Inside Health

When hospitals are full of patients, they're said to be "hot". The coronavirus crisis will push up the temperature of hospitals across the UK and in the first in a special series of weekly dispatches from the medical front line, producer Erika Wright will be taking the temperature of University Hospital Southampton - or The General - in Hampshire (which services almost two million people in the south of England) as they cope with the influx of Covid-19 patients. In this first dispatch, Erika talks to the Divisional Director for Medicine, Dr Trevor Smith, who says as patients have been moved out of this large teaching hospital to make space for coronavirus patients, the hospital's current temperature reading is "cold", but all staff know that this will soon change.This virus is deeply frightening for everybody, but often for older people and those with underlying health conditions it is even worse. The fear is that if hospitals are overflowing, then crude cut-offs by, for example, age, might determine who does or doesn't, get a a bed in intensive care. But Dr Mark Roberts, consultant in acute and geriatric medicine and chair of the British Geriatric Society in Northern Ireland, tells Claudia that health care professionals don't and wouldn't make such arbitrary decisions based on age. Instead, he says, decisions about access to intensive care beds (or in-patient care) will continue to be made at the bedside, with compassion, and with a focus on who has the greatest capacity to benefit.Some people have already decided that they won't go to hospital if NHS services are overwhelmed but they do want reassurance that they would get urgent care at home should they become seriously ill. Retired GP Dr Lyn Jenkins has written to the Prime Minister calling for this to be addressed as a priority. He's in good health, only 69 years old, but believes that he has a moral obligation not to use up scarce hospital resources if critical care beds can be given to younger people. For those who need it, he wants a quick response team to bring pain relief and supplementary oxygen and importantly, the presence of another person, a carer, so people who were very sick wouldn't be alone. GP and Inside Health regular Dr Margaret McCartney talks to Claudia about supplies of personal protective equipment and whether long-promised supplies are finally arriving and she delves into the evidence to find out whether the loss of a sense of smell or taste could be a symptom of coronavirus. Listener Rachel says she can't smell cheese, garlic or lavender oil and she's worried that she could have the virus. Producer: Fiona Hill

Margaret McCartney on COVID-19 and how the military has been deployed to get protective equipment supplies to critical care staff. Dean of the Faculty of Intensive Care Medicine, Dr Alison Pittard tells of the difficult ethical decisions staff are facing. And Professor Carl Heneghan - suffering from COVID-19 symptoms himself - explains the importance of fast action when treating secondary pneumonia in the elderly; while Deirdre Hollingsworth explains the term "Viral Load". Plus Margaret McCartney visits the famous Belford Hospital in Fort William - specialising in hostile environment trauma - and hears a story of intense mountain rescue.

The UK has one of the lowest numbers of critical care beds in Europe but as the coronavirus threatens to engulf us, drastic measures are being taken to increase capacity. Dean of the Faculty of Intensive Care Medicine, Dr Alison Pittard, tells Saleyha that the NHS has been asked to plan for doubling, trebling and then quadrupling the number of critical care beds. So far, health authorities in England, Northern Ireland, Scotland and Wales have identified how they can increase the number of beds from just under 5,000 to around 10,000 but as Nicki Credland, Chair of the British Association of Critical Care Nurses says, increased beds mean more specialist intensive care nurses in numbers that can't be invented overnight. Additional non-specialist staff are being earmarked to help fully qualified intensive care nurses in the current virus crisis.Dr Margaret McCartney addresses the confusion around two medications: ibuprofen for viral symptoms and the potential risks to Covid-19 patients who are using ACE inhibitors for their high blood pressure or heart failure. Meanwhile away from coronavirus, Saleyha reports on new advances for the treatment of glaucoma, a condition which involves increased pressure to the eye and damage to the optic nerve. It's usually treated using eye drops, but laser treatment could be coming to a hospital near you. Saleyha watches as Gus Gazzard, Professor of Ophthalmology at University College London, uses a laser to treat the high pressure in Veenay Shah's right eye. Evidence from the LiGHT trial, which showed the laser works for newly diagnosed glaucoma patients, is likely to lead to new NICE guidelines which could give patients the choice: eye drops or laser.Faecal incontinence is one of the most debilitating conditions and patients can go for years without even seeking help. But at Sandwell General Hospital in West Bromwich, a revolutionary non-surgical approach is transforming lives. Called the FINCH service, Lead Nurse Kelly Stackhouse, colorectal consultant Rajeev Peravali and patients 21-year-old Lara and 74-year-old John, tell Saleyha how the new approach works. Producer: Fiona Hill

