The popular Dukan diet has been slammed as “ineffective and without scientific basis”, The Daily Telegraph has today reported. The newspaper says that the British Dietetic Association has criticised a range of celebrity diets, including the Dukan diet rumoured to be used by Kate Middleton.

Anticipating the huge surge in dieting around Christmas and New Year, the association has drawn up a list of five 'fad diets' that slimmers may be considering after reading about celebrities using them to stay trim. According to the British Dietetic Association (BDA), the top diets to avoid are:

• The Dukan diet: this restrictive, complicated diet includes phases of eating only protein and avoiding a number of foods. Kate Middleton, Jennifer Lopez and Gisele Bundchen are reported to be fans. However, the BDA says ‘there is absolutely no solid science behind this at all’ and cutting out food groups is not advisable. They point out that even Dr Dukan himself warns of side effects such as a lack of energy, constipation and bad breath.
• Alcorexia: this is where people heavily restrict what they eat during the day so they can save calories and drink more alcohol without gaining weight. The BDA says, ‘to do this in order to ‘bank’ your calories so you can go a use them on alcohol is pure madness and could easily result in alcohol poisoning and even death’. The association says it has had a worrying rise in press enquiries about this dangerous practice.
• The Blood Group diet: this diet restricts what people can eat based on their blood group. Its premise is that only certain blood groups can handle certain foods. Cheryl Cole and Sir Cliff Richard are rumoured to be devotees. The BDA says the diet ‘is completely based on pseudo-science’, and could lead to serious nutrient deficiencies.
• The Raw Food Diet: as its name suggests, this diet, reportedly followed by Demi Moore and Natalie Portman, focuses on eating food raw but also on eating only unpasteurised dairy products. Although some vegetables are more nutritious when eaten raw, the BDA points out that it means many nutritious foods cannot be eaten at all, and that it carries a risk of food poisoning.
• The Baby Food diet: this diet, made famous by reports that Lady Gaga is a fan, calls for people to eat up to 14 jars of puree or baby food each day. The BDA says that it is a restrictive diet as baby food provides few calories and lacks fibre or texture. Without chewing on firmer food at meal times you may be left feeling hungry.

Sian Porter, consultant dietitian and spokesperson for the BDA says, ‘Sadly, there is no magic wand you can wave. If you have some weight you need to lose, then do it in a healthy, enjoyable and sustainable way. In the long term this will achieve the results you are after.’

But isn't there proof supporting the Dukan diet?

Among the diets chosen by the BDA, the Dukan diet stands out as the most popular, with millions of people around the world having tried it in recent years. In particular, the interest has grown even further since newspapers reported that Kate and Pippa Middleton may have used the diet to slim down before the royal wedding.

However, while the diet is hugely popular it has come under some serious criticism from organisations such as the BDA. In addition to their damning conclusion that there is ‘absolutely no solid science behind this at all’, a respected French health publication has said they could not find any scientific reports that supported a long-term impact from the diet.

Unable to find this evidence, Le Journal des Femmes Sante surveyed followers of the diet and found that despite rapidly losing weight in the initial, restrictive phases of the diet, the vast majority regained all the weight they had lost within the next few years.

In addition, given the rise of restrictive diets such as the Dukan plan, the French Agency for Food, Environmental and Occupational Health and Safety reportedly published warnings against the nutritional deficiencies that restrictive diets might cause. The agency also highlighted the potential long-term effects of these restrictive diets, especially the tendency for most restrictive dieters to regain the weight they had lost.

Does the Dukan diet work in the long term?

While many Dukan diet users have reported impressive weight loss results in the initial phases of the diet, many organisations feel there is a lack of solid scientific evidence on whether the Dukan diet is sustainable and effective in the long term.

While survey results must be approached cautiously, as they are less robust than scientific studies, the results gathered by Le Journal des Femmes Sante give perhaps the best indication to date on whether the Dukan diet actually produces lasting results. Based on the survey of nearly 5,000 Dukan dieters:

• 35% of respondents regained all the weight they had lost less than a year after starting the diet
• 48% regained the weight within a year
• 64% within two years
• 70% within three years
• 80% over a period of more than four years

The study's authors say,’These results explain why people give positive feedback when interviewed during the first year. They also confirm that in the medium and long term, the Dukan diet is no more efficient than any of the other restrictive diets.

‘When the diet fails, the weight regain accelerates after six months. For 50% of respondents it occurs most of the time between six months and two years after the start of the diet.’

The authors of the report say that these results are consistent those from a 2009 survey on restrictive diets conducted by the French health authorities.

What might stop the Dukan diet working in the long-term?

Again, the reported lack of long-term research means it is difficult to tell, but the report offers some insight from both dieters and medical experts.

The stabilisation phase

Around two-thirds of people that failed to complete the diet said they did not get through the 'stabilisation phase' of the diet, the fourth and final stage in the regime. It includes features such as a dedicated protein day and the inclusion of simple exercises. Some detractors of the diet have said that it is too hard to follow and that adjusting to this phase is too difficult.

The yo-yo effect

The report also featured the opinions of a panel of doctors and dietitians, who were generally critical of the Dukan diet and the effect it can have on the body. In particular, they say that the restrictive diet changes the body's metabolism (the way the body stores and uses energy), which can lead to a yo-yo effect, where dieters constantly lose and regain weight.

Dr Marie-Josée Leblanc says, ‘It’s very uncommon for this type of diet to remain efficient in the medium run. By imposing such an abrupt decrease in the energy supplied to the body, you force it to adapt and it learns to function on fewer calories. As a result, when you revert to a normal diet again, your body receives way too many calories in comparison to what it needs. It will then start to store this energy as fat. It’s the so-called yo-yo effect.’

The psychological effect

Professor Monique Romon argues that the initial success seen with many diets such as the Dukan plan is that they can lead to negative feelings once weight loss starts to slow down: "Most of the time, overweight or obese people start a diet in order to reach an ideal weight they’ve always dreamed of. But in every diet, there are steps in the weight loss, with plateaus that are normal. As soon as they think it doesn’t work anymore, their motivation decreases and they develop a feeling of guilt and they think they won’t be able to make it. Therefore, they stop the diet, then start another one, then stop, etc."

Surely there is no harm in trying it though?

The lack of long-term research makes it hard to tell but the authors of the report stress the possibility that restrictive diets can cause nutrient deficiencies, diabetes, cardiovascular disease and bowel problems. They say that restrictive diets:

• lack fibre, which is likely to cause bowel problems
• are high in salt, with some providing 6g of sodium a day (UK guidelines suggest eating no more that 2.4g)
• are often poor sources of essential vitamins and minerals, particularly calcium
• are often followed by weight gain around the waist. The authors say that is associated with diabetes, high blood pressure, heart disease and liver problems.

What proven diets are there?

There are a number of well-researched weight loss methods that tend to focus on developing a slower, sustainable way of losing weight than can also be kept off in the future. They tend to involve eating sensibly and exercising rather than rapid weight loss and drastic rules denying you from eating what you want. Some methods include:

• Setting up a weight loss plan with your GP - a free and effective way to set yourself safe weight loss targets with expert help from your doctor
• Slimming clubs such as Weight Watchers and Slimming world, which offer group meetings, sustainable weight loss programmes and online support
• Sustainable whole-life diet plans such as the US government's hugely successful DASH diet, an evidence-based approach that emphasises simple dietary changes that can help people lose weight and keep it off. The diet also has a specific emphasis on combating health problems such as high blood pressure and diabetes

For other weight loss ideas try our section on dieting tips and real-life weight loss stories.

