Inside Health

Why asthma is both over diagnosed and undertreated. Professor Mike Thomas and GP Dr Margaret McCartney discuss this apparent contradiction and look behind recent headlines that half a million children in the UK could be taking asthma medicines they don't need. A new study finds that putting doctors under pressure or being a difficult patient may backfire, inducing them to make diagnostic errors. With scarlet fever and measles in the news, Margaret McCartney gives a quick guide on the key symptoms as both diseases have a characteristic rash. A listener has emailed to ask about visual snow, a condition where your vision is like an untuned TV set. World expert, Professor Peter Goadsby explains the latest understanding of visual snow, and says that even 15 years ago it hadn't been universally accepted as a condition. Plus the first in the latest Inside Language series with Margaret and Dr Carl Heneghan of Oxford University. This week, they discuss confounding factors and why they matter to your health.

Millions of anti-depressants are prescribed every year and more than half of people taking them have been doing so for two years or more. But how do you know when you're better and how can you tell that the time is right to stop taking them? Withdrawal symptoms are often confused with a return of the original depression so careful tapering of medication is crucial. Tony Kendrick, Professor of Primary Care at the University of Southampton gives Dr Mark Porter a run down of what to do, and what not to do, when it comes to coming off medication. If you're 40 or above you're to receive dementia awareness as part of the latest Prime Minister's Challenge on Dementia 2020, just announced. The plans to include dementia education for middle aged people in future NHS Health Checks are aimed at making England - no plans as yet to replicate this in Scotland, Wales or Northern Ireland - the best country in the world for dementia care. Dr Margaret McCartney reviews the new proposals.Seven thousand people in the UK are currently waiting for life saving organ transplants - and every year 1200 die because there's a critical shortage of donor organs. It's meant that the transplant community has had to consider using organs that aren't quite as perfect as they would like. Poorer quality, older or damaged organs are now being considered when they would have been rejected in the past. Mark visits Rutger Ploeg, Professor of Transplant Biology at the University of Oxford at the Oxford Transplant Centre to find out about the pioneering work to treat, heal and re-condition organs using normothermic perfusion devices - essentially mini-life support machines that work at body temperature. Frederique Rattue was the first woman at her local hospital to use "vaginal seeding" when her fourth child was born by caesarean section a year ago. It's a practice that involves taking a swab from the mother's vagina and rubbing it over the baby's mouth, face and skin after birth and the theory is that vaginal seeding will restore the microbiota of infants born by caesarean section, boosting their gut bacteria and reducing the risk of allergies or obesity. Dr Margaret McCartney discusses the theory of vaginal seeding and the evidence that the practice leads to health benefits for the baby.

The use of talc and its potential connection with ovarian cancer has hit the headlines after a court ruling in America. Given that nearly half the UK population uses talc to some degree GP Dr Margaret McCartney looks at the evidence and puts any link in perspective. PBC is an often missed condition that causes severe itching and fatigue with the resulting liver damage mistakenly associated with drinking too much. Laura Gilmore lived with the symptoms for many years - scratching herself raw and falling asleep during the day but still not waking refreshed - before getting a diagnosis. Professor James Neuberger explains the science behind PBC.Plus treating severe head injury and why a commonly used intervention used in intensive care units across the country is being questioned. Professor Peter Andrews is the man behind a new trial looking at the evidence for hypothermia, or cooling people with head trauma to prevent damage. The trial was stopped because early evidence suggested harms from this commonly used practice. Dr Mark Porter discusses the implications for critical care medicine across the world with Peter Andrews and Professor John Myburgh who is at the University of New South Wales in Sydney.

