Inside Health

Dr Mark Porter asks whether doctors can try too hard in the early detection of disease and investigates the overdiagnosis of hypertension. This week he discovers that as many as 3 million people who have been told they have high blood pressure may not actually have it - could you be one of them?

Dr Mark Porter finds out that some medical conditions are over-diagnosed and therefore over-treated, because of the results of certain tests.

Apart from a few cases that hit the headlines, the use of anabolic steroids is rare among the athletes in the Olympic village. But in the wider society abuse has exploded, according to an expert from Liverpool John Moores University. Jim McVeigh - who's Deputy Director at the Centre for Public Health - says that anabolic steroid abusers are the largest group using needle exchanges. Anabolic steroids are naturally occurring hormones, like testosterone, which influence growth, physical development and the workings of the reproductive system. Abuse allows athletes to train harder for longer so they become bigger, stronger and faster. But those effects will not be seen if you don't exercise or fail to eat and sleep properly. The injected steroids are often combined with tablets. There are a number of side effects like a growth in breast tissue, acne, baldness and shrinking testes - as well as longer-term health concerns for the heart and kidneys. Although they share the same umbrella term - steroids - anabolic steroids are not the same as drugs from the corticosteroid family - found in cortisone joint injections and some types of creams for eczema, sprays for hayfever and inhalers for asthma. For the best chance of good recovery from strokes patients need to be treated within a few hours. In the Lake District new technology is giving suspected stroke patients access to specialists - using high speed broadband and video cameras. Dr Paul Davies is Consultant Stroke physician at the Cumberland Infirmary in Carlisle. He can assess a patient's scans and other tests over a video connection - with the help of nurses and doctors treating them locally. Thrombolytic - or clotbusting treatment - can be given if the stroke is one of the 80% caused by a clot. It's important to get this diagnosis right as the other 20% are the result of a bleed - which could be potentially fatal if thrombolysis is given. It's has been dubbed the Killing Season by some sections of the media - but Dr Margaret McCartney believes that August isn't as risky a time to be in hospital as the headlines claim. One study compared the number of deaths at the end of July and the beginning of August - but the difference wasn't statistically significant and could have been down to chance rather than a real harmful effect of new doctors.Inside Health listener and keen pianist Roger emailed the programme about Dupuytren's contracture - where the fingers curve into the hand and can't be straightened. A new treatment is becoming available on the NHS for this common problem which affects 1 in 10 people's hands. The only option used to be surgery but Mike Hayton, who's a Consultant Orthopaedic Hand Surgeon at Wrightington Hospital in Lancashire, is now carrying out collagenase injections on some of his patients. Up to 60% of Dupuytrens patients can benefit from the treatment - which helps to break down the collagen-rich cords so they can then be snapped a day or two later.

If you believe recent headlines the growing increase in deaths from liver disease is entirely down to excessive alcohol consumption, but it's estimated that two thirds of liver related deaths are caused by other conditions. Dr Mark Porter investigates two liver conditions that do not hit the headlines but could be silently creeping up on millions of people in the UK.

Do you have trouble getting an appointment to see your GP? If so, you are not alone. A Department of Health review from 2009 suggested that as many as 200,000 patients a day struggle to get a consultation with their doctor. And a quarter of those who want to book an appointment in advance simply can't. One Inside Health listener emailed us to ask why some surgeries seem to only release appointments on the day - a bit of a telephone lottery - and others do allow for some advance booking. Chair of the the Royal College of General Practitioners Dr Clare Gerada offers some insight. Monitoring patients in their own homes - telehealth - is one of the latest developments in general practice. The government hopes that the technology will help at least 2 million people over the next 5 years, saving the NHS more than a billion pounds. The £2,000 black boxes measure blood pressure, blood sugar levels and blood oxygen - information that's then sent over the internet to a medical professional. But the project to monitor patients with long term conditions like diabetes, heart failure and breathing difficulties hasn't got off to a good start and GP Margaret McCartney questions whether it will ever live up to the hype. The most seriously ill patients in hospital are looked after in Intensive Care - where they are given life-saving treatment and support with vital bodily functions like breathing. To help staff relieve anxiety - and enable staff to carry out procedures like inserting breathing tubes - patients are often sedated. Dr Chris Danbury from the Royal Berkshire hospital in Reading says it's important to get the level of sedation right - not too little and not too much. One consequence of the drugs and environment can be hallucinations and flashbacks - with some patients reporting dreams of being abducted by alien space ships. Specialist outreach nurses in Reading - like Sister Melanie Gager - are skilled at offering strategies to overcome this - including follow-up visits to the ICU for both patients and their families. Now that summer has finally arrived for most parts of the UK, if you are planning an outdoor swim then there may be hazards lurking in the water. Heavy downpours result in the release of sewage into the sea from overflow pipes - which can affect water quality for a couple of days. Inside Health reporter Anna Lacey met Pollution Control Manager Dr Robert Kierle on the banks of the river Axe in Weston-Super-Mare - and Surfers Against Sewage who are offering a free text service to alert would-be bathers about local measurements of any pollutants.