Inside Health gets exclusive access into Ysbyty Gwynedd, the Bangor emergency department, to see how they are preparing staff to deal with coronavirus patients arriving at the front door. Although advice is for patients to stay at home and call 111, some will be sick enough to need hospital admission. For that outcome, staff need to be properly fitted for face masks and trained in putting on personal protection equipment or PPE. Saleyha works in the department and Inside Health follows her getting kitted out with the help of Tim Hamilton Jones, an ED staff nurse tasked with the job of getting everyone ‘fit tested’.GP Dr Margaret McCartney talks about the evidence on face masks and the different types that are out there and gives the latest information on the incubation period for COVID19. It’s estimated that 80% of cases will be able to recover at home but 20% may need hospital care. Reports coming from Italy describe the demand on intensive care beds for patients with coronavirus because of the disease’s potential impact on the lungs. Dr Alison Pittard, Dean of the Faculty of Intensive Care and herself a practising ITU consultant in Leeds tells Inside Health about plans for increasing critical care bed capacity, in the NHS. The service is however already stretched before the disease has even taken hold here. As the government works out a plan of action to support the NHS to cope at this time, Inside Health talks to the British Red Cross, already working in hospitals across Wales, about supporting staff during the normal pressures, even before coronavirus struck. We hear from support workers within the Emergency Department and get an insight into what they do.Producer, Erika Wright

Chris van Tulleken examines cigarette filters - the tobacco industry's hidden marketing tool. He talks to historian Robert Proctor, author of The Golden Holocaust and May van Schalkwyk explains why she wrote her paper 'No More Butts'. Plus Margaret McCartney discusses whether the media portrays a balanced view of Sepsis.

Evidence is building about the impact of air pollution on health, but the relationship between the cocktail of chemicals, gases and particles in the air we breathe and the direct effect on an individual's health is a tricky one to prove. Dr Farrah Jarral cycles to Kings College London to hear about a new study by researcher in respiratory toxicology, Dr Ian Mudway, which revealed, to the surprise of Ian and his colleagues, that particles from brake dust had the same damaging impact on our lung immune system as that familiar culprit, diesel exhaust. It's a result that demonstrates that the toxic risk to our health doesn't just come out of the exhaust pipe and suggests the concept of a zero emissions vehicle might need further work. COPD or Chronic Obstructive Pulmonary Disease is an umbrella term for a range of respiratory conditions that used to be known by names like emphysema or chronic bronchitis. COPD flare ups or exacerbations are the second largest cause of emergency hospital admissions in the UK. Dr Jennifer Quint, consultant physician in respiratory medicine at the Royal Brompton Hospital tells Dr Farrah Jarral about a world-first study where the individual air pollution exposure of COPD patients was tracked in real time to find out how toxic air can make their condition worse.What's it like for healthcare professionals working on the front line of infectious disease outbreaks? Dr Michael Kiuber, a consultant in emergency medicine at University Hospital Southampton NHS Foundation Trust, volunteered to treat patients with the deadly infection, Ebola, in Sierra Leone and he describes the challenges to Farrah of caring for very sick adults and children while taking every safety step to avoid contracting the Ebola virus himself. And Inside Health regular contributor, Dr Margaret McCartney outlines the challenges for the NHS in planning how to protect staff as the UK grapples with the global outbreak of Covid-19.There's a growing trade in female cosmetic genital surgery including hymenoplasty, which claims to the restore the hymen to its virginal state. Scores of private clinics in the UK are offering the procedure with advertising claims like "Get your virginity back!" and "Restore your innocence within one hour!". Dr Leila Frodsham, consultant gynaecologist, specialist in psychosexual medicine and spokesperson for the Royal College of Obstetricians and Gynaecologists discusses the ethics of the procedure. Producer: Fiona Hill

Farrah Jarral on coronavirus transmission and the difference between a cough and a sneeze. Why is health research and media coverage about breakfast often contradictory? Farrah meets senior lecturer Javier Gonzalez and Professor James Betts from the Department for Health at the University of Bath. And Margaret McCartney discusses the complex issue of inequalities between men and women when diagnosing heart attacks. Plus Farrah talks to Dr Ruth Chambers, clinical lead for a project in Stoke on Trent that assesses the benefits of personal digital assistants in the home.

