Inside Health

Copycat biologic drugs, to treat conditions from arthritis and psoriasis to breast cancer and lymphoma, could save hundreds of millions of pounds off the NHS drugs bill. Called biosimilars, these close copies give the same clinical benefit at a fraction of the cost. Up to now the problem has been take-up, but a new initiative led by the specialist UK cancer centre, London's Royal Marsden, run across the NHS Cancer Vanguard, has demonstrated that patients can be switched effectively onto the cheaper drugs. Chief pharmacist at the Royal Marsden, Dr Jatinder Harchowal, who led the national staff education programme, tells Mark that getting clinicians and patients on board was key to achieving an 80% take up for the blood cancer biosimilar, rituximab. This month a biosimilar copy of the breast and stomach cancer drug, Herceptin (generic name trastuzumab) is being introduced to patients too. Imogen had sleep problems for almost 30 years and she admits that at times, her insomnia left her in a desperate state. For years she took sleeping tablets but she ended up increasing the dosage, to no effect. Eventually she found help at Queen Victoria Hospital's Sleep Disorder Clinic in East Grinstead. Mark visits the clinic and finds out from its Clinical Director Dr Peter Venn that sleeping tablets aren't the answer to insomnia and cognitive behaviour therapy, which Imogen used, is the best treatment.Scotland has led the UK nations in allowing early medical abortion at home. Wales in the past 10 days has followed their lead. So where does this leave England? Dr Margaret McCartney reports from Glasgow about the choice now available for Scottish women who opt for a medical termination. Since last autumn the second pill that induces the breakdown of the womb lining can be taken at home, a practice that already happens in Scandinavia and parts of the USA. Dr Audrey Brown, a consultant in sexual and reproductive healthcare, tells Margaret that the impetus for the change in practice in Scotland came directly from women who didn't want to make the second clinic visit for the second set of drugs and risk cramping and bleeding on the way home. A woman who has opted for early medical abortion at home in Scotland shares her experience with Inside Health.Producer: Fiona Hill.

Tamoxifen, the so called "statin of breast cancer prevention" is recommended for healthy women with a family history of the disease. So why are only 1 in 7 of those eligible taking it? And Mark Porter speaks to Professor Gareth Evans working with his team at the Wythenshawe Hospital in Manchester to reliably identify women at higher risk of breast cancer. They are testing for SNPS, spelling mistakes in the DNA that influence growth and survival of cancer cells and that give a more accurate assessment of a woman's risk.

The UK has one of the highest recorded rates of acid attacks in the world, nearly 500 cases in 2016. Most of the victims are men and most have corrosive liquid, typically acid or bleach, squirted into their faces while they are being mugged for their phone, bag or car. Andrew Keene was attacked in London last year while he sat in his car, and blinded by a robber who then drove off in his car. He's had five operations, including two corneal grafts, to try to restore the sight in his right eye. Dr Mark Porter talks to Andrew at Queen Victoria Hospital in East Grinstead, where sight-saving eye surgery was pioneered over sixty years ago. This hospital set up the UK's first Eye Bank for donor eyes and it is from these donations that eyes, damaged like Andrew's, are repaired using grafts. Mark hears about the shortage of donated corneas which mean long waiting lists for eye surgery and Eye Bank head Dr Nigel Jordan tells him they're having to import donor eyes from the USA to meet demand. BBC News anchor George Alagiah has gone public with the news that his bowel cancer has come back three years after it was diagnosed at an advanced stage. He has questioned why screening starts at different ages in different parts of the UK. If he lived in Scotland where the bowel cancer screening programme starts at 50, up to 10 years before the rest of the country, he would have been screened earlier and his cancer might have been picked up earlier, making it easier to treat. Inside Health's Dr Margaret McCartney discusses the complexities involved in rolling out national screening programmes and tells Mark why there's a difference in Scotland and the rest of the UK about the starting age for bowel screening.Until a couple of years ago, children who were born without a limb, or those who lost a limb after illness or injury, could get a traditional prosthesis, or artificial limb fitted, but it was a limb of the most basic kind which would enable them to walk, but not to run or do sports. But thanks to money released into a special fund by the Department of Health in England, for the last 18 months these children have been fitted with the high-tech futuristic-looking prostheses - racing blades - that allow them to run, jump and compete in all sorts of activities and sports. Mark visits a paediatric rehabilitation clinic at the Royal National Orthopaedic Hospital in Stanmore and meets the children who are benefiting from these new activity blades.