Up to half a million people in the UK could have it, but it's a condition that hardly anybody has heard about: Charles Bonnet Syndrome. It happens to people who are losing their sight through age-related macular degeneration, cataracts, diabetic eye problems or glaucoma. They see vivid and often frightening visual hallucinations and these images are soundless. Judith Potts' mother Esme was in her 90's when she eventually admitted to her daughter that she was seeing frightening images of goblins and Victorian children all around her. Judith had never heard of the condition and as she tells Dr Mark Porter, neither had any of the health professionals taking care of her mother. Shocked that there was so little awareness about something that is so common, she set up an awareness group, Esme's Umbrella. Dr Dominic Ffytche, Clinical Senior Lecturer at King's College London's Institute of Psychiatry and an expert in visual hallucinations, tells Mark that a key area of research is why some people have Charles Bonnet Syndrome and others don't.Co-proxamol, or Distalgesic as it's better known, was a common drug for mild to moderate pain in the 1990's. But a decade ago, a review by the Medicines and Healthcare Products Regulatory Agency (MHRA) decided that it wasn't a good painkiller and it had very worrying side effects. Its licence was withdrawn and doctors were urged to switch patients onto different medication (although it could still be prescribed on a "named patient" basis). Dr Andrew Green, Chair of the Clinical and Prescribing arm of the GP committee of the British Medical Association tells Mark he's disturbed that nearly ten years after the licence was withdrawn, thousands of patients are still being prescribed co-proxamol at a high cost to the NHS while Bedfordshire GP Dr John Lockley defends continued and careful prescribing for a tiny number of patients who can't get relief from other medication.In a week in which hundreds of thousands of people have signed a petition calling for more children to receive the Meningitis B vaccine, Dr Margaret McCartney talks to Mark about the tricky decisions involved in planning immunisation programmes.Traditional bedside paper charts, which record and monitor patients' vital signs, have been replaced in Oxford hospitals with smart PC tablets. Clinical staff enter patients' blood pressure, heart rate and temperature on the tablet and the new "smart" system provides an early warning traffic light system, alerting them if there's a deterioration in the patient's condition. This means clinicians can prioritise care and another major bonus is that the same information is available, at the touch of a button, to medical staff across Oxford's hospitals. The project is called SEND - System for Electronic Notification and Documentation - and it's a collaboration between the University of Oxford and Oxford University Hospitals NHS Foundation Trust. Mark goes to Oxford and with intensive care consultant and SEND Project Leader Dr Peter Watkinson, sees how the new paperless system is working.

The UK's first licensed e-cig, owned by a tobacco company, is now classed as a medicine paving the way for it to be prescribed on the NHS to help people quit. Robert West, Professor of Psychology at University College London and one of the world's leading experts on smoking cessation, and GP Margaret McCartney debate the issues.Asherman's Syndrome, a little known complication of surgery that is often missed but can cause infertility. Obstetrician Virginia Beckett explains how Asherman's Syndrome occurs and how it is treated.Rugby is growing in popularity, particularly among children, with 1.2 million of them now playing at schools and clubs in England alone. But at what cost? Rugby is rough and injuries are more common than most parents think.After her son and other young people were hurt repeatedly on the rugby field, Allyson Pollock, Professor of Public Health Research and Policy at Queen Mary, University of London, explored the incidence of injuries. From her research she is now recommending an end to the contact element of rugby in young people. Rugby Football Union's community medical director Dr Mike England responds.

Dr Margaret McCartney reviews advice to pregnant women concerned about the Zika virus while Andrew Shennan, Professor of Obstetrics at King's College and St Thomas' Hospital in London tells Dr Mark Porter about the risks of infection closer to home - chicken pox.One in every one thousand babies born in the UK has congenital talipes, or club foot. This is where the foot points inwards and downwards, the sole facing backwards. But thanks to the late Ignatio Ponseti, an orthopaedic surgeon from Iowa in the USA, 95% of children born with club foot will make a complete recovery. Dr Ponseti was concerned about the low success rate of surgical treatment, which often resulted in life-long pain and stiffness and a 50% chance of recurrence. He developed a new technique in the 1960's that involves stretching the foot, holding it in plaster casts and eventually braces. The problem was that nobody believed him and it wasn't until the early 2000's that his technique became the new gold standard for club foot treatment - the news spread by his patients and their parents using the internet. Mark visits the club foot clinic at The Royal London Hospital, which sent a team, led by consultant paediatric orthopaedic surgeon, Manoj Ramachandran to study with Dr Ponseti at his Iowan clinic. Mark meets Hannah, whose 8 week old baby, Penelope, is just beginning treatment and hears from Claire, whose son, Lucas, now four years old, has, post-treatment, two perfect feet. Professor of Endocrine Hypertension at Queen Mary University London, Morris Brown, gives more details about the test for Conn's Syndrome - which could account for as many as one in ten cases of high blood pressure. And Inside Health listener Howard, calls on Mark to settle a teeth cleaning dispute between him and his wife. Should you brush before or after breakfast? The British Dental Association's Chief Scientific Officer, Professor Damian Walmsley adjudicates.

How low should you go when treating blood pressure? Mark Porter talks to the author of landmark study that was stopped early because the benefits of aggressive treatment were so convincing. This looks set to change the management of high blood pressure and millions more people in the UK will be taking extra medication. Dr Margaret McCartney debates the issues with Professor Tony Heagerty.Imagine if your high blood pressure could be cured by an operation that meant no pills at all? That's possible if it's due to a condition called Conn's syndrome, now thought to be much more common than previously thought. Mark Porter hears from leading specialist, Professor Morris Brown, plus a school teacher who spent 10 years on pills before being diagnosed and is now cured.And an Inside Health listener asks: why is palm oil in everything?