It's not a household name but RSV or Respiratory Syncytial Virus is responsible for 30,000 children under five ending up in hospital every year in the UK. The virus can cause serious infections of the lungs and airways (like pneumonia and bronchiolitis). Hannah and Sean from Oxfordshire had baby girls, Millie and Freya, born prematurely in October last year. Just weeks later, the twins spent 12 days in intensive care and then 3 days in the high dependency unit at the John Radcliffe Hospital in Oxford with bronchiolitis caused by RSV. Andrew Pollard, Professor of Paediatric Infection and Immunity at the University of Oxford tells James, the BBC's Science and Health Correspondent, about the dangers of RSV in lower income settings where the virus claims more babies' lives under 12 months old than any other disease apart from malaria. Hopes are that a vaccine for RSV to protect children during the vulnerable first years is imminent.And as one of the world's leading experts on vaccinations (and chair of the UK's Joint Committee on Vaccination and Immunisation) Professor Pollard tells James that he is confident that a vaccine for the coronavirus, which some experts have suggested could become a pandemic, could be developed by the end of this year. Inside Health regular contributor Dr Margaret McCartney raises the issue of unnecessary vaginal examinations. A new American study in JAMA Internal Medicine suggests that more than half of the bimanual pelvic examinations performed on girls and women aged 15 to 20 in the USA are potentially unnecessary and could cause harm. The fact this is still routine for many American women contradicts clear guidance which states there is no evidence for such internal examinations to be carried out in healthy girls and women who don't have symptoms. It doesn't happen in the NHS, Margaret reports, but they are carried out in the private sector under the banner of "well women checks". Could you tell somebody that they were going to die? Could you comfort family members after their loved one has passed away? Crucially could you do this as part of your job, day in, day out, without it affecting you? James talks to nurses at the Royal Marsden Hospital in Surrey which has been raising "compassion fatigue" as an occupational hazard within the profession.Producer: Fiona Hill

James Gallagher, BBC health and science correspondent, and Dr Margaret McCartney talk about the new coronavirus and how GPs have been advised to manage a patient at risk. He meets listeners Rich and Lucy who have asked about probiotics and gut health in early life after one of their twins had a vaginal delivery while the other a C-section. They want to know whether the different types of birth might impact on the good bacteria passed from mother to child. What is the evidence for the potential impact on long term health and can probiotics help? Dr Trevor Lawley at the Sanger Centre and Dr Lindsay Hall of the Quadram Institute provide the answers. Debi Bhattacharya of the University of East Anglia and James discuss pill organisers and whether arranging medicines into one single packet is always a good idea. And Prof John Pasi explains the results of trials on a 'Holy Grail' treatment for Haemophilia A and Shaun, who took part in the trial at Guy's and St Thomas in London, reveals how it has changed his life.

Nigel Edwards, Chief Executive of the health think tank the Nuffield Trust, joins Dr Margaret McCartney for this special programme about the challenges of remote and rural healthcare. Margaret travels by boat from Mallaig to the Hebridean islands of Eigg, Muck, Rum and Canna off the north west coast of Scotland where, after 100 years the islanders lost their resident doctor. When it was clear there wouldn't be a replacement, the islanders and NHS Highland instead opted for a radical new healthcare model. Taking inspiration from indigenous tribes in Alaska, the NUKA model has been adapted for the Small Isles and it is very different, with a high level of community engagement. The idea is that local people own their own healthcare rather than having healthcare delivered to them, as passive recipients. Local people are trained up in first aid and become salaried Rural Health and Social Care Workers. They are the eyes and ears of healthcare professionals. Volunteers also act as First Responders coordinating helicopter and lifeboat rescues in emergencies. Dr Margaret McCartney joins GP Dr Geoff Boyes on his weekly visit to Eigg and discovers how the community has adapted to this new way of delivering care. She hears from Gill McVicar, former NHS Highland Director of Transformation and Camille Dressler, chair of the Small Isles Community Council, about how the reorganisation was managed; from Julie McFadzean about the new health and rural health and social care worker role; from Sheena Kean, the Eigg healthcare practice manager who makes sure everything runs smoothly and to Eigg residents about how they think their new healthcare model is working.Producer: Fiona Hill Credit Photo of Margaret McCartney: Paul Clarke

When is the best time of day to take blood pressure pills? A new study from Spain has hit the headlines, with dramatic results that could change practice but are the findings too good to be true? And why is getting help for ADHD or other behavioural conditions such a struggle for parents, schools and doctors? Plus recurrent fevers - a rare genetic condition that feels like flu every day. And evidence for the best way to get rid of headlice!

Antidepressants and revised guidance from NICE reflecting that, for some people, they can be difficult drugs to come off; Margaret McCartney explains why this initiative is long over due. Chemotherapy backpacks - a novel way of giving cancer therapy that allows people to stay at home, improves quality of life during treatment and takes pressure off the NHS. Plus dizziness - or vertigo - is a common problem but it can mean different things to different people and occasionally can be a sign of stroke; so what are the clues? And our insider's guide to over the counter treatment: this week anti-inflammatory gels for pain relief.