Whooping cough is on the rise - but the official figures could be the tip of the iceberg, according to one doctor. Retired GP from Nottinghamshire Dr Doug Jenkinson has spent most of his professional life researching the condition which is also known as pertussis. He says that instead of around 1,700 cases every year, there could be tens of thousands. He personally has seen around 700 cases and a blood test available for the last few years has helped to confirm cases. The key to diagnosis is a cough which almost causes choking - sometimes with the characteristic whooping sound - which then subsides for a few hours. The cough can last up to 3 months. The cough can be dangerous for infants under the age of one - who can catch it from parents and grandparents. Dr Jenkinson suggests a vaccine booster could be offered to parents-to-be.Following the recent high profile cases of elite sportspeople collapsing with undiagnosed heart conditions should screening be made available to amateurs? Since the collapse of footballer Fabrice Muamba on the pitch earlier this year the profile of so-called silent heart conditions has risen. Sanjay Sharma is Professor of Cardiology at St George's Hospital - he works closely with the charity Cardiac Risk in the Young or CRY - and supports screening. CRY believes that screening will pick up an abnormality in as many as 1 in 300 youngsters - although it freely admits that the vast majority of these would never have gone on to develop a serious problem. And it is the resulting disruption to these children's lives that puts some people off screening, not least because they far outnumber those likely to be saved by the tests. Dr Anne Mackie is the Director of Programmes for the UK National Screening Committee. She says that she wouldn't even opt for screening for her own children Following last week's feature on unfounded rumours that toys were to be banned from GP waiting rooms to reduce the risk of cross infection, an Inside Health listener emailed the programme to ask about the evidence behind products marketed as killing germs on the various surfaces we touch at home. So what's the science behind adding antibacterial agents to household products? Dr Kamran Abbasi, Editor of the Journal of the Royal Society of Medicine reveals that there is no evidence to show that products labelled 'antibacterial' reduce the number of infections in the home any more than 'regular' cleaning products. GP Margaret McCartney explains why she thinks the latest campaign to encourage more self-care for minor ailments is wrong to imply that people who consult their doctor about dandruff are wasting NHS resources. The NHS 'Choose Well Summer' campaign says 'self care is the best option if you have a summer health complaint' and it's supported by the National Association for Patient Participation, who say it's all about 'empowering individuals'. The campaign was launched with headlines about the 40,000 visits in a year to GPs which were for dandruff. But what was really behind those consultations? And how good are we at looking after our own health?Computer games are being used to help people recover from strokes and brain injury, thanks to experts in Reading. Products like Microsoft's Xbox Kinect - which can recognise a player's movements - are being adapted by Professor Malcolm Sperrin at the Royal Berkshire Hospital. The technology allows patients to select an activity - from dancing to golf or ten pin bowling - and monitor their progress as part of their recovery. The charity Headway - which supports people with brain injury - is using the technology in the community to help people to recover at home.

Dr Mark Porter debates whether the recent lung cancer awareness campaign on TV, radio and the internet, hits the spot or is scaremongering. He discovers new research suggesting some people with exercise induced asthma are being given the wrong diagnosis and treatment. And GP Margaret McCartney investigates rumours this week that children's toys are to be thrown out of the doctors surgery in the on going battle against infection.Producer: Erika Wright.