Links To The Headlines

Trendy Middleton Dukan diet slammed as 'utterly ineffective and with no scientific basis' as experts compile list of worst weight loss plans. Daily Mail, November 17 2011

Dukan diet 'not based on science'. The Daily Telegraph, November 17 2011

Dukan diet 'worst diet of 2011'. November 17 2011

“Doctors want to ban smoking in cars… even if you’re on your own,” the Daily Mail has reported. The Mail and most other newspapers and news broadcasters covered the call from the British Medical Association (BMA) for a government ban on drivers and passengers smoking in private vehicles.

In a briefing paper from its board of science, the BMA argues that there is strong evidence that smoking in cars exposes non-smokers to high levels of secondhand smoke (SHS), with about 23 times more toxins than in a smoky bar. A blanket ban on smoking in cars, it argues, would protect vulnerable groups such as children and the elderly, who often have no choice about taking a journey in a smoky vehicle. The BMA’s report also highlighted the risk of injury and death from road traffic accidents as a result of the distraction of smoking while driving. However, the report provided only a small amount of evidence on this issue.

The briefing paper coincided with the second reading of a private members' bill calling for a ban on smoking in private vehicles when children are present. The bill is due to be debated on November 25.

Why is this in the news today?

The BMA has produced a briefing paper on smoking in cars, in response to a motion debated at its annual representative meeting earlier this year, where its members voted in favour of extending smokefree legislation to cover private motor vehicles. The association has issued a press release highlighting its reasons for supporting such a move, and urging a ‘bold and courageous step of banning smoking in private vehicles’ by UK governments.

Why is secondhand smoke dangerous?

In the paper the BMA points out that exposure to secondhand smoke (SHS) is a major public health concern. In the UK, an estimated 23 children and 4,000 adults die each year due to SHS. Tobacco smoke contains 4,000 known chemicals, 69 of which are known or probable carcinogens, it says. SHS, which consists of both ‘mainstream’ smoke exhaled by the smoker and ‘sidestream’ smoke from the burning of tobacco products, contains several major classes of known carcinogens as well as toxins and irritants.

There is particularly compelling evidence about the adverse effects of SHS on children, who absorb more pollutants, says the BMA. It reports that children are more susceptible to the harmful effects of SHS because they breathe more rapidly, absorb more pollutants because of their size, have less developed immune systems and are more vulnerable to cellular mutations.

A child’s immune system is also less developed than that of an adult, and lacks the necessary defences to deal with the harms of SHS. Evidence suggests that SHS increases the risk of sudden infant death syndrome (cot death), children’s respiratory tract infections, ear diseases, and other conditions associated with impairment of lung function, such as asthma.

What does smokefree legislation cover at present?

The current smokefree legislation was introduced in England in July 2007. It requires all enclosed premises where people work or where the public have access, to be smokefree. This includes public transport and taxis. Current regulations say enclosed vehicles should be smokefree at all times if they are used by the public or if they are used in the course of paid or voluntary work by more than one person. At present, UK smokefree legislation does not apply to private vehicles.

Why does the BMA want the legislation extended to cover private vehicles?

The BMA says that research has confirmed that smoking in vehicles in particular, exposes non-smokers to high levels of SHS, due to the restrictive internal environment. There is evidence to suggest that the levels of SHS present in vehicles can be a serious health hazard to both adults and children. In addition, studies have demonstrated that the concentration of toxins in a smoke-filled vehicle is 23 times greater than that of a smoky bar.

There is evidence to suggest that private vehicles are a significant source of SHS exposure for children as well as adults. In England, an estimated 30% of smokers smoke in their vehicles and more than half of all journeys made by children under 16 are by private vehicle. One study has found that more than half of 8-15 year olds have been exposed to cigarette smoke in a vehicle.

Why does the BMA not just call to ban smoking in cars when children are present?

The BMA argues that banning smoking in all private vehicles would be the simplest and most easily enforceable measure.

They also point out that SHS in vehicles is a serious health hazard for adults, particularly elderly people who are prone to respiratory problems. One report found that 26% of adult non-smokers are exposed to SHS in vehicles. Residual toxins are known to remain in the interior furnishings of cars long after a cigarette has burnt out. This means that simply not smoking when driving with passengers does not prevent the harmful effects of SHS. A total ban on tobacco, regardless of who is present, would keep vehicles free from residual smoke toxins, the BMA claims.

The BMA report also says there is evidence to suggest that the physical act of smoking itself could be a risk to road safety. It bases this claim on four studies that looked different aspects of vehicle crashes and smoking habits. The report also points out that the UK Highway Code lists smoking as a distraction from safe driving, and that drivers can be fined if they are found to drive recklessly because they have been smoking.

What does the BMA say about freedom of choice?

Several news reports included the views of the pro-smoking organisation Forest, which claimed that there was ‘no justification’ for a ban on smoking in cars. In its report, the BMA argues that smokefree legislation already restricts people’s freedom to smoke, for the benefit of those around them. While most adults have the freedom to leave a smoky vehicle or ask a smoker to stop smoking, children and other vulnerable groups such as the elderly and disabled are often dependent on their parents or carers and are not free to make the same choices.

What is the government’s position?

In the latest tobacco control plan, published in March 2011, the Department of Health said it favoured a policy aimed at increasing public awareness of the risks of SHS. It said this would lead to greater personal responsibility to keep homes and vehicles free of smoke. And in response to the BMA’s paper, a spokesperson for the Department of Health is quoted in The Daily Telegraph as saying: ‘We do not believe that legislation is the most effective way to encourage people to change their behaviour’.

A national marketing campaign is reportedly due to be launched next year to remind smokers of the risks of exposing children and adults to secondhand smoke.

In June 2011, a private members’ bill was presented to the House of Commons to ban smoking in private vehicles when children are present. It won a slight majority in favour and is due to be debated on November 25. In Wales, the government is considering a ban on smoking in vehicles when children are present.

What does the report say about public opinion?

The BMA says that smokefree legislation banning smoking in public places has been supported by 80% of the English population (2002 data from the Office for National Statistics), and 90% of non-smokers (a 2010 report by the Royal College of Physicians). The association says that public support for a ban on smoking in private cars has increased in recent years, as demonstrated by opinion polls. These include two YouGov polls that found majority support among adults in England for a ban on smoking in vehicles (2009), and 74% of adults in England supported a ban on smoking in vehicles with children (August 2010).

The BMA also highlights a British Lung Foundation study that showed that 86% of UK children surveyed want to stop people smoking when they were present in the vehicle.

Links To The Headlines

Smoking in cars should be outlawed to protect children from poisons, says BMA. The Guardian, November 16 2011

Doctors want smoking ban extended to cars. The Independent, November 16 2011

Smoking in cars should be banned: doctors. The Daily Telegraph, November 16 2011

Now doctors want to ban smoking in cars... even if you're on your own. Daily Mail, November 16 2011

Doctors call for smoking ban in cars. Channel 4 News, November 16 2011

Smoking in cars should be banned, doctors insist. Daily Mirror, November 16 2011

Ban smoking in cars, say docs. Sky News, November 16 2011

At least 12 million Britons now suffer from allergies caused by dust mites, The Independent has today reported. The newspaper says that a report by the charity Allergy UK has revealed an epidemic of “home fever”, a range of symptoms caused by dust mites and other triggers around the home.

The report has been published as part of Indoor Allergy Week, which is intended to raise awareness of the kind of steps that can be taken to remove allergy triggers, or ‘allergens’, from the home. A survey in the report suggests that, currently, around two-thirds of people with allergies experience symptoms such as sneezing and itchy eyes caused by allergens including dust mites, chemicals, pets and mould.