Zantac alert over concerns that the branded reflux treatment is contaminated with a carcinogenic impurity, so what are the risks? And a new device helping to identify Newborn brain injury earlier. An Inside Health Guide to Over the Counter choices and evidence for those that work best - this week Warts and Veruccas; Plus surgery for reflux as an alternative to pills.

There are plans to make high dose statins available over-the-counter without a prescription to improve uptake. Currently around two thirds of people likely to benefit most don't take them, but will these plans make a difference? Amyloidosis is a debilitating rare disease that is often missed: Pam tells her amazing story of recovery and Mark meets the specialists helping her. And news about new gene silencing treatments that could transform the outlook for people with other rare conditions too.

Mark Porter reports on shortages of Heparin, a drug to treat blood clots, due to swine fever in Chinese pigs! And staying with anticoagulants Margaret McCartney discusses concerns about taking these drugs along with common pain killers like ibuprofen. Why is this a risky combination? And Alice tells her story of opting for ovarian freezing, the latest technique to preserve fertility when undergoing cancer treatment. Plus a pioneering new type of surgery for arthritis of the thumb.

Why aren't prescription charges free across the whole of the UK? Acute Kidney Injury has shot up the NHS agenda in the last decade. Mark Porter visits Derby Royal Hospital to find out why kidney problems are so common and discovers what's been done to prevent damage to an organ many of us take for granted. Plus the World Health Organisation has removed the UK's measles free status because too few children are being immunised. Could making the vaccine mandatory be the answer? Margaret McCartney examines the evidence. And as the academic term gets underway Inside Health learns of a novel method to help with the prevention of meningitis amongst university students who are at risk of the disease.

Dr Mark Porter finds out about 'singing for lung health', an evidence based therapy for helping people with breathlessness arising from conditions like Chronic Obstructive Pulmonary Disease. He hears from the choir based at Charing Cross Hospital in London and talks to respiratory physiologist, Adam Lound, to find out how the breathing and singing techniques being taught there, as well as the camaraderie, improve people's quality of life and confidence. Does exercise increase the risk of worsening an aortic aneurysm? Consultant vascular surgeon, Rachel Bell talks about the benefits of cardio vascular exercise for people with aneurysms. Dr Margaret McCartney reviews the evidence on sunscreens. Also in the programme, Saiju Jacob discusses myasthenia gravis, an auto-immune condition that causes muscle weakening. He explains what causes it and how it's treated.

What is the risk of catching rabies from bats in the UK? We answer this question prompted by a case at Mark Porter's surgery last week when a bat flew straight into a person in broad daylight. Hip dysplasia in babies is a condition where the ball and socket of the joint don't form properly in early life. Every baby is examined as part of the National Screening Programme but new research suggests hundreds are being missed. Plus tips from Margaret McCartney and Carl Heneghan on finding reliable health information online. And what is clinical law?

Dr Mark Porter finds out why non-steroidal anti-inflammatory painkillers can affect female fertility by preventing ovulation. Prof Richard Anderson from Edinburgh explains. And the link between gut bacteria and Parkinson's disease and why a new trial that is finding out if a particular probiotic can improve symptoms of the disease. Prof Ray Chaudhuri from King's College London explains. Also the latest evidence on the optimum intervals between blood donations and in the latest look at health and the internet Dr Margaret McCartney and Carl Heneghan unpick the pros and cons of patient groups and online forums

Decline in Male Fertility and evidence sperm counts have dropped dramatically over the last 40 years but despite this, research into the understanding of male fertility problems have fallen behind. Two leading specialists in the filed explain the issues. Plus diagnosing Urinary Tract Infections in the Elderly and risks of over treatment leading to antibiotic resistance. And tips from Margaret McCartney and Carl Heneghan on identifying health websites to trust.

The new Cancer Research UK campaign that compares obesity to smoking as a risk factor for cancer has come under criticism; Margaret McCartney debates the issues with Professor Linda Bauld. And how healthy is your liver? Do you know? Does your doctor know? Liver Function blood tests are notoriously difficult to interpret and early disease is often missed. Hence a new initiative - Intelligent liver function tests devised by a team from the University of Dundee. And a new mini series on which websites to trust and whether the health information you've found is reliable. Top tips on how to navigate the internet.

In a new series of Inside Health Dr Mark Porter explores the growing initiative to 'deprescribe'. The last two decades have seen a dramatic increase in prescriptions and over the counter medication use with one third of people aged over 75 taking at least six medicines. Evidence suggests a person taking ten or more medicines is 3 times more likely to be admitted to hospital. Yet this is not just an issue in the elderly. Inside Health visits a children's ward with a new drug optimising service leading the way in appropriate prescribing for kids. Mark Porter investigates why such a huge number of people are on multiple medications and discusses the barriers to change with tips from leading experts trying to achieve a new approach.

