. Two donors had no organic pigments in their lymph nodes, possibly because they were at low levels or had degraded. The most common organic compound in tattoo ink, carbon black, was "not accessible" with the methods used in the study.
• Higher levels of five "toxic" elements in the skin and lymph nodes of people with tattoos. The elements identified were aluminium, chromium, iron, nickel and copper.
• Traces of the element titanium (probably from the white pigment titanium oxide) in the skin and lymph nodes of people with tattoos. Micro-X-ray absorption showed this was "mostly" present in its more stable, less toxic, "rutile" form.
• Particle size varied a great deal depending on the type of pigment. Smaller pigments were more likely to be found in the lymph nodes, although relatively large titanium oxide particles were also found in lymph nodes.
• "Biomolecular" changes to tissue around pigment particles in the skin and lymph nodes. The researchers say the tissue near particles had higher levels of lipids and lower levels of proteins than similar tissue without particles.
• They also found protein in the tissue around particles had a changed structure in both the skin and lymph nodes.

How did the researchers interpret the results?

The researchers said they found "strong evidence for both migration and long-term deposition of toxic elements and tattoo pigments" from tattoos on the skin into the lymph nodes.

They added they have found evidence for "alterations of biomolecules" in the tissues of skin affected by pigment particles, which may contribute to skin inflammation "and other adversities" connected with tattooing.

Conclusion

If you already have a tattoo, there's nothing in this study that should alarm you. It doesn't show that people with tattoos are more likely to get cancer, despite the scaremongering headlines.

The researchers explain how tattoo pigments are picked up as "foreign bodies" by the body's immune system and are then stored in the skin and lymph nodes.

But they can't tell us what effects this process has on our health. The researchers weren't told any medical information about the donor samples, such as any diseases they had (including cancer) or the cause of donors' deaths.

The study also has other limitations. It looked at samples from a small number of people, and an even smaller number of controls.

And some of the findings might not be linked to tattoos – for example, higher levels of iron in the lymph nodes might come from blood within the samples, and aluminium in armpit lymph nodes could be from antiperspirants.

If you're considering getting a tattoo, it might be worth thinking about whether you want to introduce pigments that include metals into your body unnecessarily.

While we don't know much about the possible effects now, harmful long-term effects can't be ruled out.

As well as asking a tattoo artist about the hygiene of their tattooing equipment, it may also be worth asking them about the types of pigments they plan to use and what's in them.

Titanium dioxide, for example, is known to increase inflammation and can delay healing.

Links To The Headlines

Why tattoos could give you cancer: toxins in inkings stay in your bloodstream for life and accumulate in lymph nodes. Mail Online, September 12 2017

Tattoo ink contaminants can end up in lymph nodes, study finds. The Guardian, September 12 2017

Links To Science

Schreiver I, Hesse B, Seim C, et al. Synchrotron-based ν-XRF mapping and μ-FTIR microscopy enable to look into the fate and effects of tattoo pigments in human skin. Scientific Reports. Published online September 12 2017

"There is little evidence having the occasional drink while pregnant harms a baby," reports the Mail Online.

This follows a review of international research looking at whether low-to-moderate alcohol consumption – no more than 1 to 2 units, once or twice a week – was linked with adverse pregnancy outcomes. To put this in context, a pint of low-strength lager contains about 2 units of alcohol, a small glass (125ml) of 12% wine contains 1.5 units and a single shot of spirits contains 1 unit.

The review found that low-to-moderate alcohol consumption may slightly increase the risk of having a baby small for gestational age.

The Chief Medical Officers for the UK currently recommend that pregnant women, or those planning to become pregnant, avoid drinking any alcohol at all to keep risks to a minimum. Long-term health risks for the baby are greater the more alcohol you drink.

And as the researchers conclude, no evidence of harm is not the same as evidence of no harm: there could still be risks that haven't been identified.

However, the research does provide reassurance that women who have drunk small amounts of alcohol during pregnancy, or before they knew they were pregnant, are unlikely to have harmed their baby.

Where did the story come from?

The study was carried out by researchers from the University of Bristol in the UK. It was funded by the UK Medical Research Council, the University of Bristol, the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, and the Higher Education Funding Council for England.

The study was published in the peer-reviewed medical journal BMJ Open on an open-access basis, meaning it's freely available to read online.

Media reporting of the study was generally accurate and responsible, making it clear that it's probably still best to avoid alcohol during pregnancy.