This new report raises lots of questions, such as whether its small survey of symptoms in 1,600 allergy sufferers is actually strong enough evidence to suggest that there is an epidemic sweeping the nation.

Also, the report’s suggestions to change your mattress and use an air filter are likely to raise a few eyebrows since the awareness week is being run in conjunction with a mattress company and an air filter manufacturer.

What is “home fever”?

“Home fever” is a term used by Allergy UK to describe out-of-season hay fever symptoms. The most common of these are runny nose and sneezing, symptoms which the charity reports have risen greatly in recent years. Unlike regular hay fever, which is usually triggered by high pollen levels that vary seasonally, “home fever”, Allergy UK suggests, is triggered by allergens such as dust mites, moulds, cleaning products and pets that are present in the home or office. These can cause symptoms throughout all seasons.

Who compiled the report?

The news is based on a report by Allergy UK that surveyed more than 1,600 allergy sufferers about indoor allergies. The report was released ahead of Allergy UK’s Indoor Allergy Week, launched today, which aims to raise awareness about indoor allergies caused by house dust mites, moulds and pets.

As mentioned above, the awareness-raising week and report are supported by a mattress company and an air purifier manufacturer. It is not clear what role these companies had in the survey, which featured recommendations to prevent “home fever” by replacing your mattress and using an air purifier. This affiliation may be something to take into account when considering the report’s recommendations.

Allergy UK is a national charity supporting people with allergies, food intolerance and chemical sensitivity.

What did the report say?

The survey asked allergy sufferers what triggered their symptoms, offering the possible options of house dust mites, cleaning products, mould or pets. Participants could choose more than one option. The most popular answer was house dust mites at 57.6%, followed by pets (45.2%), cleaning products (31.2%) and mould (30.9%).

The report says these figures have risen since the last survey was published in February 2010. The Allergy UK report does not give any detail on the characteristics of the people surveyed or how many people answered each question. It also does not include any statistical analysis to say whether the differences observed between years are real or the result of random variation that occurs when different groups of people are surveyed. We must be very cautious in taking these figures at face value without more information about how the survey was carried out.

The most commonly reported symptoms of indoor allergy or “home fever” were runny nose (67.8%), sneezing (66.9%) and itchy eyes (62.1%).

Other findings include:

• 58.9% of indoor allergy sufferers found their symptoms were worse in the bedroom. The authors suggest that this was due to dust mites in the bed, quoting figures that “the average bed harbours 2 million dust mites and the average pillow doubles in weight over a period of six months due to dust mite faeces”.
• 16% of allergy sufferers said they wash bed linen every three weeks or less often, and 58% of those surveyed said they are washing at 30 or 40 degrees. This is two weeks longer than Allergy UK recommends and at a temperature that they say does not kill any dust mites present.
• 13% of allergy sufferers had had their current mattress for 11 years or more, and 3% kept theirs for 20 years or longer.

The authors suggest people “too often confuse allergy symptoms with a common cold or flu and, therefore, don’t treat the root cause of the problem”. Allergy UK believes the root cause is allergens such as dust mites, which trigger these allergic reactions and symptoms.

How common are household allergies?

Allergy UK estimates that at least 12 million people are allergic to their own home and so could be classed as household allergy sufferers. NHS Choices reports that indoor allergies are very common and that 10-20% of the population has an indoor allergy. The top estimate of 20% would be broadly in line with the figure suggested by Allergy UK, although it is not apparent how the charity has reached this estimate.

Most sufferers first develop indoor allergies in childhood, with 80% of cases developing before the age of 20. Men and women are equally affected by indoor allergies.

What causes household allergies?

The main cause of indoor allergies or “home fever” are house dust mites. Dust mites are microscopic creatures that survive well in warm damp conditions such as the average UK home. Beds provide the ideal environment for dust mites as they can feed on the skin cells we shed, obtain warmth from our bodies and gather water from our sweat and exhaled breath. They are also commonly found in carpets, upholstered furniture, fabrics and furry toys. While they are completely harmless to most people, in some they can trigger an allergic reaction. The allergen that triggers most allergic reactions is the mite droppings. These can collect in pillows, mattresses, duvets, upholstery and carpets.

Other common causes of indoor allergies include allergens from animals and from mould spores.

What can I do to ease my allergies?

Allergy UK recommends many ways to manage symptoms and reduce the amount of indoor allergens in the home.

• Buy products that have been tested to ensure they prevent the escape of the house dust mite allergen.
• Use allergen-proof barrier covers on all mattresses, duvets and pillows.
• Dust regularly but use a damp duster first, then a dry cloth. Otherwise, you are just moving the dust around.
• Wash all bedding that is not encased in a barrier cover (for example sheets and blankets) every week. Washing at 60 degrees or above will help eliminate house dust mites. The allergens produced by house dust mites dissolve in water so, while washing at lower temperatures will wash the allergens away temporarily, the mites will survive and produce more allergen after a while.
• If possible, remove all carpeting in the bedroom and vacuum all surfaces of upholstered furniture at least twice a week.
• Change your mattress every 8-10 years and replace pillows every year.
• Use a high-temperature steam cleaner to rid carpets of dust mites.
• Use light, washable cotton curtains, and wash them frequently. Reduce unnecessary soft furnishings.
• Washable stuffed toys should be washed as frequently and at the same temperature as bedding. Alternatively, if the toy cannot be washed at 60 degrees place it in a plastic bag in the freezer for at least 12 hours once a month and then wash at the recommended temperature.
• Reduce humidity by increasing ventilation. Use trickle-vents in double-glazing or open windows. Use extractor fans in bathrooms and kitchens.
• If necessary, use a dehumidifier to keep indoor humidity between 30 and 50%, plus an air purifier to trap large airborne allergens such as pollen, house dust mite debris and mould spores.

These are just some of the recommendations given. To read the recommendations in full visit the Allergy UK website.

One point to note is that in the Allergy UK publication participants reported on various symptoms, most commonly runny nose, sneezing and itchy eyes (typical symptoms of allergy), but also a wider range of symptoms such as wheezing, disturbed sleep and poor concentration. The full range of symptoms offered is not specific to allergy, and could cover many things, including symptoms of the common cold and flu.

Additionally, participants appear to have self-reported what they believe triggers their symptoms. Therefore, taking these things into account, people with respiratory symptoms, irritable skin, poor concentration or difficulty sleeping should not necessarily assume that these symptoms are due to household allergies. If symptoms persist it may be advisable to see your GP.

Do these preventative measures work?

A recent high-quality systematic review looked at the evidence on whether controlling exposure to house dust mites improved asthma symptoms in people who were sensitive to house dust mites. Chemical and physical preventative measures were examined, including mattress covers, vacuum-cleaning, heating, ventilation, freezing, washing and air filtration. Measures of asthma included subjective wellbeing, medication use and various established measures of airway function.

The review, which included 3,121 patients from 55 studies, concluded that these measures had no effect on asthma symptoms (i.e. they were no more effective than doing nothing) and that such measures could not be recommended.

This high-quality review focused on symptoms of asthma caused by dust mites and not the more general symptoms of a runny nose and sneezing as described for "home fever". It also does not specifically address each of the Allergy UK recommendations. However, it raises an important question. If controlling exposure to dust mites in these ways fails to improve asthma allergic reactions caused by house dust mites, would they be effective in preventing "home fever" also caused by dust mites?

Currently it is not known whether these preventative measures are effective in preventing "home fever". This should be kept in mind before making potentially costly changes to your bedroom or house to reduce dust mite allergens.

Links To The Headlines

Millions suffer 'home fever' as allergy epidemic begins to bite. The Independent, November 14 2011

A batch of Loyd Grossman Korma sauce has been recalled after two cases of botulism in Scotland. The two family members were hospitalised after they had eaten from a jar that was later found to contain botulism-causing bacteria. Both are reportedly recovering well.