Fiddling figures in research and why it matters that outcomes aren't switched or goal posts moved; involving parents in the care of premature babies to improve recovery; feedback on the current series

Why vaping is dividing public health experts causing a polarised split; prehabilitation before cancer surgery and the benefits of preparing for an operation; plus can hospital safety be compared to lessons learnt from the aviation industry?

Cannabidiol or CBD oil has had a recent surge in popularity but is there any evidence for it having any health benefits? Dr Margaret McCartney reviews the research. Mark visits the Dental psychology service at Guy's Hospital in London and talks to Tim Newton about dental phobia, the treatment available and how successful it is at treating a phobia which affects 1 in 10 people in the UK. Also what causes gout and why has advice changed on the best way to treat it? Mark talks to rheumatologist, Dr Tim Tait at United Lincolnshire hospitals.

Research suggests opioids don't work in long-term chronic pain but dispensing in the UK has risen four-fold since the nineties, and we consume more than any other country in Europe. There is a dearth of good evidence for how best to help people come off these drugs. Mark Porter meets the team trying to change that. And an objective pitch-side test that takes the guesswork out of diagnosing concussion.

Regulation of Home Fetal Heart Monitors prompted by concerns that the burgeoning use of these devices could be harmful. Deconditioning - there is a popular adage that spending 10 days in hospital can age people 10 years, but is this backed by evidence and could it actually be worse? Mark Porter visits Warwick Hospital to meet the team working to combat deconditioning in the elderly. Plus the Alcohol Harm Paradox - why do less affluent drinkers tend to develop more problems than their better off peers even if they drink exactly the same amount.

Dr Mark Porter investigates the digitisation of the NHS: are online, asynchronous GP consultations the future? He visits a GP surgery in Tower Hamlets to find out how patients are getting in touch online, in their own time. Does it help improve access for patients and manage workload for busy GPs? Manu Vatish, an obstetrician from the University of Oxford, explains that currently every pregnant woman will be tested for pre eclampsia and how a new test could help accurately identify the 4% of women who actually get the condition.And could aspirin help in the treatment of cancer? Mark talks to Professor Peter Elwood from Cardiff University about his recent study into the evidence and to Professor Janusz Jankowski, a gastroenterologist at Morecambe Bay hospital to talk about the implications and risk and benefits.

A new handheld device for migraine is being pioneered at Guys and St Thomas's Hospital in London. Using single pulses of transcranial magnetic stimulation the device is helping prevent and treat migraines in people who haven't responded well to other treatments. Dr Anna Andreou, director of headache research, and nurse specialist, Bethany Hill talk Mark through how it works. Some people, particular of North European and Irish ancestry have the faulty genes that mean they are unable to get rid of excess iron in the body. This can lead to symptoms ranging from tiredness, joint pain, and diabetes to skin discolouring and liver disease. New research has shown the condition is far more common than has been previously thought and is often missed as a diagnosis. Haematologist at Gartnavel Hospital in Glasgow, Ted Fitzsimons and epidemiologist, David Melzer of the University of Exeter, talk testing and treatment for iron overload, or haemochromatosis.Cancer is an umbrella term which covers a spectrum of disease. Some cancers, like lung cancer grow and spread rapidly. But others like some forms of breast, thyroid and prostate cancer have a less than 5% chance of progressing over twenty years. So should we redefine low risk cancers? GP Margaret McCartney and consultant histopathologist, Murali Varma of University Hospital of Wales in Cardiff discuss this question.

Genetics and confidentiality; a fascinating legal case where a woman is suing the hospital trust that looked after her father with Huntington's disease for not warning that she too could be affected. And a well established use of very low carb diets that isn't so well known - to treat complex childhood epilepsy. Plus cancer of the voice box and persistent sore throat. And should hairy arms be shaved for a hospital drip? This question has prompted a transatlantic spat when Sir Andy Murray posted a photograph after his recent hip operation.

Warnings that expensive, unproven 'add-ons' are being offered by IVF clinics ; Keen jogger Margaret McCartney asks whether rest helps running problems such as stitch, shin splints and plantar fasciitis. Plus DNA testing on the NHS to anyone prepared to pay for it with the results contributing to research. But what exactly is the aim of such testing and are there hidden implications?