Saying as The Guardian does, however, that "women worried by guidance advising abstinence should be told there is little evidence that the odd glass of wine causes harm to the baby" is a little misleading, as it could be interpreted to mean that there's definitely no harm in drinking. The reality is that there isn't enough research being done in the area, so we cannot firmly say whether or not it may be harmful.

What kind of research was this?

This was a systematic review and meta-analysis study looking at the effect of low-to-moderate alcohol intake in pregnancy (fewer than 2 UK units, no more than twice a week) on pregnancy and longer-term infant outcomes.

While this is a good way of summarising all evidence on a particular issue, systematic reviews will include any limitations of the studies reviewed. It wouldn't be ethical to randomise pregnant women to consume alcohol or not, so most studies are observational – such research cannot prove that a certain level of alcohol intake has directly caused any adverse outcomes.

It's also difficult to be sure of exact alcohol intake, and a range of other health and lifestyle factors may contribute to the outcome too.

What did the research involve?

Researchers looked at 24 cohort and two quasi-experimental studies (which don't involve randomisation) from a range of high-income countries, including the UK.

Low-to-moderate alcohol intake was defined as 32g a week (1 or 2 units, once or twice a week) as this was the "safe" threshold cut-off previously specified by UK guidelines. There has been a recent move among guideline development groups to recommend total abstinence during pregnancy.

Pregnancy outcomes assessed included:

• stillbirth (pregnancy loss after week 24)
• miscarriage (loss before week 24)
• pregnancy duration and premature delivery (less than 37 weeks)
• hypertensive disorders of pregnancy
• gestational diabetes
• baby born small for gestational age
• birth size (weight, length and head circumference)
• low birth weight (under 2.5kg)
• low amniotic fluid, placenta previa and placental abruption
• assisted delivery (using forceps, for example)
• Apgar score at birth and admission to neonatal unit (Apgar scores assess the health of a newborn on a scale from 1 to 10, based on factors such as heart rate and breathing patterns)
• congenital malformation

They also looked at features of foetal alcohol syndrome disorder (birth defects caused by heavy alcohol consumption in pregnancy), including childhood growth restriction, head size and circumference, developmental delays, behaviour problems, cognitive impairment and IQ, and facial malformations.

Researchers looked at whether study results had been adjusted for potential confounders, including socioeconomic status, smoking during pregnancy, maternal age and ethnicity.

What were the basic results?

Of the 24 studies, 17 were suitable to be pooled in a meta-analysis for four outcomes: birth weight, small for gestational age, premature birth and low birth weight (under 2.5kg).

There was modest evidence that low-to-moderate alcohol consumption gave an 8% increased risk of being small for gestational age compared with abstinence (odds ratio 1.08, 95% confidence interval 1.02 to 1.14).

This was from pooled results of seven studies, although 95% of the participants came from a single US study.

Low-to-moderate alcohol consumption had no significant effect on the likelihood of a low birth weight (six studies) or premature birth (nine studies). Seven studies also found no significant difference in the average infant birth weight between drinkers and non-drinkers.

For all other outcomes, there was not enough data to combine the results or reach firm conclusions.

How did the researchers interpret the results?

The researchers concluded there is "limited evidence for a causal role of light drinking in pregnancy, compared with abstaining, on most of the outcomes examined".

They added: "Despite the distinction between light drinking and abstinence being the point of most tension and confusion for health professionals and pregnant women and contributing to inconsistent guidance and advice now and in the past, our extensive review shows that this specific question is not being researched thoroughly enough, if at all."

Conclusion

The results of this review found that low-to-moderate alcohol consumption during pregnancy was linked with a slightly increased risk of having a baby small for gestational age.

However, there was no evidence for any other links, including any difference in the average birth weight of babies born to drinkers and non-drinkers.

There are some important limitations of the research to note:

• The evidence still doesn't prove that drinking directly increases the risk of a baby born small for gestational age. Studies were observational and varied widely in accounting for the extensive number of confounding factors that could be having an influence, such as maternal lifestyle and diet. And even when factors such as socioeconomic status were adjusted for, they may still have had some residual confounding effects.
• Because studies were observational, it's hard to be certain of exact alcohol intake. It may have varied week to week, and many women may not have been able to accurately judge the number of units of alcohol they had.
• As the authors acknowledge, there was little evidence available for many pregnancy and birth outcomes, and the studies weren't suitable for pooling. As such, we can't be sure that being small for gestational age – if this is a true risk – is the only one associated with drinking during pregnancy.

