Inside Health

About six thousand people in the UK lose a leg every year from amputations due to vascular problems, trauma and disease. Others are born without limbs. Standard prosthetic knees often meant frequent falls and stumbles as well as the need to use two sticks. But microprocessor power is set to change all that. A new generation of intelligent joints is now available for the first time on the NHS in England - you can already get them in Scotland and Northern Ireland - and they adjust the knee stiffness to match the individual's weight, gait and activity and they even have anti-stumble software. Dr Mark Porter joins Dr Imad Sedki, consultant in rehabilitation medicine at the Royal National Orthopaedic Hospital in Stanmore at a retrofitting clinic, where patients like Naitik Patel are fitted with these new smart knees.Almost a decade ago, researchers in Scotland coined the term "The Glasgow Effect" after they exposed the shocking fact that premature deaths were 30% higher in Scotland's biggest city compared with cities with similar histories like Liverpool and Manchester. Since then studies have highlighted a toxic combination of social, political and economic decisions which adversely affected the health of Glaswegians. Sir Harry Burns, the former Chief Medical Officer for Scotland, now Professor of Global Public Health at the University of Strathclyde, talks to Mark about why the phrase "The Glasgow Effect" has fallen out of favour and what he thinks should be done to address continuing health inequality.Glasgow - in fact the UK as a whole - has one of the highest rates in the world of mesothelioma, a cancer which attacks the lining of the lung and which is directly linked to the breathing in of asbestos fibres. From her home city, Inside Health's Dr Margaret McCartney reports from the Queen Elizabeth Hospital in Glasgow, which is a specialist centre for patients with this cancer. She talks to Robert Henderson, who contracted mesothelioma fifty years after working as an apprentice electrician and to 68 year old Boyd McNicol, who worked as an art teacher in a school full of asbestos when he was in his 20s. Their doctor, Kevin Blyth, is a respiratory consultant who coordinates a mesothelioma service across Western Scotland. He tells Margaret that the 20, 30, 40 and even 50 year time lag between exposure to asbestos and a diagnosis of mesothelioma means that the cancer will still be claiming lives for many years to come and urgent new treatments are needed. Producer: Fiona Hill.

News that the pharmaceutical giant Pfizer has pulled out of research into Alzheimer's and Parkinson's disease is casting doubt over the future of long promised breakthroughs in this area. Mark Porter hears from two leading experts who explain that due to the complexity of the disease the pharmaceutical industry's single agent 'magic bullet' approach needs to change. And while over the last 15 years nearly every trial into new treatments for Alzheimer's has ended in failure, lifestyle and medical prevention are starting to make a difference. Plus clarity on headlines that women who've had the HPV vaccine to prevent cervical cancer will need far fewer smear tests in future. But how will the national screening programme know for sure who has been vaccinated - and who hasn't? And Margaret McCartney's thoughts on other news that women treated for breast cancer who carry the BRCA1 and BRCA2 mutations that dramatically increase the risk of developing the disease, are just as likely to survive their illness as women who don't.

It's fifty years since the first human heart transplant but the number of donor organs - about 200 per year in the UK - remains dwarfed by demand. About 2,000 people under the age of 65 a year will die of heart failure without a transplant. Kevin Fong explores new ways that people with heart failure can be helped. He talks to Dr Doris Taylor, director of the Center for Cell and Organ Biotechnology, at the Texas Heart Institute, in Houston, about her research into growing hearts from stem cells. Kevin discusses the prospect of taking organs from pigs and using them for so-called xenotransplants with cardiothoracic surgeon Prof John Dark, of Newcastle University, who says this approach has not delivered benefits. An alternative to a heart transplant is the left ventricular assist device (LVAD) - an artificial pump that helps the left side of the heart do its job. This has shrunk from a large external piece of kit to a tiny battery-operated device that can be implanted into the chest. For the first year, they are as effective as a transplant, but they have a risk of infection, and they are not always easy to live with. Kevin meets patient Vincenzo Avanzato who had an LVAD that became infected and then a successful transplant.Kevin also talks to surgeon Mr Andre Simon of Harefield Hospital about the future of completely mechanical hearts made of metal and plastic.