Concerns about conflict of Interest and reputational damage. Should policy making organisations in the public health arena form partnerships with charities funded by industry? And living with a Stoma. Mark goes to Addenbrookes hospital in Cambridge to meet Michael, who explains what life is like after having his large colon removed. 1 in 500 people in the UK - children and adults - live with some form of bowel stoma, where part of their gut has been brought out through their abdominal wall to empty into a bag. But how does it all work, and what it’s like living with one? Plus Margaret McCartney on diet books and why they are rarely discussed on Inside Health.

An unprecedented number of medicines are in short supply, according to NHS England. Doctors, pharmacists and patients all over the UK are finding common drugs like naproxen are more difficult to get hold of. Why is there such a problem with supply of medicines that are normally cheap and easy to get hold of? And why a 'severe shortage protocol' due in the next few weeks should give pharmacists more power help ease the situation. Mark talks to Ash Soni, president of the Royal Pharmaceutical Society and pharmacist, Ben Merriman to find out more. The number of children with short-sightedness, myopia has doubled in the last 50 years. Mark finds out why atropine eye drops, which are widely used in China and Singapore, are being trialled on children in the UK to help prevent the progression of myopia. Professor Augusto Azuara-Blanco from Queens University Belfast explains. And is muscle more dense than fat? Jason Gill, professor of cardio metabolic health at the University of Glasgow discusses how even a small amount of fat loss can have hugely significant health benefits. Elaine Dennison, professor of Musculoskeletal Epidemiology at the University of Southampton explains why muscle is an under researched part of the body and how we lose muscle mass and strength in middle age and what we can do to prevent it.

Dr Mark Porter discusses High Blood Pressure , a silent threat that isn’t well managed, with only a third of those affected being diagnosed and treated as advised in the latest guidelines. Dr Margaret McCartney and Professor of Medicine, Bryan Williams help unpick areas of confusion including lifestyle and treatment with the latest thinking in the UK, on who should be offered what and when.

Clarity behind recent headlines linking cancer to pills for high blood pressure; Margaret McCartney unpicks the numbers. And the aorta is the largest artery in the body so should it burst due to an abdominal aortic aneurysm, results can be catastrophic. Now Surgeons are concerned that restricting the use of the latest keyhole techniques to repair aneurysms would be a backward step and harm patients. Plus how sinks could be causing hospital infections.

Adrenaline auto injectors are used to treat life-threatening allergies, anaphylaxis, but there are severe supply issues with the brand leader, epipen, particularly with junior epipen and many parents are reporting problems when their children's devices need replacing. It's an anxious time for those caring for severely allergic children and Dr Margaret McCartney reviews the reasons for the shortage and the latest advice for worried parents. At the same time, epipen has come under fire from a UK coroner, who concluded during an inquest into the death of 15 year old Natasha Ednan-Laperouse, that epipens aren't fit for purpose because they don't contain enough adrenaline or have a long enough needle to deliver it properly. Consultant paediatric allergist at St Mary's Hospital, London and a researcher in children's allergies at Imperial College, Dr Robert Boyle, tells Mark there is widespread belief that the companies behind adrenaline auto injectors need to innovate and better designs are needed.Meningitis is every parent's nightmare. It can strike anyone at any age but around half of those with the most serious form, Meningitis B, are toddlers and young children. Two years ago, Ezra, who is now three and a half, contracted the disease. His parents, Cosmin and Serena from Carrick Fergus in Northern Ireland, tell Inside Health how this devastating illness spread so rapidly. Ezra's life was saved but septicaemia meant both of his legs, below the knee, were amputated, followed by the fingers on one of his hands. One of the paediatricians who looked after Ezra at the Royal Belfast Hospital for Sick Children was paediatrician Dr Thomas Waterfield. Inspired by Ezra, Tom worked with colleagues at Queen's University in Belfast to develop a rapid bedside test for Meningitis B. The LAMP test - Loop Mediated Isothermal Amplification test - takes just an hour to identify the Meningococcal DNA and it doesn't need specialists to use it. The current lab test for the disease takes a minimum of 48 hours.Age related macular degeneration, AMD, is the leading cause of blindness around the world, with at least half a million people living with this condition in the UK alone. Treatment has hugely improved in recent decades, with regular injections helping to prevent progressive loss of vision. But intensive monitoring is necessary with monthly trips to hospital for patients for vision tests. Researchers at the Centre for Public Health at Queen's University, Belfast, are trialling ways to avoid these regular hospital visits - saving patients the journey and saving the NHS money. The Monarch Study will assess different ways that patients can monitor their own vision at home, using paper tests or more sophisticated ipad-style eye tests. Mark meets Patricia, who has wet AMD in one eye and dry AMD in the other, who's agreed to be part of the trial and talks to research optometrist Lesley Doyle and Chief Investigator, Dr Ruth Hogg, about the study. Producer: Fiona Hill