Only one jar from the batch is known to have been contaminated, but as a precautionary measure the the Health Protection Agency is advising the public to immediately dispose of any products from the batch. The recall applies to all 350g jars of Loyd Grossman Korma sauce with a best before date of February 2013 and a batch code of: 1218R 07:21.

The matter is currently being investigated and medical professionals across the UK have been advised to look out for people with possible symptoms. Supermarkets are also removing any products affected by the recall.

Botulism is very rare in the UK, although it can can cause very serious illness or even death in those infected if not treated promptly. The HPA has urged the public to be aware of the signs and symptoms of food-borne botulism, which include nausea, vomiting and diarrhoea. Blurred vision, difficulty swallowing, headaches and muscle weakness are other direct effects that can be caused by the toxin that the bacteria produces. For more information read our sections on botulism, the symptoms of botulism and the causes of botulism.

Links To The Headlines

Batch of Grossman korma recalled after poisonous bacteria is discovered. Metro, 14 November 2024

Grossman sauce in health scare. The Independent, November 14 2011

Botulism in Loyd Grossman sauce. The Sun, November 14 2011

Loyd Grossman 'distressed' over Korma sauce botulism alert. Daily Mirror, November 14 2011

Loyd Grossman sauce in botulism alert. The Guardian, November 14 2011

Korma sauce recalled after botulism outbreak. The Daily Telegraph, November 14 2011

Loyd Grossman 'very upset and distressed' as two children are taken to hospital with botulism after eating his curry sauce. Daily Mail, November 14 2011

Botulism warning over Loyd Grossman korma sauce. BBC News, November 14 2011

Children hospitalised after eating Loyd Grossman sauce. BBC News, November 14 2011

Loyd Grossman Korma sauce poisoning victims 'improving'. Daily Mirror, November 14 2011

Links To Science

Health Protection Agency: Recall of Loyd Grossman Korma sauces following botulism link. November 13 2011

Food Standards Agency: FSA warning on certain jars of Loyd Grossman Korma sauce. November 13 2011

The global eradication of malaria could be a step closer, according to The Independent. The newspaper reported that scientists have identified a key mechanism in the way that malaria-causing parasites attack red blood cells and spread through the body.

The widely reported research has revealed how a range of malarial parasites exploit a protein called basigin on the surface of blood cells, using the protein to identify and infect the cells. The scientists were able to show that several types of malaria parasites use basigin in this way, and that the process can be blocked during lab experiments. If all malaria parasites use this mechanism then the findings could have far-reaching consequences, as they could allow the development of a single drug or vaccine that blocks all strains of the infection.

Like the recent results of a malaria vaccine trial, this research could lead to a genuine breakthrough in the fight against malaria, which affects hundreds of millions of people around the world. However, this is only an initial step towards developing a universal malaria treatment, and the technology will still need extensive development and research before we can tell if it provides a safe and effective treatment.

Where did the story come from?

The study was carried out by researchers from the Wellcome Trust Sanger Institute in Cambridge and other institutions in Japan, Senegal and the US. The research was funded by the Wellcome Trust.

The research was published in the peer-reviewed scientific journal Nature. The story was widely reported, with the media generally providing good accounts of the research and useful background information about malaria. The Independent provided a particularly thorough and accurate description of the research.

What kind of research was this?

Malaria is caused by a type of parasitic organism called a plasmodium that can enter the bloodstream when a mosquito bites a person. After the plasmodia have taken hold in the person’s liver they begin seeking out and entering the red blood cells. Once inside red blood cells, the plasmodia begin multiplying until they eventually cause the blood cells to burst, re-entering the bloodstream to infect more blood cells.

This laboratory study was designed to identify a protein required for malaria infection that was common to all strains of the Plasmodium falciparum parasite, the most deadly malaria-causing parasite. The researchers initially identified a candidate protein, and then tested it to determine whether or not it was essential for malaria infection to occur. They then sought to determine whether manipulating this protein could keep the parasites from invading the red blood cells.

This research used standard laboratory techniques to identify target proteins, test their interaction with the parasite, and determine if the protein was essential for malaria infection.

What did the research involve?

In order to infect a person with malaria, the parasites must get inside their red blood cells. To do this they must first recognise the cell by interacting with the proteins on its surface. Thus far, research has identified multiple different proteins that allow this to happen, but none that is used by all strains of the parasite. This has made the process of developing a single treatment to prevent infection difficult.

The researchers identified proteins that appear on the surface of, or are secreted by, red blood cells, and screened these proteins in order to select those that interact with the parasite.

The researchers selected a candidate red blood cell protein called basigin. They then carried out a series of experiments to see if they could interfere with the binding of the red blood cell and parasite proteins, and whether this could prevent the parasites from infecting the cells. These experiments included attempts to physically block the interaction of the two proteins by introducing other molecules that would bind to the proteins instead. The researchers also used genetic techniques to prevent the red blood cell-parasite interaction from occurring.

The researchers carried out experiments in parasite strains produced in the laboratory, as well as in strains obtained from the field.

What were the basic results?

The researchers found that the basigin red blood cell protein interacted with an essential parasite protein.

When the researchers introduced a form of basigin that was not attached to the red blood cells, they found that parasite invasion of the cells was prevented in a “dose-response” manner; in other words, the more free floating basigin they used, the fewer parasites invaded the red blood cells. This prevention was found to occur across multiple strains of the parasite. A similar result was found when the researchers introduced antibody proteins that would bind to the target red blood cell proteins.

When the researchers repeated their tests using parasites obtained from the field, they achieved similar results to those seen in laboratory-developed parasites.

How did the researchers interpret the results?

The researchers conclude that they have identified a single red blood cell protein that is essential for malaria infection, regardless of the specific parasite strain of Plasmodium falciparum tested. They said that using modest amounts of antibodies to bind to this protein kept the parasites from invading the red blood cells. They said that the identification of this protein “may provide new possibilities for therapeutic intervention.”

Conclusion

The researchers appear to have identified a human protein that is key to malaria parasites’ ability to infect red blood cells. This could prove to be an extremely important discovery in the global fight against malaria, a disease that affects hundreds of millions of people and kills around one million people every year. The knowledge gained from this research could be put towards future anti-malaria therapies, or even vaccines.

However, it is important to put this research into context, as it is still at an early stage: the study has identified a mechanism used by the malaria parasite, but researchers will still need to design and optimise possible therapies based around these findings. These would then need testing in people to ensure that they are safe to use in a real-world setting.

For many years, malaria prevention has focused on environmental and physical interventions such as mosquito nets and insecticide to prevent mosquitoes from biting people and infecting them with malaria-causing parasites. Research into therapies and vaccines to fight the parasites themselves has often been frustrated by the multiple strains of the parasite that cause the illness, and the various ways they invade cells.

However, this study appears to have identified a promising target for future research that may apply to most strains of the parasite. Together with the recent news of a potential malaria vaccine, it seems this is a promising step forward in the battle against malaria, which is still one of the world’s greatest health problems.

Links To The Headlines

Malaria: The beginning of the end? The Independent, November 10 2011

The long road to victory over humanity's old enemy malaria. The Independent, November 10 2011

Malaria could be stopped by blocking cell path. The Daily Telegraph, November 10 2011

Malaria vaccine hope after blood entry route discovered. BBC News, November 10 2011

Malaria breakthrough excites scientists. Daily Mirror, November 10 2011

Malaria vaccine could be developed within two years, after scientists find disease’s Achilles heel. Daily Mail, November 10 2011

Malaria's weak spot pinpointed in the hunt for an effective vaccine. The Guardian, November 10 2011

Links To Science

Crosnier C, Bustamante LY, Josefin Bartholdson S et al. Basigin is a receptor essential for erythrocyte invasion by Plasmodium falciparum. Nature 2011

The Patients Association has today published a report highlighting poor cases of NHS care. The charity’s report provides detailed accounts of patients’ negative experiences, which include elderly patients not being given pain relief, assistance when eating or access to toilet facilities. The report has been given high-profile press coverage.