The research generally supports the opinion that it's difficult to say what a "safe" amount of alcohol is for women who are pregnant or trying for a baby.

The current advice from UK Chief Medical Officers is that, if pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all. They say drinking in pregnancy can lead to long-term harm to the baby, with the risk becoming greater the more you drink.

They also advise that women who find out they're pregnant after already having drunk in early pregnancy should avoid further drinking but shouldn't worry unnecessarily, as the risks of their baby being affected are likely to be low.

Links To The Headlines

Little evidence that light drinking in pregnancy is harmful, say experts. The Guardian, September 11 2017

'Weak evidence' light alcohol use in pregnancy harms. BBC News, September 12 2017

Light drinking in pregnancy 'unlikely' to harm babies, but experts caution lack of evidence. The Daily Telegraph, September 11 2017

Light drinking during pregnancy 'may be OK' as researchers find limited evidence of harm. The Sun, September 12 2017

'No proof' that the odd glass of wine harms your baby, despite Government advice to abstain while pregnant. Mail Online, September 12 2017

Links To Science

Mamluk L, Edwards HB, Savovic J, et al. Low alcohol consumption and pregnancy and childhood outcomes: time to change guidelines indicating apparently 'safe' levels of alcohol during pregnancy? A systematic review and meta-analyses. BMJ Open. Published online September 11 2017

"It's not what you eat, it's when you eat that matters: study shows timing your meals right is the key to beating obesity," the Mail Online reports.

The headline was prompted by a small US study involving 110 university students.

Researchers gave them activity monitors to wear, measured their sleep patterns, and observed how much they ate and at what time.

The researchers were particularly interested in what they termed dim-light melatonin onset (DLMO). DLMO is when the body begins to wind down in preparation for sleep and starts producing the sleep hormone melatonin.

For most of us, our DLMO usually begins around 8pm. But the timing can vary if you do shift work.

The researchers found students with a higher body weight tended to eat more of their calories later in the day, closer to their DLMO.

This adds to previous evidence suggesting it's good to consume more of our calories earlier in the day, when we have more opportunities to be active ahead of us. Eating large, heavy meals late in the evening has also been linked with higher body fat.

But as a single study in a small, specific sample of students, this study provides little evidence that lifestyle and eating habits have a direct effect on body weight.

As advice goes, it may be sensible to consider whether regularly eating a large, heavy meal close to bedtime is the best thing for your health and wellbeing.

Eating earlier in the day may not make you magically thinner, but it may help prevent night-time indigestion.

Where does the study come from?

The study was conducted by researchers at Brigham and Women's Hospital and Harvard Medical School in the US, and the University of Murcia in Spain.

It was published in the peer-reviewed American Journal of Clinical Nutrition.

No external sources of funding are reported for the study, although the authors declared various conflicts of interest as many of them work, or have worked, for a wide range of commercial interests.

The Mail Online's coverage was accurate, but may have benefitted from noting the limitations of this small, cross-sectional study.

What kind of research was this?

This cross-sectional study aimed to see whether timing of eating, particularly eating at a later hour in the evening, was related to body clock and the amount of calories consumed.

The human body normally defaults to a 24-hour light-dark, wake-sleep cycle. Put simply, we wake up when it's light and go to bed when it's dark.

But with electrical lighting and modern lifestyles, we're now able to control our own wakefulness, and can stay awake and eat late into the evenings.

Various studies suggest eating at a time naturally reserved for sleeping could have adverse effects on weight and metabolic health.

This study observed the eating and activity patterns and body measurements of some university students across the course of a week.

You can observe links in this type of study, but you can't prove cause and effect.

What were the basic methods?

The study recruited 110 university students aged 18 to 22. They took part in a 30-day sleep-wake monitoring study, where they were instructed to wear a wrist actigraph monitor at all times.

An actigraph is a device that can provide a reasonably accurate estimate of time spent asleep by measuring physical activity and light exposure.

The students also kept daily sleep and exercise diaries. Sleep timing and duration was assessed from the actigraph monitor and correlated with the diaries.

For 7 consecutive days in the middle of the course, participants were asked to record all the food and drink they consumed.

They did this using a mobile app that allowed them to take photos of all the food they ate and record which meal or snack this was.

They also came in for a single night's sleep in the study lab, where they had saliva samples taken in dim-light conditions to measure levels of the sleep hormone melatonin.

Release of melatonin marks the start of the biological night, when our body clocks begin to shift into sleep mode.