50,000 people end up in hospital every year in the UK because of bleeding from the top end of the gut - an upper gastrointestinal bleed. Around 1 in 10 of them will die. Gastrointestinal or GI bleeds are often due to ulcers - a side effect of taking aspirin and other non-steroidal anti-inflammatory drugs like ibuprofen and diclofenac. The bleeding can occur in the gullet, stomach or the first part of the intestine, the duodenum. Other causes include cancers and liver disease. The location of the bleed can be pinpointed by using an endoscope - a camera to look inside the gut - and treatments include stopping the bleeding with clips, heat or injections of adrenalin. The National Institute for Health and Clinical Excellence hopes to change that with new guidelines on managing GI bleeds - guidelines which, as of last month, hospitals in England, Wales and Northern Ireland will be expected to follow. Scotland has had similar guidance in place for the last few years. David Patch is a Consultant Hepatologist at the Royal Free Hospital in London and has a special interest in this type of bleeding. He says that patients whose needs cannot be met at smaller hospitals should be transferred to specialist units where they can be treated promptly. Tariq Iqbal who's a consultant gastroenterologist at the University of Birmingham is evaluating a new kind of treatment called Hemospray. This is a powder that can sprayed over the bleeding area to stop or slow any bleeding by accelerating the natural clotting process. New research appears to show that standing at work for long periods in pregnancy can affect the unborn child. Research in the journal Occupational and Environmental Medicine, followed 4,680 mothers throughout their pregnancies. Some of the women had jobs where they were on their feet a lot - such as hairdressing, sales and working with toddlers. Women who stood for a long time had babies with smaller heads. It's thought that standing for long periods of time causes blood to "pool" in the legs, limiting the blood supply to the rest of the body including the uterus and therefore the developing foetus. The study also showed that working up to 36 weeks of pregnancy had no impact on birth weight, size or prematurity. Previous studies have shown that heavy lifting increased the risk of babies being born early - but this study showed no such link. Many people with pain and stiffness in the shoulder are told they have a frozen shoulder. But the label is often incorrect as a truly frozen shoulder means restricted movement in all directions, accompanied by pain. It's not known what causes it but it is commoner in people with diabetes. During the very painful initial phase it's best to rest the shoulder and use analgesia to help relieve the pain, especially at night time when it can be at its worst. TENS and acupuncture can help sometimes. The tissues in the shoulder "capsule" appear to be thickened and rubbery - and some relief can be gained from surgery, to let the shoulder move more freely. If left alone about half of patients still have discomfort after 7 years - so the common belief that it lasts 2 years is a myth. As the pain starts to recede physiotherapy can be helpful and if there is inflammation - eg with calcified tendonitis - then steroid injections can relieve pain. Producer: Paula McGrath.

In Inside Health, Mark Porter clarifies recent headlines claiming that researchers have found a "Blood test that identifies depression". It certainly isn't that simple. GP Margaret McCartney reports from Paisley Abbey in Glasgow on the health benefits of joining a choir.And do special muscle building drinks live up to the marketing hype? Max Pemberton looks at the science behind the recent explosion in sales of high protein sports drinks.Plus a new treatment for helping people with fluid retention due to heart failure, that can transform a puffy face to a chiselled jaw bone overnight.Producer: Erika Wright.

Whooping cough is making a comeback - the latest figures show that there were more confirmed cases in the first 3 months of this year than there were in the whole of 2010. But the condition can only be monitored properly if GPs test for it - and it's estimated that up to 40% of persistent coughs in children could actually be down to whooping cough. Kamran Abassi who's Editor of the Journal of the Royal Society of Medicine, explains how immunity wears off as we get older. The coughing can last for up to 3 months and is most serious in small babies. Up to 10 deaths are reported each year in the UK and antibiotics can be used to treat it. In the UK all deaths in pregnancy and childbirth are recorded. Just 1 in 10,000 British women currently die - on average one woman every week. The information is held by the Maternal and Newborn Clinical Outcomes Review Programme - known as the Confidential Enquiry. Last year this clinical audit was effectively suspended after the process was put out to tender. Susan Bewley who's Professor of Complex Obstetrics at King's College, London explains why it's so important to keep such detailed information. Blushing can become a vicious cycle - with those severely affected finding it impossible to lead a normal life. Some turn to psychological therapies. Dr Jennifer Wild from the Centre for Anxiety Disorders and Trauma in Oxford says she sees a success rate of 90% in patients who opt for cognitive behavioural therapy. An operation called a sympathectomy - where the nerves are cut - can be carried out by surgeons like Alan Cameron, who works in Ipswich. He sees mixed results - with many experiencing side effects like increased sweating and sensitivity to light and sound. Dr Margaret McCartney doesn't like it when doctors use euphemisms for our genitals. Children often use words like "twinkle" or "pee pee" instead of the correct anatomical terms. But whose blushes are they sparing - theirs or their parents? An Inside Health listener emailed the programme to find out about what happens to the food he he eats - specifically how quickly peas pass through his gut into the loo. Neuro-gastroenterologist Anton Emmanuel from University College Hospital, London, demystifies gut transit times.