The report itself does not provide statistics on the overall standard of care in England’s hospitals or on how common such experiences are. However, nearly all of the NHS trusts involved have provided responses to these accounts and, in many cases, they have acknowledged failings and suggested ways to prevent these failings happening in the future.

In response to the publication, the Department of Health said: “Wherever there is poor performance we will root it out, and whatever the reason for that poor performance we will tackle it. The Patients Association is right to raise these examples and issues, and we will work with them and with the NHS to sort these problems out”. The department has also asked the Care Quality Commission to carry out 700 unannounced inspections in 2012, with focus on issues including patient dignity and nutrition.

What is the focus of the report?

The report is a collection of 16 firsthand accounts of poor care in hospitals in England and Wales, which the association says came to its attention through its helpline. Most, but not all, of the accounts focus on the care of elderly people. It is the third such report from the Patients Association, which previously published reports on patients’ experiences in 2009 and 2010.

The new report also publishes responses from the NHS trusts involved. Fifteen out of 16 trusts responded.

What kind of problems did patients report?

Cases in the report include:

• one patient being left “desperately thirsty” and having toileting needs neglected
• the wife of a dying patient running out into the corridor screaming for help as her husband lay dying in his bed, because nobody answered the call buzzer
• a patient who had to wait seven hours for an ambulance and was given no pain relief on arrival at the hospital

The daughter of one elderly patient admitted with a chest and urinary infection describes her experience:

“As you can imagine, my mother was horrified when she then turned up in hospital to discover Dad sat beside his bed, quite literally sitting in his own faeces … In general during Dad’s time in hospital the nursing staff treated him as an object that they had to treat rather than a human being who should be included in [decisions about] his care and given the dignity that he deserves.”

Not all the cases reported are of elderly people. The wife of a 52-year-old patient diagnosed with pneumonia writes:

“He told me that at one point during the night of the 18th of December he pressed the emergency button because his breathing had become so laboured he felt he was gasping for his life. It was a full fifteen minutes before anyone responded to him.”

The daughter of an elderly woman admitted with a broken leg said:

“At one point during her stay my mother was in desperate need of pain relief. A doctor visited her and said that she could have more morphine straight away. She waited and waited, and it was only when she rang the buzzer and a nurse arrived that we discovered that no morphine was coming. We were told that this was because the doctor had given no instruction for it.”

What is the Patients Association?

The Patients Association is a campaigning charity representing the opinions of patients. It says its aim is to ensure that the patient voice is heard and listened to by policy makers.

The association has recently launched a care campaign to improve fundamental patient care, jointly with the Nursing Standard magazine. The campaign will focus on four areas – poor communication, assistance with toileting, pain relief and encouraging adequate nutrition and hydration.

Alongside today’s new report the charity is also launching an appeal asking for donations to support and expand its work.

What does it recommend?

The association argues that the role of the Care Quality Commission (CQC), the body that regulates standards of care in England and Wales, is inadequate. It says only a long-term action plan and repeated hospital-wide inspections can ensure sustained and lasting improvements for patients.

“It is simply not good enough to allow hospitals to make changes in the short term to pass follow-up inspections, which mask a longer-term culture among nursing staff who then allow standards to slip once the gaze of the CQC has shifted away to another problem hospital,” the report argues.

The association has also repeated its previous call for independent clinical “patient safeguarding champions”, who would be able to identify wards “where a long-term cultural change is required. They propose that these champions would continue to scrutinise problem wards “until they deliver the levels of care and dignity that the elderly people being treated there deserve”.

The association also argues that improvements need to be made in the NHS complaints system. It has repeated a previous call for a national survey of all complainants, to find out which trusts are providing a good complaints system and which ones are not.

Speaking about the launch of the report, Patients Association Chief Executive Katherine Murphy said: “It’s simply not good enough for this report to be recognised and then business to carry on as usual. There needs to be a culture shift in the way we treat patients on our wards”.

How common is poor care?

The report does not feature any statistics on the overall quality of care available through the NHS or how common incidents such as those in the report are. However, it does say that for every story published in the report, there are many others of equal severity in which the complainant wishes to remain private.

Earlier this year a report by the Care Quality Commission, which is based on 100 inspections of NHS hospitals undertaken between March and June 2011, found that one in five of the hospitals inspected was delivering care that posed risks to the health and wellbeing of patients. The report also said that around half of all hospitals visited gave cause for concern.

How can I report poor care?

You have the right to complain if you are not happy with the care or treatment you or a relative has received, or you have been refused treatment for a condition. You also have the right to have your complaint properly investigated and to be given a full and prompt reply.

The NHS has its own complaints procedure, which is always the first step for any complaint. You can find detailed information about the NHS complaints procedure on NHS Choices.

If you are not satisfied with the way the NHS deals with your complaint you can take it to the independent Parliamentary and Health Service Ombudsman.

You can also raise your concerns by contacting regulatory bodies such as the Care Quality Commission. Read more about this in other options for complaints.

The Patients Association helpline is 08456 08 44 55.

You can also use the NHS Choices site to give feedback on the service you have received from your GP, hospital, dentist or optician. The system allows you to add positive and negative ratings and write comments on what you have experienced. To post your views, simply find your facility in our NHS directory and click the button marked ‘Rate and comment’ to begin.

Links To The Headlines

Hospital patient neglect uncovered. Daily Express, November 9 2011

NHS care: Hospitals treat elderly 'like slabs of meat'. Daily Mail, November 9 2011

Hospital elderly care criticised. BBC News, November 9 2011

'Age discrimination within NHS' leaves elderly neglected. The Daily Telegraph, November 9 2011

NHS care quality comes under fire. The Guardian, November 9 2011

Increasing the number of kidneys that are donated to strangers could save both lives and money, says a new charity.

Several media sources have highlighted the campaign by Give a Kidney – One’s Enough, which aims to increase the number of “altruistic” kidney donations, where people offer one of their kidneys to help a stranger. The charity has highlighted the severe shortage of kidneys available for transplants, and that thousands of people are currently waiting for a transplant. Each year, around 300 people die while waiting for a donor.

The charity argues that if more people considered altruistic donation, the waiting list would shrink and thousands of people currently on dialysis would regain their health and independence. It also points out that the costs of a transplant are much lower than those for long-term kidney dialysis. Some news sources estimated that clearing the waiting list would save £650m a year.

The news also highlights the fact that most kidney donors live healthy and normal lives, as having only one kidney is unlikely to cause future health problems. That said, the decision to donate a kidney is a major one that needs much consideration. You can read more on the process at the Give a Kidney website and in our section on organ donation.

How big is the kidney shortage?

Despite long-running public campaigns to increase the number of donations after death, there is still a severe shortage of kidneys for transplant. In addition, the number of people who need a kidney transplant is increasing. The charity points out that:

• 6,500 people are on the waiting list for a kidney transplant.
• Only 2,500 kidney transplants take place each year.
• This means that 4,000 people who could benefit from a transplant each year do not get one and must remain on dialysis.
• 300 people die each year while waiting for a transplant.

The average waiting time for a kidney transplant is two-and-a-half to three years, and for some ethnic minority groups and people with rare tissue types it may be more than five years.