Deciding between healthy ageing and early dementia; how useful are modern imaging techniques in deciphering this difficult question that many families are grappling with. Margaret McCartney tries to make sense of conflicting research on the impact of fish oils on children's reading ability and memory - how can the same research group, in the same university run two trials and get completely opposite results? And recently Baroness Tessa Jowell called for more access to adaptive trials but what does this type of research actually mean for patients taking part? Plus the evidence for the health benefits of yoga.

There are many myths about recovery from a heart attack. The most dangerous is that exercise is too risky. The truth is that for most people, they should be doing much more exercise, not less. Patrick Doherty, Professor of Cardiovascular Health at York University and lead author for the National Audit of Cardiac Rehab tells Dr Mark Porter that 70,000 people who should be accessing life saving cardiac rehabilitation therapy are missing out. The answer? Don't blame the patients but improve the design of rehab packages, he says. Inside Health visits a rehab session at Charing Cross Hospital in London and hears from cardiac patients about the impact of supported exercise programmes on their health.A group of psychiatrists, psychologists and patients have complained to the Royal College of Psychiatrists about the withdrawal effects of antidepressants. They say claims that side effects are resolved, for the majority of patients, within a few weeks of stopping treatment are false and in fact, many people suffer unpleasant, frightening symptoms for much longer. Inside Health's Dr Margaret McCartney looks at the evidence.We're all familiar with hearing aids, amplifiers which boost volume in a failing ear. And you might have heard of cochlear implants which, in people too deaf for aids, can be used to send signals directly to the inner part of the ear, and on to the brain. But in the future we're likely to hear more about middle ear implants, devices implanted because the outer ear hasn't developed properly. ENT surgeons at Guy's and St Thomas' Hospital in London, Professor Dan Jiang and Harry Powell, have performed a middle ear implant on the UK's youngest ever patient, Charlotte Wright was just three years old when she had this pioneering treatment. Producer: Fiona Hill.

This week it has been hard to miss news on prostate cancer. The papers were full of a 'one stop shop' service for the diagnosis of the disease being rolled out in three hospitals in England. Plus celebrities have described their diagnosis and encouraged men to see their doctor for a PSA test. But just published today, the largest every study of prostate cancer over 10 years confirms that a single screening test of PSA does not save lives. With all these headlines this week is an ideal time to repeat Inside Health's prostate special. One in eight men in the UK will develop prostate cancer at some stage, but deciding who needs treatment - and when - is still far from clear. Mark Porter and Margaret McCartney report on two landmark trials that could provide some clarity, and hears from men and their doctors, faced with the dilemma of choosing the right course of action.

First urine testing then finger pricking and now high-tech scanning. The monitoring of glucose levels is undergoing a revolution for patients with Type 1 Diabetes. Dr Margaret McCartney reports from Glasgow on the new sensing devices which allow for endless glucose scanning without the need for multiple finger prick blood tests. She talks to parents like Ben, who's paying for a continuous glucose monitor because the fingers of his young son George, were so sore from constant finger prick testing that he couldn't even play with his lego. And to 18 year old Matthew and his mum, Barbara, about the flash glucose monitor which they say has transformed the control and management of his diabetes. Dr Kenneth Robertson, who's led NHS Greater Glasgow and Clyde's Children's Diabetes Service for the past 25 years tells Margaret that the new technology is a game changer for diabetes, but urges a cautious, evidence-based roll-out of the best devices.Many patients, as Margaret hears, are paying for the devices out of their own pockets and the charity UK Diabetes is keeping tabs on which areas of the NHS are funding flash glucose monitors after they came on NHS license four months ago. Policy Manager Nikki Joule tells Mark that they'll lobby hard on behalf of patients denied access to this life-changing technology. Meanwhile Dr Partha Kar, Associate National Clinical Director for Diabetes at NHS England urges clinical commissioning groups to review national guidance and where patients are multiple testing or at risk of the life-threatening high sugar level condition, ketoacidosis, allow access. Enthusiastic headlines following the recent Lancet study of antidepressants claimed the drugs work, that they're better than placebo and that more should be prescribed. Inside Health's Dr Margaret McCartney takes a closer look at the large meta-analysis of over 500 clinical trials.Every year in the UK almost 200,000 hip and knees get replaced, mainly because of osteoarthritis. But if the damaged cartilage could be repaired in younger people, would this prevent arthritis and a replacement joint later in life? Researchers have been using stem cell therapy to re-line damaged joints but it's an expensive and complex process, which up to now has involved two stages, one to harvest the stem cells and another, weeks later, to put the tissue back into the injured joint. But now a team at the Royal National Orthopaedic Hospital at Stanmore has developed a one stop operation. Stem cells are harvested from the pelvis and then in the same operation, put back into injured knees to "seed" new cartilage . George Bentley, emeritus Professor of Orthopaedics, orthopaedic surgeon James Donaldson and patient, Nick Brown, talk to Inside Health about this pioneering new treatment. Producer: Fiona Hill.