France delists Alzheimer's drugs, a move that is a world first, after concluding that the dangers of side effects outweigh any benefits. Mark assesses the evidence and hears the arguments from France and the UK including from the head of drug evaluation at the French Health Authority which is behind the decision. Plus a more holistic approach to hip fracture and a visit to a busy clinic in Oxford where research measuring quality of life after surgery aims to improve outcomes that really matter to patients. And Margaret McCartney on prostate cancer and the Stephen Fry effect

Until recently it was assumed that placebo pills would only produce a therapeutic benefit if patients didn't know that's what they had been given. But there are early suggestions that patients can still get symptom relief even when they're told that there is no active ingredient at all in the pills they've been given. So should placebo pills be openly prescribed to patients? Ted Kaptchuk, Professor of Medicine at Harvard University tells Mark he believes open-label placebo could, if evidence continues to accumulate, form part of the physician's therapeutic toolbox. But Inside Health's Dr Margaret McCartney urges caution. She says there is insufficient evidence about the long-term impact on symptoms. Nearly 500 people died on the transplant waiting list last year and if you're one of the 7,000 waiting for a life-saving organ, how would you feel if the organ on offer came from a donor infected with hepatitis C? Such organs are about to be available on the NHS and this radical change has come about because of the revolution in treatment for this potentially-serious blood borne viral infection. Yes recipients of Hepatitis C positive organs will be infected by the virus after transplant, but a short course of treatment, direct acting antivirals, will then cure them. Consultant kidney and transplant specialist Dr Adnan Sharif from Queen Elizabeth Hospital in Birmingham explains why patients on the waiting list should have this option available to them and Professor James Neuberger from the UK government's advisory committee on the Safety of Blood, Tissues and Organs, tells Mark why SaBTO have recommended this policy change and are now keen to see it implemented. Back pain is common but most of us recover in a matter of weeks. For 10-20% of people though, the pain and discomfort doesn't go away and they suffer chronic pain throughout their lives. What many people don't know is the extent to which genes feature in back pain - it runs in families. Frances Williams is Professor of Genomic Epidemiology at Kings' College, London and a consultant rheumatologist at Guy's and St Thomas' NHS Trust. She tells Mark about the genetic clues that emerged from the world's largest ever study of 500,000 individuals with chronic back pain across five countries.Producer: Fiona Hill

When is the best time to clamp a baby's umbilical cord? It is a controversial question that has perplexed maternity units for years but new evidence from Nottingham has changed practice at the hospital's busy labour ward. Mark Porter pays them a visit. Natural Cycles is a much promoted contraception app advertised as an alternative to more conventional methods. But the Advertising Standards Authority has ruled that claims of it being 'highly accurate' were misleading so Margaret McCartney expresses her concerns that the app doesn't live up to the hype. And once the initial enthusiasm of having a pedometer wears off do they keep people walking in the long term?

Four years ago, Peter, a retired engineer from Gloucestershire, suffered a small stroke and lost the ability to speak. He communicated by hand signals and writing notes to his wife, Carol. But this summer, as he tells Dr Mark Porter, he woke up one morning and, much to everybody's amazement, began to talk....and he hasn't stopped since. Later that same day, a second stroke was diagnosed but his newly-returned speech was unaffected. It's a remarkable story and Alex Leff, Professor of Cognitive Neurology at the Queen Square Institute of Neurology in London discusses Peter's experience but describes what usually happens when stroke patients experience aphasia. We're all familiar with devices like FitBits and gym monitors that measure your pulse rate but the latest development in wearable tech is a watch that monitors your heart. The latest Apple watch will offer ECG-like capabilities which can spot potentially worrying disturbances in heart rhythm. But Inside Health's Dr Margaret McCartney has serious concerns about the use of such tech for screening in healthy populations. If you're under 50 you've almost certainly had it. The heel prick test or NHS newborn blood spot screening programme is done during the first week of life and it's designed to detect nine different conditions before they can cause symptoms or irreversible damage in young children. Dr Elaine Murphy is a consultant in inherited metabolic diseases at the Charles Dent Metabolic Unit at the National Hospital for Neurology and Neurosurgery in London and she tells Mark about the history of the heel prick test and describes the original condition, phenylketonuria or PKU, that the 1969 test was designed to detect. Producer: Fiona Hill