Who can donate a kidney?

Most living kidney donors are close relatives of the person who needs the kidney, but sometimes they are partners or friends. However, a small but growing number of people are putting themselves forward as altruistic donors – individuals who will offer a kidney to a recipient they do not know. It is this type of donation that Give a Kidney – One’s Enough wants to see increase.

There is nothing in the law to stop living donors giving their kidneys to anyone they choose, including a stranger. The Human Tissue Authority, set up by the Human Tissue Act which came into force in 2006, regulates organ transplantation in the UK. It oversees all organ transplantations by living donors, whether or not they are related to the recipient.

In England, Wales and Northern Ireland, there is no lower or upper age limit for being a donor, although most donors are over 18. In Scotland, kidney donors have to be over 16. Old age does not necessarily mean that someone is unsuitable to donate a kidney, and the Give a Kidney charity presents the account of a man who donated a kidney at the age of 72.

What sort of person needs a kidney transplant?

A wide range of people need kidney transplants, although most have chronic kidney failure, which causes long-term deterioration in their kidney function. The kidneys are crucial to human health, removing excess water, salt and waste from the body and producing hormones that keep bones and blood healthy.

Causes of kidney failure can include diabetes, inflammation, polycystic kidney disease (an inherited condition) and renovascular disease (where the blood vessels to the kidney are furred up). However, in up to 30% of patients with kidney failure, the cause is unknown.

For people with advanced kidney failure, a transplant is the best option. Until that becomes possible, they have to have dialysis, which takes over the kidneys’ job of filtering our waste products. There are several different forms of dialysis, but generally they are time consuming for patients and require regular medical support. For example, patients undergoing haemodialysis (which involves a special machine filtering the blood) usually have to attend four-hour sessions three times a week.

Kidney failure is more common as people get older, but it can affect people of all ages, including children. People whose personal stories appear on the new charity’s website include a 52-year-old father of two with polycystic kidney disease and a 41-year-old man who has had kidney problems since his 30s after a bad attack of gout.

Can I choose who gets a kidney?

While you can donate to someone you know, being an altruistic kidney donor means that the kidney is given without you knowing who will receive it. Last year, altruistic donations accounted for just 3% of all living donor kidney transplants.

The NHS Blood and Transplant Centre finds a suitable recipient, and the transplant is then arranged by local kidney transplant centres. Most altruistic donors never meet the person who receives their kidney, although it is possible for both parties to meet after the operation if they want to.

Is it safe to donate a kidney?

In the short term, donating a kidney carries some risk, as all operations do. Donors may be at risk of infections and, more rarely, bleeding or blood clots. There is a very small risk of death for a kidney donor, estimated to be 1 in 3,000. However, donors go into the operation in good health and undergo rigorous testing and evaluation of their health before the donation to make sure any risks are minimised.

In the long term, there is a small possibility of a slight rise in blood pressure and excess protein in the urine. However, studies have shown there is no long-term effect on the health of the donor or on the remaining kidney.

It is perfectly safe to live with one kidney. People who live with one kidney are at no greater risk of developing kidney failure than anyone else. Once you have recovered from the operation, no change in lifestyle is required, and a donor should lead a normal healthy life as before. For example, having one kidney should not affect what you can eat or drink.

What happens if I choose to become a living donor?

You will need to go through a series of tests and examinations to ensure you are healthy enough to donate a kidney. These tests include medical, surgical and psychological checks and may take three to six months. Blood tests will be carried out to assess the donor’s tissue type and blood group, so that they can be matched with a potential recipient.

If all the tests are successfully passed, potential donors are usually invited to meet the transplant surgeon to discuss the donation, details of the operation and possible dates. The final stage involves seeing an independent assessor, trained by the Human Tissue Authority, who will ensure you understand the process and are giving your kidney freely and voluntarily.

The operation to remove a kidney is major surgery. It requires a general anaesthetic and takes about two to three hours. The kidney may be removed by either open surgery, in which an incision is made in the side of the abdomen, or using “keyhole” (laparoscopic) techniques, which involve smaller incisions. The kidney is then taken to the recipient, who is usually in another hospital.

Recovery from a kidney donation can take between two and 12 weeks, depending on whether the surgery was keyhole or open. Most donors are more or less back to normal within six weeks.

What are the benefits of a living kidney compared to one from someone who has died?

Living donor kidneys are sometimes referred to as the “Rolls-Royce” of kidney transplants, and there are several benefits to living kidney donation over donation from a deceased donor:

• The kidney comes from a person who has been found to be fit and well.
• The transplant can be planned some time in advance, in some cases before there is a need for dialysis.
• Recipients who have a transplant before going on to dialysis have a better chance of the transplant being successful.
• Transplants from living donors are significantly more successful than those from deceased donors.

Will giving a kidney benefit me?

There is no financial benefit to kidney donation, and the process is carefully regulated to ensure that no payment is involved. However, many donors have said they found helping a stranger through donation rewarding, positive and meaningful.

Some studies have shown that donors live longer than the average person, although it is not clear why this is. It’s thought that this could be due to donors being selected on the basis of good health, or because of the extra medical attention and monitoring they receive before and after their transplant.

It has also been estimated by some that higher rates of transplants could save the NHS money, as it is cheaper to perform a transplant than to keep patients on long-term dialysis. According to figures published in the Daily Mail, clearing the 6,500 patient waiting list could save £650m over the next five years, and while a transplant costs around £50,000, five years of dialysis and care will cost around £150,000 for each patient.

Links To The Headlines

Charity appeals for kidney donors. BBC News, November 4 2011

Wiping out kidney transplant waiting list 'could save NHS £650million'. Daily Mail, November 1 2011

Many news sources have reported that a “major review” of the NHS breast screening programme is to take place. BBC News said “the evidence for breast cancer screening in the UK is being reviewed amid controversy about the measure's effectiveness”.

The news of the review comes from Professor Sir Mike Richards, national cancer director at the Department of Health, who discusses it in an open letter in the BMJ. It follows criticism of the current screening programme by some doctors who believe that by throwing up some false results, screening may be doing more harm than good.

The majority of specialists in the field are thought to support the current breast screening programme. However, Richards said: "Should the independent review conclude that the balance of harms outweighs the benefits of breast screening, I will have no hesitation in referring the findings to the UK National Screening Committee and then ministers.”

What has prompted this review?

Professor Richards announced the review in response to debate among scientists over the effectiveness of breast screening. For example, a recent Cochrane Collaboration review of breast screening concluded that “it was not clear whether screening does more good than harm”.

The three highest-quality studies covered by the review showed that screening did not significantly reduce death from breast cancer after 13 years in comparison to women who weren’t screened. However, lower-quality studies showed a significant reduction in breast cancer death in those who were screened.

When the high- and lower-quality studies were combined, the overall effect showed screening did reduce the relative risk of breast cancer death by 13-26%. The authors highlighted that the lower-quality studies may be biased to favour screening, and estimated the true relative reduction in death from breast cancer due to screening to be in the region of 15%.

What are the pros and cons of breast screening?

There has always been debate about the pros and cons of screening, revolving around the complex balance of its benefits and harms.

The benefit of screening is in finding breast cancer at an early stage when there is a good chance of successful treatment and full recovery. The drawback, however, is that screening will also result in some women being over-diagnosed - receiving a diagnosis of cancer that would not have led to death or sickness. Currently, it is not possible to tell who these women are, and they are therefore likely to have breasts or lumps removed and to receive unnecessary radiotherapy. The investigations, such as a biopsy, needed to reach a firm diagnosis can also cause harm.

Different research studies and reviews have produced different figures for the relative number of women who benefit from screening versus those potentially harmed. Hence, it is difficult to establish exactly how accurate the current screening programme is.