Researchers assessed meals, calories consumed, and their timing against sleep, activity and body fat.

What were the results?

The study gives a breakdown of the average calories consumed and their timings.

There was no difference between students with higher and lower body fat in the timing of melatonin release.

But researchers noticed that for individuals with higher body fat, the midpoint of all the calories they consumed for the day was later than for leaner people, and 1 hour closer to the onset of melatonin release.

And those with a calorie intake-midpoint later in the day were also more likely to consume a greater number of calories at this time. People eating more calories later in the day also tended to have less sleep.

What do the researchers conclude?

The researchers said: "These results provide evidence that the consumption of food during the circadian evening and/or night, independent of more traditional risk factors such as amount or content of food intake and activity level, plays an important role in body composition."

Conclusions

Previous research suggests we may be better off consuming more of our calories earlier on in the day, when we have a full, active day ahead of us to use up the energy.

It's also been observed that people who consume large calorific meals late in the evening can have a higher body weight.

In a sense, the results of this study seem plausible and don't really say anything different from what's already been observed. But as this is a cross-sectional study, it can't really prove very much.

The study involved a small, select sample of US university students. Their results can't be applied to everyone, as they have different lifestyles and sociodemographics from the general population.

And a cross-sectional study can only show associations – it can't prove cause and effect.

The participants' body weight was assessed at the same time as their food intake and sleep patterns.

Though again it seems plausible, we can't assume that the students' lifestyle and eating habits have directly caused their current body weight.

This study will doubtless contribute to the body of evidence around timing of food intake, relationship to the sleep-wake cycle, and body weight. But it provides little proof as a single piece of evidence.

The best way to achieve and maintain a healthy weight is to eat a balanced diet high in fruit and vegetables and low in saturated fat and sugars, and to get regular exercise.

Read more advice on how to eat a healthy, balanced diet.

Links To The Headlines

It's not what you eat, it's when you eat that matters: study shows timing your meals right is the key to beating obesity. Mail Online, September 8 2017

Links To Science

McHill W, Phillips AJK, Czeisler CA, et al. Later circadian timing of food intake is associated with increased body fat. The American Journal of Clinical Nutrition. Published online September 6 2017

"Why the Mediterranean diet is the best cure for acid reflux: Study found patients who ate plenty of fish and veg had fewer symptoms and avoided side effects of medication," the Mail Online reports.

Acid reflux, also known as gastro-oesophageal reflux disease (GORD), is a condition where stomach acid leaks back up into the gullet, causing pain. Standard treatment for GORD is a type of medication known as a proton-pump inhibitor (PPI), which reduces the amount of acid produced by the stomach.

This latest study looked at the medical records of people with GORD to compare whether taking PPI treatment or following a Mediterranean-style diet with alkaline water was better at reducing symptoms. A Mediterranean diet is largely based on vegetables, fruits, nuts, beans, cereal grains, olive oil and fish.

The study found the dietary changes were equally good at reducing symptoms as PPIs. This suggests dietary changes could be a first option to try for reflux symptoms, which may avoid the need for some people to take PPIs.

However, drug-free treatment may not be suitable for everyone (for example people whose symptoms are linked with stomach irritation or ulcers). Also, completely changing your diet can be complex and nutritional guidance may be needed.

Nevertheless, switching to a Mediterranean diet brings other health benefits such as reducing your risk of heart disease. Read more about the benefits of a Mediterranean diet.

Where did the story come from?

The study was carried out by researchers from New York Medical College, New York Eye and Ear Infirmary of Mount Sinai and The Institute for Voice and Swallowing Disorders, Phelps Hospital, all in the US.

No sources of funding are reported. One author served on the scientific advisory board of Restech Corporation (a company that specialises in GORD treatment), for which he received no financial compensation. There were no other conflicts of interest reported.

The study was published in the peer-reviewed medical journal JAMA Otolaryngology – Head & Neck Surgery on an open-access basis, meaning it is freely available to access online.

The Mail Online's reporting is misleading and contradicts itself with the headline suggesting fish was one of the main dietary components in the Mediterranean diet, then going on to describe how the diet consisted of "barely any dairy or meat including beef, chicken, fish, eggs and pork". Fish is not actually mentioned in the paper at all, we only know they were minimising intake of meat and dairy.

What kind of research was this?

This was a retrospective cohort study looking back at medical records of people with acid reflux who had either been prescribed usual medication (proton pump inhibitors or PPIs) or changed their diet to a Mediterranean style and alkaline water (water that is less acidic than tap water). It aimed to compare effects on reflux symptoms.