Every GP surgery should provide access to a dedicated social prescriber, according to the Royal College of GPs. Supporting peoples' non-medical needs - including housing, finance and social care - will, it is hoped, free up GP time for urgent medical care and at the same time, provide much-needed access to activities in the community. Arabella describes how social prescribing worked for her. A support worker helped her to join a choir, sort out finances and plan how to return to work after a period of serious illness. Dr Marie Polley, senior lecturer in health sciences at the University of Westminster and co-chair of the Social Prescribing Network (with Dr Michael Dixon) tells Dr Mark Porter that social prescribing will be embedded within medical and social care in the next decade as long as the voluntary sector is supported.Steroid cream and ointments - like hydrocortisone, clobetasone and betamethasone - are used to treat a number of skin problems. But for some patients long-term topical steroid use can lead to painful, disfiguring and debilitating skin flare-ups. Some call this condition topical steroid addiction. But consultant dermatologist Dr Tony Bewley from Bart's Health in London tells Mark that health care professionals prefer the term topical steroid withdrawal syndrome. He sees the condition fairly often in his clinic and reassures sufferers that there is treatment available. We're used to having our blood pressure checked using a cuff on our arms but we can also have high blood pressure in our lungs. Pulmonary hypertension tends to put our hearts under strain and causes breathlessness. It can be caused by a range of diseases but in pulmonary arterial hypertension (PAH) the raised pressure is due to constriction of the blood vessels. This narrowing of the arteries makes it difficult for the heart to pump blood through the lungs, leading to breathlessness. Inside Health's Dr Margaret McCartney visits the Scottish national specialist centre for the disease at the Golden Jubilee Hospital in Glasgow's Clydebank. She talks to Lorraine who is living with the disease, to pulmonary vascular consultant Dr Colin Church and watches a team led by Dr Martin Johnson performing right heart catheterisation, the gold standard diagnostic test for the disease. Producer: Fiona Hill.

If you are taking low dose aspirin - typically 75 mg day - to protect against heart attack or stroke and you haven't been weighed then there is a good chance you are on the wrong dose. And from prevention to treatment; a new way of managing the most common form of stroke by grabbing the blockage in the brain and pulling it out. Charlotte Smith tells her story of a remarkable recovery from the procedure whilst she was pregnant with her second child. Plus a continuation of our guide to the help available when people lose the capacity to make decisions about their care. This week Mark Porter explains Best Interest Decisions and Lasting Power of Attorney. And GP Dr Margaret McCartney reflects on the Hadiza Bawa Garba case.

Does running damage your knees? And is cycling any better? Runner, cyclist, GP and Inside Health regular, Dr Margaret McCartney goes to the new Motion Analysis Lab at Glasgow's Jubilee Hospital and asks orthopaedic surgeon and competitive cyclist Jason Roberts about the latest evidence.Around 30,000 people a year suffer cardiac arrest - their heart suddenly stops pumping blood around their body - and fewer than one in ten survive. Paramedics and ambulance crews will give CPR and use a defibrillator to try to restart the heart, and for the past 50 plus years, most patients will be given a shot of adrenaline too. But a landmark new study funded by the government and run by Warwick Medical School reveals that giving adrenaline barely increases survival and almost doubles the risk of severe brain damage. Dr Margaret McCartney discusses likely changes to policy with Dr Mark Porter.It's said that eyes are the windows to the soul - and certainly looking into other peoples' is the key part of human interaction. But what if one of yours isn't real? Sixty thousand people in the UK have an artificial eye and Europe's largest maxillo-facial laboratory at Queen Victoria Hospital in East Grinstead offers a bespoke service where specialists make individual eyes from live sittings. Susan lost one eye as a child and she tells Mark that her latest prosthesis is her favourite. Why? Because it's almost half the weight of eyes she's had fitted before. Dr Emma Worrall, principal prosthetist, has invented a lighter sphere. In a lightbulb moment sitting in a café stirring a sugar cube into her coffee and watching it melt, Emma tells Mark that she realised she could build the plastic sphere around sugar, drill a tiny hole, then melt the sugar out of the middle! Twenty patients at the hospital are now benefiting from lighter eyes (which means less surgery). And there's another plus. The new eyes float in the swimming pool and the sea!Producer: Fiona Hill.

The relationship between when babies are weaned and the amount of time they sleep has hit the headlines after a new study has been published. Now UNICEF has got involved. Margaret McCartney reviews the evidence. Also proof that seeing the same GP saves lives. Mark Porter meets the man behind new research on mortality and continuity of care, Sir Denis Pereira Gray, who also works in the same GP surgery as his father and grandfather did. And a guide to Mental Capacity, an issue that touches many people but is increasingly pressing as more families manage elderly relatives living with dementia. Plus research and the NHS charter.

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.