What is the breast screening programme?

The NHS Breast Screening Programme screens around 1.6million women a year. Women aged 50 to 70 years of age, who are registered with a GP, are automatically invited for screening every three years. In 2012, an extension to the programme is being introduced by conducting a large trial where women aged between 47 and 73 will be invited to take part in the study.

Screening takes place at a special clinic or mobile breast screening unit where a mammogram (X-ray of the breast) is taken by a female health professional. This is then studied to look for any abnormalities. The aim is to find breast cancer at an early stage, when any changes in the breast would be too small to feel and when there is a good chance of successful treatment and full recovery.

The main treatments for breast cancer are surgery (removing a lump or the entire breast), radiotherapy, chemotherapy, hormone therapy and biological therapy. Patients may have one of these treatments or a combination.

How will the review be carried out?

The independent review will be led by Professor Richards and Harpal Kumar, chief executive at Cancer Research UK. Professor Richards says they are seeking independent advisers for the review who have never previously published on the topic of breast cancer screening. The letter did not give any indication of how long the review might take.

Links To The Headlines

Breast cancer screening under review. BBC News, October 27 2011

Fears that breast screening 'does more harm than good' prompts major NHS review. Daily Mail, October 27 2011

Breast screening is no longer a no-brainer. The Guardian, October 27 2011

Breast screening review will give women 'more accurate information'. The Daily Telegraph, October 27 2011

Links To Science

Bewley S. The NHS breast screening programme needs independent review. BMJ 2011; 343:d6894
http://www.bmj.com/content/343/bmj.d6894

Richards M. An independent review is under way. BMJ 2011; 343:d6843
http://www.bmj.com/content/343/bmj.d6843

Government drug advisers have today called for tighter regulation of ‘legal highs’ - recreational drugs sold legally due to loopholes in the law. In a new report the Advisory Council on the Misuse of Drugs (ACMD) has published details of how drugs such as ‘meow meow’ (mephedrone), which was banned last year, have been openly sold over the internet under the guise of being ‘plant food’ or ‘research chemicals’.

The report also highlighted the false perception that just because a drug is technically legal it must be safe, pointing out that there have been at least 42 deaths associated with the use of mephedrone, and dozens more where its use has been suspected.

While the mephedrone family of drugs has now been banned, the ACMD said those manufacturing legal highs are increasingly tweaking the chemical formulas of banned legal highs to bypass bans on specific substances. In response, it suggested that legislation should be used to make it illegal to produce substances with similar effects to banned drugs, rather than just banning specific chemicals as they emerge.

In its report, the ACMD made further recommendations aimed at trying to reduce sales, demand and harms.

What are legal highs?

Legal highs are drugs that are intended to mimic the effects of illegal drugs but can technically be sold or possessed legally. However, the lack of legal control does not imply that they are safe, and a number of substances sold as legal highs in the past have since been associated with health problems and even death. For example, until it was banned in 2010, the substance mephedrone (also known as meow meow) was legally allowed to be sold when labelled as a research chemical or as a plant food. However, recent data has shown that despite perceptions that it was safe, the drug has contributed to at least 42 recorded deaths. Its use has also been suspected in dozens of further deaths.

While many substances that were once sold as legal highs have since been banned, the ACMD says that chemists are constantly using their knowledge to develop new ‘legal highs’ that fall outside existing drug legislation. These are often chemically similar to banned substances and produce similar effects, but due to them having different chemical compositions they may not technically be governed by existing laws. Given the new, or novel, nature of legal highs, the ACMD refers to them as Novel Psychoactive Substances (NPS).

The ACMD says legal highs generally fall into four broad categories:

• products with names that give no indication of what they contain
• substances that are designed to be similar to specific controlled drugs
• substances related to medicines
• herbal or fungal materials or their extracts

NPS products cannot be marketed, sold or labelled as being intended for human consumption, which would make them subject to strict pharmaceutical legislation. To circumvent these laws they are often labelled as something else; for example, plant food, bath salts, research chemical or boat cleaner, with disclaimers saying they are ‘not for human consumption’.

What issues did the report consider?

The report considered a number of different factors relating to NPS, their use and measures to tackle them. Among the specific issues examined were:

• legal highs’ place in the UK drug scene
• personal harm
• societal impact
• measures to reduce demand
• measures to reduce supply
• current and future legislation
• ways to future-proof drug laws

The ACMD was keen to point out that the report does not provide a solution to the current problem or guidance on specific NPS products, but rather options that may help reduce the harmful impact of legal highs. However, in considering the issue in general, the report described cases studies for mephedrone, which was banned in 2010, and Ivory Wave (also known as Desoxypipradrol or 2-DPMP), an NPS that has not yet been classified as a controlled substance.

In the case of mephedrone the report highlighted how quickly the novel drug rose in popularity, but also that there has been a growing number of adverse incidents reported, and at least 42 deaths where the drug played a significant role. The report also stated that a few months after mephedrone was banned, those manufacturing legal highs started producing a similar (and technically legal) substance called naphyrone, highlighting how quickly existing laws can be circumvented.

Desoxypipradrol, the main active ingredient in Ivory Wave, is not yet a ‘controlled substance’ (illegal to supply or possess), although its import into this country has been banned. However, testing of Ivory Wave products has shown its chemical contents can vary, and at times it may contain controlled substances. This means that a person who had bought an Ivory Wave product thinking it was legal could still subject to prosecution if they were stopped by the police and found to carrying a controlled substance.

What are the dangers from using legal highs?

Generally, there is a lack of safety data on the legal highs, which mostly appear to be untested and unregulated compounds. Aside from these obvious risks, the contents of products are often variable and not specified on packaging, meaning people can never be sure exactly what they are taking, even if they have used a product before.

Even though there is limited data available on these substances, there appears to have been an increase in hospital admissions and medical appointments due to the toxicity of legal highs. In addition, health services are starting to see health problems caused by regular use of legal highs, including, dependence that requires detoxification treatment.

Testing has also shown that many NPS are synthetic amphetamine-like stimulants, meaning they are likely to share many of the well-documented adverse effects of amphetamines, such as dependence. It also means that it is possible that the more potent NPS are likely to carry an overdose risk at just a few milligrams, which is likely to be associated with acute toxic effects.

How popular are legal highs?

The ACMD says that NPS use is such a new phenomenon that it is hard to gauge how popular and readily available these substances are. However, while the council says that robust data on the issue is often unavailable, sources such as the British Crime Survey have recently started collecting data on their use. The council highlights some of the survey’s data on mephedrone for 2010/11, which suggested that:

• 4.4% of people aged 16-24 had used mephedrone in the past 12 months, the same proportion that had used cocaine. (This data related to both the period when mephedrone was considered to be legal high and when it became a controlled substance and was banned).
• Across all adults surveyed (ages 16-59), 1.4% had used mephedrone in the past 12 months, a similar level of usage to ecstasy.

The report also cited a 2011 survey run by the dance music magazine Mixmag, which asked clubbers several question on their use of drugs. Although the survey was aimed specifically at clubbers, 75% of them said it was easy or very easy to obtain mephedrone prior to the ban. Post-ban 38% of respondents said it was easy or very easy to obtain. The same survey, however, said that 42% of respondents had tried the drug pre-ban, but that 61% had tried it post-ban.

The ACMD report noted that British Crime Survey figures suggested that overall drug use is coming down in the UK.

What recommendations does the council make?