Gastro-oesophageal reflux (GORD) is when stomach acid rises up into the oesophagus (gullet), which can cause heartburn and indigestion. Standard treatment can involve removing dietary triggers (such as fatty foods) and medication with acid-blocking tablets called proton pump inhibitors (PPIs). PPIs can however have mild side effects such as headaches, diarrhoea or constipation, feeling sick, tummy pain and dizziness.

A cohort can look at associations, but as this study is looking back in time at what people have previously done, it can be hard to assess or control for confounding factors that could have had an influence.

What did the research involve?

Researchers looked back at medical records of people diagnosed with GORD between 2010 and 2015 in the US. They compared two cohorts, one being treated with PPI medication and the other with a Mediterranean diet and alkaline water to determine differences in the improvement of acid reflux.

The first cohort of 85 participants, on average aged 60, were treated between 2010 and 2012 with one of two PPI drugs (esomeprazole or dexlansoprazole [not used in the UK]) and asked to follow standard advice to cut out coffee, tea, chocolate, fizzy drinks, greasy, fried, fatty and spicy foods, and alcohol from their diet.

The second cohort of 99 participants, on average aged 57, were treated between 2013 and 2015 with alkaline water (pH >8.0) and a plant-based, Mediterranean-style diet, and also cut out the same things from their diet as the first group.

Participants of the second cohort were asked to replace all drinks with alkaline water and eat 90-95% of their diet as a plant-based diet with vegetables, fruits, wholegrains and nuts with less than 5 to 10% from animal-based products for six weeks. To meet this, participants had to limit animal products to only 2 or 3 meals a week containing 3 to 4 ounces of meat, with minimal intake of dairy.

Compliance with medication or diet was assessed by a questionnaire and verbal discussion and those not complying were excluded.

The outcome researchers were measuring was the change in reflux symptoms using the Reflux Symptom Index (RSI) after six weeks of treatment. The RSI is a scoring system based on how many symptoms of GORD a person has, and how troublesome those symptoms are.

A clinically meaningful change in RSI score was a reduction of at least 6 points.

What were the basic results?

A meaningful 6-point reduction was achieved by 54% of the medication group compared with 62.6% in the alkaline water and Mediterranean diet group. This was not a statistically significant difference, but the changes in overall scores were:

• In the PPI group, RSI scores reduced by 27.2% (95% confidence interval [CI] 18.5% to 35.9%) from an average of 20.2 (95% CI 18.4 to 22) to 14.3 (95% CI 12.4 to 16.2).
• In the Mediterranean diet and alkaline water group, scores reduced by 39.3% (95% CI 33.1% to 45.5%) from an average of 19.1 (95% CI 17.6-20.6) to 12.1 (95% CI 10.4-13.7).
• The mean reduction was greater in the Mediterranean diet and alkaline water group (mean difference 12.1%, 95% CI 1.53 to 22.68).

How did the researchers interpret the results?

The researchers conclude that their "data suggest that the effect of PPI on RSI scores among patients with [GORD] is not significantly better than that of alkaline water and a plant-based, Mediterranean-style diet. In fact, our data suggest that the plant based approach is at least as good, if not better, than PPI therapy. Thus, we recommend that a patient with suspected [GORD] at least attempt a dietary approach prior to any pharmacological intervention".

Conclusion

The results of this relatively small cohort study seem to show that a plant-based Mediterranean diet with alkaline water is equally good as PPI medication at treating acid reflux symptoms when people also follow standard advice to cut out certain things from their diet.

This might suggest that the first port of call for people with gastro-oesophageal reflux could be to try a Mediterranean diet before going on PPI medication, to avoid potential side effects.

There are, however, some limitations to this research:

• Cohort studies can only show links and cannot prove definite cause and effect, and retrospective cohorts such as this are even more limited than prospective cohorts. Prospective cohorts that follow people up over time have the advantage that they can at least assess and collect data on other factors that could be having an influence. When you have to rely on previously collected data, you cannot be sure that all relevant information has been collected.
• We do not know exactly what people in each group were eating and we cannot tell what it was about the plant-based Mediterranean diet or alkaline water that might have provided a benefit. Food diaries or food frequency questionnaires might be one way to determine this in the future.
• Follow-up was only six weeks, which is not much time to see longer-term outcomes. It might be that either PPIs or the Mediterranean diet have a different effect in the longer term.
• We don't know for sure that the Mediterranean diet had no adverse effects – for example, it could have a detrimental effect on other health measures (such as vitamin and mineral levels). Therefore we can't say with confidence that it has no side effects compared with drug treatment.
• For this reason there may be a need for guidance from dietitians. Changes to the diet often require self-control and it can be complex and difficult to achieve and maintain nutrition merely by doctor recommendation.
• There will always be some people with reflux symptoms who need drug treatment, such as those with stomach irritation or ulcers.