What goes into our flu vaccine always has an element of guesswork. Usually the experts get it right but sometimes nature has other ideas and a new strain emerges. Dr John McCauley, Director of the Worldwide Influenza Centre at the Francis Crick Institute in London tells Dr Mark Porter about Aussie flu and how different flu strains pose risks to different groups of people. Cow's milk allergy is the most common food allergy among infants and it affects at least one in 50 babies, toddlers and pre-school children in the UK. It's an allergic reaction to the protein in cow's milk. There are two different types though and one type, called delayed cow's milk allergy, is often missed by health care professionals because it's easily confused with other common conditions. Lucy Wronka tells Inside Health her baby son George was ill for months with reflux, eczema and an upset stomach. It was only a chance meeting with a friend who recognised the symptoms that led to a diagnosis of delayed cow's milk allergy. Twenty four hours after diagnosis and treatment, Lucy says George was a different baby. Dr Adam Fox, paediatric allergist at the Evelina London Children's Hospital explains the difference between the two different types of cow's milk allergy and discusses new guidance for GPs and health visitors which are designed to improve diagnosis.One of Europe's largest robotic pharmacies is housed in Glasgow and this super high-tech hub has replaced fourteen separate pharmacy stores. It handles almost a hundred thousand packs of medicines a week and Inside Health's Dr Margaret McCartney, herself a GP in the city, reports on how this automation has transformed pharmacy services in Greater Glasgow and Clyde.

Can dogs smell cancer? Ever since Hippocrates the odour of disease has been used to aid diagnosis but has this simple technique been forgotten? Dr Mark Porter investigates the evidence for whether canine super noses can be used to accurately detect cancer. There have been plenty of anecdotes reported but what about hard science? Studies since 2004 from the Medical Detection Dogs Centre in Milton Keynes have shown convincing results and they've now teamed up with MIT in the US, specialists in 'e-noses'. Could devices the size of a mobile phone be used to sniff for disease?

The Chief Medical Officer has warned of a "post-antibiotic apocalypse" and "the end of modern medicine". As antibiotic resistance increases, the options to treat potentially deadly infections reduces. Inside Health's Dr Margaret McCartney discusses the latest campaign by Public Health England to remind us all not to take antibiotics when they're not needed.It's been over thirty years since there was a breakthrough in the treatment of pneumonia, but that could soon change....and from an surprising source. Researchers in Birmingham at Queen Elizabeth Hospital have been working with the cholesterol-lowering drugs, statins, and discovered that this medication can turbo-charge our immune systems, helping us to fight infection. Dr Liz Sapey, respiratory consultant and researcher tells Dr Mark Porter about the exciting possibility of tablets that cost just a few pence each, being used to treat potentially deadly lung infections like pneumonia. Epilepsy is normally controlled by anti-seizure medication but for a third of patients, pills don't work, and constant fits can have a devastating impact on the developing brain. Neurosurgery - removal or disconnection of parts of the brain where the seizures originate - is now done at a much younger age in patients with untreatable epilepsy. Operating on children takes advantage of brain plasticity. Mark visits Bristol Children's Hospital, one of four national centres which since 2011 have offered increased access to epilepsy surgery. Paediatric neurosurgeon Mike Carter is part of the national drive to operate on children before they are two years old, all to take advantage of brain plasticity. Mark meets 8 year old Lucy, 20 days after she had major surgery to remove a finger-nail sized portion deep in her brain. Lucy's father, Mark Nettle, describes how, before surgery, his daughter had suffered from multiple daily seizures with increasing weakness down the left side of her body. The possibility of ending these debilitating attacks made surgery an attractive option. Producer: Fiona Hill.