There are questions in Parliament following the story of 6 year old Alfie Dingley who was refused medical cannabis to help relieve his epileptic seizures. But what is the body of evidence for medical cannabis and does the reality live up to the hype? And age, immunity and the poor performance of this season's flu vaccine. Why do our defences decline as we get older and what can be done to improve vaccines that aim to protect the elderly against flu? Plus blood in your urine - pee the colour of Ribena is hopefully enough to drive anyone to their doctor - but what about tiny traces invisible to the naked eye frequently picked up by sensitive dipstick tests? If that has happened to you listen to our comprehensive guide.

Rickets was eradicated from the UK after World War Two but "The English Disease", as rickets has long been known, is back. Two children have died of this completely preventable disease in the past two years. Dr Mark Porter talks to paediatrician Dr Benjamin Jacobs at the Royal Orthopaedic Hospital in Stanmore about the importance of Vitamin D supplementation and calcium for proper bone growth. He meets Zana, whose toddler son was diagnosed with rickets six months ago and talks to Dr Priscilla Julies, paediatrician from the Royal Free Hospital in London about the forthcoming British Paediatric Surveillance Unit survey of the disease. Consultant Paediatric Endocrinologist Dr Wolfgang Hogler from Birmingham Children's Hospital tells Mark that the UK's record of vital Vitamin D supplementation is woeful compared to our European neighbours and warns that unless rickets is given a higher priority, more lives will be lost.The number of drug related deaths has soared in recent years and this is against a background of growing concern about the misuse of prescription medicines - particularly morphine type painkillers - and the burgeoning popularity of novel psychoactive substances like spice and mamba. But this changing drugs scene has been accompanied by changing attitudes and approaches to what helps addicts recover. A new European survey - in England, Scotland, Belgium and the Netherlands - led by David Best, Professor of Criminology at Sheffield Hallam University aims to map what has helped people out of their drug addiction and he tells Mark this will better shape policy and services. Advances in pacemaker technology mean that many people who are prone to life-threatening heart rhythm disturbances, will have, inside their chests, their own internal defibrillators, known as implantable cardioverter defibrillators, or ICDs. These tiny devices, not much bigger than a matchbox, sit in the upper chest and monitor the heart. When they detect a problem they automatically deliver a shock, direct to the organ. This is life-saving technology but arrhythmia specialist nurse, Sharlene Hogan from St Thomas' Hospital in London six years ago set up a support group for patients with ICDs, because she realised that there was enormous anxiety about when the device might fire. The group meets three to four times a year and Inside Health reports from their most recent get together.Producer: Fiona Hill.

Over half of all blood clots are acquired during hospitalisation, particularly for surgery, so prevention is key. Deep vein thromboses - DVTs - typically occur in the veins of the leg and central to prevention is the need to assess individual risk, while taking steps like special stockings, leg massagers and anticoagulant "blood thinning" drugs to mitigate them. But there are concerns in some quarters - particularly among orthopaedic surgeons - that the drive to protect patients against clots has exposed them to risks of bleeding and that the pendulum has swung too far the other way. Three leading specialists discuss the issues. And iron deficiency, a very common problem, but what is the best way to treat it? New research from Switzerland unexpectedly suggests that giving less iron, less frequently, leads to more absorption. Plus, what's in a doctor's bag?