Making changes to the diet and adopting a more Mediterranean-style diet might be one simple first option that people or practitioners could consider as a way of managing reflux.

Links To The Headlines

Why the Mediterranean diet is the best cure for acid reflux. Mail Online, September 7 2017

Links To Science

Zalvan CH, Hu S, Greenberg B, et al. A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngogly – Head and Neck Surgery. Published online September 7 2017

"Drinks industry downplaying alcohol-cancer link," The Guardian reports as new analysis has been published looking at the accuracy of health information circulated by the alcohol industry on the link between alcohol and cancer.

Many people still don't appreciate that alcohol can increase the risk of a range of cancers, such as breast, liver and mouth cancer.

As part of their corporate and social responsibility goals, the UK alcohol industry shares health information to inform and encourage their consumers to drink responsibly.

But the industry has been accused of misrepresenting the evidence to favour their own interests.

Researchers wanted to see if the health information produced by the alcohol industry is scientifically accurate.

They found the industry and affiliated organisations use three main approaches when disseminating health information:

• denial of the link between alcohol and cancer
• misinterpretation of the risk
• distraction by focusing on other risk factors for cancer, aside from alcohol consumption

Critics of the drinks industry have likened this approach to that of the tobacco industry in the 1960s and 70s, when the link between smoking and lung cancer was first proved.

The UK Chief Medical Officers' recommendation is men and women drink no more than 14 units a week, spread evenly over three days or more.

Where did the story come from?

The study was carried out by researchers from several institutions, including the London School of Hygiene and Tropical Medicine, the Karolinska Intitutet in Sweden, and the University of Tromsø in Norway.

No sources of external funding were reported.

It was published in the peer-reviewed journal Drug and Alcohol Review. It's available to read online for free on an open access basis.

Generally, the UK media coverage was balanced and accurate.

What kind of research was this?

This qualitative analysis aimed to investigate the comprehensiveness and accuracy of the health information disseminated by the alcohol industry on the links between alcohol and cancer.

It's well established that drinking alcohol is associated with an increased risk of at least seven types of cancer, including mouth, throat, oesophageal, liver, breast and colon cancers.

Alcohol is reportedly responsible for approximately 4% of new cancer cases every year.

Despite the volume of evidence, the alcohol industry has disputed the relationship between drinking alcohol and cancer.

This research highlights important themes and strategies used by the alcohol industry.

But it's unclear whether the sources and websites included in the research were chosen in a systematic manner.

A systematic review, where the search methodology is determined in advance, would be a better way to look into this thoroughly.

What did the research involve?

The researchers analysed websites and documents from 27 organisations linked to the alcohol industry.

They checked information published on cancer and alcohol between September and December 2016.

The websites were identified using the Global Alcohol Producers website and progress reports.

The researchers looked for related themes, and checked the reliability and validity of the content and whether representative scientific examples were used, before identifying the strategies the industry used to circulate the information.

What were the basic results?

The researchers found between 24 and 26 of organisational websites misrepresented or omitted scientific evidence confirming the link between alcohol consumption and cancer, particularly when discussing breast and colorectal cancers.

Three main strategies were identified.

Distortion

This is where the risk of cancer was mentioned, but the nature or size of that risk was obscured or misrepresented.

This was the most common strategy used by the alcohol industry.

The relationship between alcohol and cancer was presented in a highly complex way before implying that an independent link wasn't possible.

Three further approaches were found when this strategy was used:

• Claiming or implying that the risk only applies to particular patterns of drinking, such as heavy drinking or consumption for long periods of time.
• Claiming or implying that, as knowledge of the mechanism is incomplete, the evidence of a causal relationship isn't trustworthy, or there's a lack of consensus among experts.
• Claiming protective effects of alcohol on some cancers, thus confusing the picture of overall risk.

Denial or omission

This involves denying or disputing any link with cancer, or deliberately failing to mention the relationship.

Five out of the 27 organisations denied there was any association between drinking alcohol and developing cancer.

Examples include inaccurate claims that light to moderate drinking doesn't lead to an increased risk of developing cancer.

