Inside Health

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?

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?