Scotland is considering whether to add folic acid to staple foods like flour to protect babies against conditions like spina bifida. Frustrated at the lack of action by the UK government on the issue - despite government advisers recommending for 16 years that flour should be fortified with folic acid - the Scottish government is preparing to go it alone. Spina bifida is one of a group of severe congenital abnormalities known as neural tube defects that affect around 5000 developing babies in Europe every year. It's long been known that taking folic acid supplements, before and after pregnancy, can reduce the likelihood of these defects, as Helen Dolk, Professor of Epidemiology at the University of Ulster explains to Dr Mark Porter. Professional footballers are vulnerable to hip and groin injuries and much more likely to get arthritis as they get older. Southampton Football Club has introduced a new hip stretch and flexibility programme for all their players and the result is a dramatic reduction in injuries. Mark visits the club and meets Olufela Olomola, who, before his transfer to The Saints, spent a season on the bench with hip and groin injury at Arsenal. Just a season later he's recovered and now captains The Saints under 18 team. Mo Gimpel, Director of Medical and Science Performance Support at Southampton FC says the decision to focus on hip flexibility came several years ago, after serious hip and groin injury was keeping key players off the pitch, and the club was losing matches. The new pre-activation sessions have transformed the club's injury rates and research teams are partnering the club to find out how hip impingement develops in the first place. Professor Sion Glyn-Jones from the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences is leading a group tracking 110 young players from The Saints' Footballing Academy, a league two club, a cricket club and pupils from local schools. Detailed mechanical and imaging studies of these young players' hips will help to show exactly when hip injury, or femoroacetabular impingement, first appears, what causes it and most importantly, how to prevent it in the first place. Private medical helplines providing 24/7 advice are the latest development in private medicine. New companies are popping up, attracting millions in private finance. They offer people access by e-mail, phone or online visual link to a GP consultation, for a fee. Dr Karen Morton, founder of DrMortons.co.uk tells Mark why she believes pressure on primary care will result in an inevitable rise in demand for such services. People who want reassurance and advice, she says, can use such helplines and avoid clogging up GP waiting rooms with relatively minor complaints. But Dr Margaret McCartney disagrees and says phone-only consultations risk fragmenting medical records and undermining the relationship between a GP and their patient.

Dr Mark Porter unpicks the science behind the so called 'weekend effect'. Politicians have quoted research claiming that people are 20% more likely to die of a stroke at the weekend, while another much cited study finds 11,000 more deaths in people admitted at the weekend. But how valid are these figures and the research that generated them? Dr Margaret McCartney reviews the stroke data that has been criticised by experts as being out of date. While Mark Porter talks to Editor of the BMJ, Fiona Godlee, who published the 11,000 figure but is concerned about the political use of the findings. And discusses the study with lead author Nick Freemantle, plus Consultant Surgeon Sam Nashef who is sceptical about the results.

Inside Health listener and keep fit enthusiast, David Heathcote, wanted advice on how far he should safely push himself when he's training in the gym.In this special programme about the health benefits of keeping active, Dr Mark Porter helps David to find the answer to his question about the exercise "sweet spot". If you struggle to screw the top off a jar, or use your arms to push yourself out of your chair, that's a sure fire sign, according to Dr Philip Conaghan, consultant rheumatologist and Professor of Musculoskeletal Medicine at the University of Leeds, that your muscles are weak. And the good news is that building muscle strength will protect your joints, not damage them. Dr Conaghan tells Mark that there's a worrying lack of understanding about the impact of muscle weakness on arthritic joints.Over the last decade there's been a growing interest in the relationship between activity and the risk of developing cancer. Studies have demonstrated that exercise appears to have a protective effect against at least four different cancers (breast cancer, colon cancer, endometrial cancer and some upper gastrointestinal cancers) and that being fit helps recovery from cancer too. Dr Denny Levett, a consultant in peri-operative medicine and critical care at University Hospital, Southampton who has a special interest in the relationship between exercise and health, says the reason for the apparent protective effect of fitness is still being researched but the evidence that the effect exists is now widely accepted. Professor of Clinical Cardiology, Sanjay Sharma from St George's University of London outlines the benefits to our hearts of keeping active and Park Run fan and regular Inside Health contributor, Dr Margaret McCartney, admits how running has become something of an obsession and promises that the evidence shows that when it comes to getting fitter, it's never too late to start.