And some sources listed the short- and long-term effects alcohol has on the body, such as cardiovascular disease, diabetes, alcohol dependence and liver cirrhosis, but failed to mention cancer.

Distraction

This involved focusing discussion away from the independent effects alcohol has on common cancers.

Eight organisations used this strategy – by discussing a wide range of other risk factors associated with cancers, the industry is able to minimise the role alcohol plays in their development.

For example, for the link between alcohol and breast cancer, organisations pointed out that individuals were at high risk if breast cancer ran in the family, or said it's also age-related.

How did the researchers interpret the results?

The researchers concluded: "Our analysis suggests that the major global alcohol producers may attempt to mitigate this risk by disseminating misleading information about cancer through their 'responsible drinking' bodies.

"The existing evidence of strategies employed by the alcohol industry suggests that this may not be a matter of simple error."

Conclusion

This qualitative analysis aimed to determine the accuracy of health information circulated by the alcohol industry on the links between alcohol and cancer.

It found the industry and affiliated organisations use three main approaches:

• denial of the link between alcohol and cancer
• misinterpretation of the risk
• distraction by focusing on other risk factors

This analysis highlights how these strategies could be detrimental to public health.

Of course, it's possible, given this data was collected in 2016, that some of the websites and documents analysed by the researchers have since been updated.

Regardless, the researchers suggest their analysis has significant implications for both clinicians and policymakers.

They call for a full-scale investigation into how the alcohol industry represents the link between alcohol and cancer.

Current UK recommendations on alcohol advise that men and women drink no more than 14 units a week, with one unit equal to 10ml or 8g of pure alcohol.

Links To The Headlines

Drinks industry downplaying alcohol-cancer link – report. The Guardian, September 7 2017

Alcohol industry 'playing down' risk of cancer by using tobacco industry tactics. Sky News, September 8 2017

Links To Science

Petticrew M, Hessaei NM, Knai C, et al. How alcohol industry organisations mislead the public about alcohol and cancer. Drug and Alcohol Review. Published online September 7 2017

"Statins cut the risk of dying from heart disease by 28% among men, according to the longest study of its kind," The Guardian reports.

Statins help reduce the level of low-density lipoprotein (LDL), or "bad cholesterol", in the blood. This in turn helps reduce the risk of cardiovascular disease (CVD).

Current UK guidelines recommend that people with a 1 in 10 chance of developing CVD at some point in the next 10 years should be offered statins.

The results of this new analysis led the researchers to conclude that more people with high cholesterol should be offered statins.

Researchers looked at data for a sub-group of men who had high cholesterol, but no signs of heart or circulation problems, at the start of the study.

They analysed the effects of taking statins or a placebo during the five-year trial and after a 20-year follow-up period.

People took statins or not as recommended by their doctor during the follow-up period.

The researchers say men who took statins during the trial period were about 25% less likely to get heart disease or have a major event like a heart attack or stroke during the trial, and in the 20 years afterwards.

The study provides evidence to back current recommendations that people at risk of heart disease benefit from taking statins.

But it doesn't provide evidence that younger people should take them (as some papers reported) as everyone in the study was over the age of 45.

Where did the story come from?

The researchers were based at Imperial College London, the University of Glasgow, Università degli Studi di Milano, the University of Western Australia, and the Academic Medical Centre Amsterdam.

The study was published in the peer-reviewed journal Circulation. It was funded by Sanofi, a statin manufacturer.

It was based on an original study funded by statin manufacturers Bristol-Myers Squibb and Sankyo. Several of the researchers reported receiving fees from multiple drug manufacturers.

The UK media seems to have missed the point that this isn't a new study, but a new analysis of a landmark study that took place mainly in the 1990s.

Several reports refer to it as a "major new study", and the Mail Online says people were randomised to take either a statin or placebo for 20 years – even though the randomisation period lasted only five years.

Most news stories say the study means young people should be taking statins, which seems to be based on comments from one of the researchers, who also seems to have said that women would benefit as well, even though no women took part in the trial.

What kind of research was this?

This was a post-hoc (after the event) analysis of results from a previously published randomised control trial with a 20-year observational follow-up period. The main results from the study have already been published.

Post-hoc analysis is less reliable than initial analysis because researchers already know the main results – this means they can be accused of "cherry-picking" results to prove the point they wish to make.

In this case, they wanted to see the effects of statins on people who had high cholesterol, but no heart or circulation disease, at the start of the study.

What did the research involve?