GPs have been told to ask about their patients' sexual orientation as NHS England plans to record this data for everyone using the service over the age of 16. Dr Google - are doctors' noses really being put out of joint by patients searching their symptoms on the internet to come up with their own diagnoses? Hypermobility is being double jointed and flexible and is often perceived as an asset, but for around 1 in 30 of the population it can be a problem that is often missed - and mismanaged. Plus a counterintuitive approach to help people with Chronic Obstructive Pulmonary Disease. You might think the last thing someone with breathing difficulties needs is smaller lungs, but lung reduction surgery is exactly what's being offered some people with COPD.

Vaginal mesh, used for the treatment of prolapse and incontinence, has hit the news recently as women pursue litigation after suffering serious complications. But there have been concerns ever since the first type of vaginal mesh was launched in the mid-nineties, only to be withdrawn a few years later. Carl Heneghan, Professor of Evidence Based Medicine at the University of Oxford, explains the 'shambolic' regulation of medical devices, Consultant gynaecologist Swati Jha, who has been collecting data on mesh for over a decade, believes media coverage has been muddled. Women speak of living with surgery, while Inside Health's Dr Margaret McCartney calls for a registry to collect effective data. Plus, new guidance in Scotland challenges the so called 'J-shaped curve' - evidence that moderate drinking is good for the heart. Naveed Sattar, Professor of Metabolic Medicine at the University of Glasgow and part of the committee that produced the updated guidance, talks to Mark Porter about the changes.

Mention arthritis and most people think of older people with osteoarthritic hips or knees. But children get arthritis too, although it's an inflammatory condition where the child's immune system attacks the lining of the joints causing pain, swelling and stiffness. But the joints aren't the only part of the body affected. Around one in six of the 12,000 children in the UK with juvenile idiopathic arthritis also develop worrying inflammation in their eyes, uveitis. This is a silent, symptomless condition which can result in significant visual impairment and even blindness. But a new drug treatment, tested in the UK, has proved to be so successful for this group of children that it has revolutionised treatment both in this country and around the world. The benefits were so large that the trial was stopped early and the new therapy adopted as frontline treatment. Dr Mark Porter visits the Bristol Eye Hospital and meets paediatric rheumatology consultant, Professor Athimalaipet Ramanan to find out more.Bigger babies can get stuck in the final stages of labour - a condition called shoulder dystocia. Most are delivered safely but there are both enormous risks to the baby through lack of oxygen and a traumatic experience for the mother. Professor of Obstetrics at Warwick Medical School, Siobhan Quenby, tells Mark that a nationwide trial of big baby births aims to find out whether delivering the child two weeks early, at 38 weeks, reduces shoulder dystocia and makes the birth safer for mother and child.A report by NHS England highlights cost savings of around £100,000 for GP practices that use telephone triage for patients. But the first independent evaluation of this system, where everyone speaks to a doctor on the phone before they get a face to face appointment suggests that policy makers should reconsider their unequivocal support. Inside Health contributor Dr Margaret McCartney, herself a GP, reviews the findings.Several thousand people a year, many of them children, are admitted to hospital every year with serious burns. One of the country's leading centres for burns victims is at the Queen Elizabeth Hospital in Birmingham. As well as serving 13 million people in the local area, the Healing Foundation UK Burns Research Centre treats injured service personnel, airlifted from conflict zones in Iraq and Afghanistan. Mark gets a tour of the unit from director Naiem Moieman and finds out about the newest research on burns treatment which uses some of the oldest remedies.

After Simon Cowell paid for a Britain's Got talent contestant to have surgery in the US for her curved spine we examine the state of therapy for scoliosis here in the UK. Recent headlines claimed that 1 in 4 teenage girls are depressed but were they accurate? And pets in hospital: the Royal College of Nursing has called for patients to have better access to animals, including their own. Plus Eustachian tubes: tips for what to do if you have blocked ears after your summer holiday.