The report made extensive recommendations relating to policy, the law, public health messages and how to close loopholes that mean that drugs are legal until they are specifically deemed controlled substances. Some suggested measures recommend that:

• The UK should develop EU and international networks to address the issue of legal highs.
• Countries involved in the manufacture of the legal highs should be encouraged to stop.
• The UK government should put in place processes that would allow the Misuse of Drugs Act 1971 to be updated quickly and easily when minor changes are required.
• Chemical detection and testing methods need to be developed so that illegal compounds present in legal highs can be easily detected.
• That new legislation should be considered, possibly similar to the Analogue Act 1986 used in the US. This would mean that chemical substances similar to controlled chemicals would automatically be banned, that is, it would be automatically be illegal to create a chemical with similar properties to a banned substance.
• The burden of proof should be placed upon the supplier to establish beyond reasonable doubt that the product being sold is not for human consumption and is safe for its intended use - in other words, to prevent it being marketed as bath salts or plant food.
• Specific legislation, namely the Consumer Protection from Unfair Trading Regulation and General Product Safety Regulations (2005), should be applied to the sale of legal highs, and the Advertising Standards Agency should investigate claims made by the websites selling legal highs.
• Research into the chemistry, pharmacology, toxicity and social harm of legal highs should be increased.
• Moves to increase public awareness should be implemented.

Links To The Headlines

Mephedrone users told they are playing Russian roulette. The Independent, October 26 2011

Legal high linked to up to 100 deaths. The Daily Telegraph, October 26 2011

98 deaths fuel calls for legal highs ban. The Sun, October 26 2011

Government advisers call on ministers to launch a war on “legal highs”. Daily Mirror, October 26 2011

Party drug meow meow kills one young Briton a week. Daily Mail, October 26 2011

'Legal highs' should be automatically banned, says government drugs adviser. The Guardian, October 26 2011

Legal highs need more controls, say drug council. BBC News, October 26 2011

Links To Science

Advisory Council on the Misuse of Drugs: Consideration of the Novel Psychoactive Substances (‘Legal Highs’). October 2011

Doctors have warned, “drinkers should have three alcohol-free days a week if they want to avoid the risk of liver disease,” the Daily Mail reported. It continued that the Royal College of Physicians (RCP) said that the current guidance must be rewritten as it implies that drinking every day is fine.

The new advice from the RCP is part of a submission to MPs on the House of Commons' Science and Technology Committee about current alcohol guidelines. This submission discusses their review of the evidence from 1995 as well as more recent research evidence and alcohol intake guidelines from other countries. The RCP concluded that the current wording of the UK guidelines appears to sanction daily or near daily drinking. It adds that the frequency of alcohol consumption is an important risk factor for the development of alcohol dependency and alcoholic liver disease.

To address what it sees as a problematic lack of emphasis on the frequency of drinking, the RCP suggests that the current advice on safe limits for alcohol intake should be stated in terms of weekly alcohol intake rather than daily unit limits, and that two or three days in the week should be completely alcohol free. It says that men should consume no more than 21 units a week and women should have no more than 14 units, provided the total amount is not drunk in one or two sessions.

The Department of Health (DH) has reportedly said that it has no plans to change its guidance at present. It recommends that men should not regularly drink more than 3-4 units of alcohol a day, while women should not regularly drink more than 2-3 units. ‘Regularly’ is defined as drinking every day or most days of the week. People are also advised to not drink alcohol for 48 hours after a heavy session to let their bodies recover.

Alcohol abuse is associated with an increased risk of liver disease, cancer and other conditions. Read our Live Well pages on alcohol to find out more.

Where is the advice from?

The advice comes from a report by the Royal College of Physicians (RCP). The RCP submitted its report to MPs on the House of Commons' Science and Technology Committee. As such, the advice given is for the government about its policy on recommended alcohol intake limits, rather than being aimed directly at the public.

The RCP believes that government advice on sensible drinking limits can play an important role in dealing with alcohol misuse. It says that it is essential government advice is based on evidence and that it is regularly reviewed. It continues that the last systematic review of the evidence by the government, to which interested parties could submit their views, was in 1995.

The RCP believes that current government guidelines on alcohol consumption could be improved to better reflect the evidence in a number of areas, such as:

• overall levels of consumption that are ‘safe’ or within ‘sensible limits’
• frequency of alcohol consumption
• the physiological effects of ageing
• the balance of the health benefits of alcohol consumption for coronary heart disease against wider alcohol-related health harm

The RCP would also like a clear, independent evaluation of the government’s strategy for communicating its guidelines and the risks of alcohol intake to the public.

What does the RCP advise?

The RCP believes that the current wording of the UK guidelines appears to sanction daily or near daily drinking. It says this is problematic, because the frequency of alcohol consumption is an important risk factor for the development of alcohol dependency and alcoholic liver disease. The RCP cites various studies to support its argument.

It also notes that someone drinking four units a day (the current upper limit for men in the UK) would be classed as a hazardous or high-risk drinker on the WHO’s gold standard tool for identifying people at risk of alcohol-related harm.

The RCP says that these potential problems with the current guidelines could be remedied by moving to a weekly limit and adding the recommendation to three alcohol-free days a week.

It recommends that in order that people keep their alcohol consumption within ‘safe limits’, men should consume no more than 21 units a week and women should have no more than 14 units. It says that most individuals are unlikely to come to harm at these levels, provided the total amount is not drunk in one or two sessions, and that there are two to three alcohol-free days a week. It says that above this limit the risk of death from all causes increases as alcohol consumption increases.

The RCP also notes that these recommendations are a best judgement based on the evidence, and were reached after a number of areas of uncertainty and inaccuracy were taken into account.

The RCP also suggests that recommended limits for safe drinking by older people in the UK require further consideration, as older people may be particularly vulnerable to harm from alcohol due to biological changes associated with ageing. It says that current guidelines are based predominantly on evidence for younger age groups and there is concern they are not appropriate for older people.

What evidence is this based on?

The RCP’s advice appears to be based on their review of evidence from 1995, and updated with other research evidence published since 1995.

What is current UK government advice?

Official UK government guidance recommends that men should not regularly drink more than 3-4 units of alcohol a day and women should not regularly drink more than 2-3 units a day. 'Regularly' is defined as drinking every day or most days of the week. It is also recommended that people not drink alcohol for 48 hours after a heavy session to let their bodies recover.

Pregnant women and women trying to conceive should avoid drinking alcohol. If they do choose to drink alcohol, they are advised to not drink more than 1-2 units of alcohol once or twice a week and not to get drunk, to minimise the risk to the baby. The National Institute for Health and Clinical Excellence (NICE), advises women to avoid alcohol in the first three months of their pregnancy in particular, because of the increased risk of miscarriage.

How do the UK guidelines compare to other countries?

The RCP notes that comparing alcohol guidelines between different countries is difficult, as there are differences in the size of standard drinks and units. It reports that a recent analysis by the Australian government found that 15 countries recommended lower limits than the UK for men, and 12 countries recommended lower limits than the UK for women. Six countries recommended higher limits than the UK for men and six countries recommended higher limits than there are for UK women.

The RCP notes that although looking at the guidelines from other countries may be of interest, it is important that UK government guidelines are a considered and expert judgement on the risks of alcohol consumption, based on the scientific and medical evidence.

Where can I get more information?

More information on the effects of alcohol is available from the NHS Choices alcohol pages.

Links To The Headlines

Avoid alcohol three days a week, doctors warn. BBC News, October 23 2011

Avoid alcohol three days a week, doctors warn. The Daily Telegraph, October 23 2011

Doctors say alcohol free days needed to protect liver. BBC News, October 23 2011

New guide for safe drinking. The Independent, October 23 2011

Don't drink on 3 days a week. As the liver crisis deepens, leading doctors warn of the dangers. Daily Mail, October 23 2011