The original study – known as the West of Scotland Coronary Prevention Study (WOSCOPS) – was an early statin trial.

WOSCOPS recruited 6,595 men aged 45 to 64 with LDL cholesterol levels over 155mg/decilitre, and randomly assigned them to take pravastatin (a relatively weak statin) or placebo.

The trial ran from 1989 to 1995. After it finished, the men were followed up for another 20 years, during which time they and their doctors decided whether they wanted to take statins or not.

Results for the original trial and follow-up period have been published already.

This new analysis looked at one sub-group – 5,529 men with no evidence of cardiovascular disease at the start of the study. Researchers looked separately at results for those with LDL cholesterol above or below 190mg/decilitre.

They recorded the men who'd either developed coronary heart disease (non-fatal heart attack plus death from coronary heart disease) or had a major cardiovascular event (death from cardiovascular disease, non-fatal heart attack, or non-fatal stroke) during the trial or at the 20-year follow-up.

What were the basic results?

During the trial period, men who took pravastatin were:

• 27% less likely to have coronary heart disease (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.59 to 0.89)
• 25% less likely to have a major cardiovascular event (HR 0.75, 95% CI 0.62, 0.91)

Results for men with and without cholesterol over 190mg/decilitre had very similar results.

After 20 years of follow-up, men who'd originally taken pravastatin were:

• 26% less likely to have coronary heart disease (HR 0.74, 95% CI 0.65, 0.84)
• 21% less likely to have a major cardiovascular event (HR 0.79, 95% CI 0.71 to 0.88)

Again, results were similar between those with higher and lower cholesterol levels.

How did the researchers interpret the results?

In the paper, the researchers concluded their analysis "provides for the first time evidence for the benefits of LDL-C lowering for the primary prevention of [coronary heart disease] in individuals with primary elevations of LDL-C ≥190 mg/dL", and that this "may help reinforce current recommendations for this group of patients".

But they seem to have gone further in their comments to reporters. Lead researcher Professor Kausik Ray told The Daily Telegraph that millions of people in their 20s and 30s could benefit from taking statins.

Conclusion

This new analysis found that men without cardiovascular disease who were prescribed a statin were less likely to go on to develop heart disease or have a major cardiovascular event.

These findings from the five-year randomised controlled trial are useful – there's been a lot of debate about whether giving statins to people without any cardiovascular disease is helpful.

But it's harder to draw conclusions from the longer-term results, as these were from a non-randomised observational period. Potential confounding factors – such as the men's attitude to medicine, risk and health – may have influenced the results.

The study has other limitations we should bear in mind:

• A post-hoc analysis is less reliable than a primary analysis because researchers are better able to cherry-pick the results they want.

• The original study was carried out more than 20 years ago. Statins used today are usually stronger than those in the WOSCOPS study, and people's lifestyles nowadays are different. For example, more than 40% of men in the study smoked – this is much higher than today's smoking levels. The results may not be applicable to people today.

• The researchers found little difference between outcomes for men with higher or lower cholesterol levels. That makes it hard to back up their conclusions that cholesterol is the most important factor and people with raised cholesterol are most in need of treatment, regardless of other factors like age.

Guidelines from the National Institute for Health and Care Excellence (NICE) in the UK recommend that people are offered statin treatment if their risk of a cardiovascular event, such as a heart attack or stroke, is at least 10% over 10 years.

People in this category should discuss the options with their GP. NICE has a decision aid to help people make up their minds.

Lifestyle measures that can reduce your cholesterol and risk of CVD include:

• eating a healthy, balanced diet
• exercising regularly
• maintaining a healthy weight
• limiting the amount of alcohol you drink
• stopping smoking

Read more advice about treating high cholesterol.

Links To The Headlines

Statins cut the risk of heart disease death by 28% among men, study shows. The Guardian, September 6 2017

Statins DO work: Cheap pills slash heart attack and stroke deaths by 28% in men, 20-year study finds. Mail Online, September 7 2017

Millions of healthy younger adults ‘should take statins to prevent heart attacks’. The Sun, September 7 2017

Statins cut heart deaths by 28%. The Times (subscription required), September 7 2017

Links To Science

Vallejo-Vaz AJ, Robertson M, Catapano AL, et al. LDL-Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men with Primary Elevations of LDL-Cholesterol Levels of 190 mg/dL or Above: Analyses from the WOSCOPS 5-year Randomised Trial and 20-year Observational Follow-Up. Circulation. Published online September 6 2017