Inside Health

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?

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

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

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

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

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

Inside Health reveals the poor state of addiction services in England with heroin and morphine related deaths the highest on record. Professor Colin Drummond raises concerns about a split in care between the NHS and Local Authorities since the 2012 Health and Social Care Act. And personal testimony is heard from Alison Bedford Russell whose son George died of a heroin overdose last year. The Care Quality Commission, who is responsible for inspections, has found that 2/3 residential drug and alcohol treatment services failed to meet the required standard. Dr Paul Lelliott, Deputy Chief Investigator of hospitals at the CQC, explains what was discovered.The correct use of medical language is a topic close to Inside Health so Margaret McCartney was naturally drawn to discuss news this week about the misuse of the term Schizophrenia.And as London hosts the first ever Cardio-Oncology Summit in Europe, specialists from both fields discuss how to treat and prevent heart problems in people undergoing therapy for cancer.

Breast Density - the major risk factor for breast cancer that you may have never heard of. Health Education - a long term approach to changing attitudes to illness by encouraging children to be less dependent on doctors and pills. Switching Outcomes - one reason why so few clinical trials result in real changes in practice that benefit patients.

Margaret McCartney unpicks recent headlines suggesting its okay not to finish your antibiotics; Lung Cancer screening in the high risk; Can you die a broken heart? Evidence suggests this is a real condition called Takotsubo syndrome and is much more common than previously thought. And gender bias in trials.

There are growing concerns about the widespread use of PPIs, the acid suppressing family of drugs used to treat indigestion and the most prescribed in the world. They are recommended to be used for weeks in typical cases of heartburn, but most people including Mark, take them for months or years. But one reason why PPIs are being used so widely is to protect the lining of the gut from aspirin and combining these two drugs may also have benefits against cancer. Mark hears preliminary findings on the so called chemo-protective effects of aspirin. And radiotherapy is a crucial part of modern cancer treatment so why does it get so little attention compared to drugs? Plus why radiation and smoking are particularly poor bedfellows.

The Hepatitis B vaccine has been added to the childhood national programme joining the 5 vaccines already given to all young babies at 8, 12 and 16 weeks. Andrew Pollard, Professor of Paediatric Infection & Immunity at the University of Oxford, and Chair of the Joint Committee on Vaccination and Immunisation, explains why.Margaret McCartney and Mark Porter visit men in north London looking for the physical and mental benefits of community sheds. The obesity paradox - can being overweight sometimes be beneficial? Gavin Murphy, British Heart Foundation Professor of Cardiac Surgery at the University of Leicester and Naveed Sattar, Professor of Metabolic Medicine at the University of Glasgow, debate the latest research suggesting that obese people are more likely to survive heart surgery than their slimmer peers. Are clinical trials good for you? We examine the evidence behind conventional wisdom that people taking part in research tend to fare better - whatever their illness.

Are we on the cusp of a new era where computers rather than doctors will be doing the diagnosing. Ali Parsa, founder of Babylon Health, believes we are and is developing an online tool using artificial intelligence that diagnoses quicker and more accurately than a doctor. He debates the issues with resident sceptic Dr Margaret McCartney. Mark Porter visits the world's first national tissue bank for pancreatic cancer, set up to aid research into a disease that has seen no outcome improvement for over 40 years. Plus statins and muscle aches; could the drugs' bad press in the media actually increase the odds of people experiencing side effects - the so called nocebo effect?

Price rises of everyday medicines due to some manufacturers utilising monopolies; Can a simple routine blood test help identify cancer; A definitive guide on undescended testes with evidence for the best time to intervene if a baby boy's testes do not drop and the downsides of delay; Aspirin and the risk of stomach bleeds in the elderly.

Statins have dominated the cholesterol-lowering field for some years but last week the results of an international trial of Evolocumab, one a new breed of medicines for reducing cholesterol, was hailed as a breakthrough. Professor Peter Sever, one of the leaders of the trial, explains how Evolocumab differs from statins and Dr Margaret McCartney takes a look at the trial.You may have noticed them in work places, gyms, and other public spaces but do you know how and when to use a defibrillator? Every time someone has a cardiac arrest and CPR is performed we should also be running for the nearest defibrillator. But currently this only happens in 2-3% of cardiac arrests, putting thousands of lives at risk every year. Mark speaks to teacher Erica Melsom and the pupil, Alex Cowes, whose life she saved by using the school defibrillator. Professor Gavin Perkins explains why and when we should run and get one. And Mark demonstrates just how simple they are to use, even if you've never touched one before.Posttraumatic Stress Disorder, a psychological condition which can begin after a traumatic event and last for many years, is the equivalent for your cardiovascular system of smoking 10 cigarettes a day. Dr Donald Edmondson explains how extreme stress takes a toll on our arteries.More than 80% of pregnant women take at least one prescribed medication and yet very few of these drugs are actually licensed for use in pregnancy. Mark talks to Professor Anna David about why there has been a reluctance to license medications for use in pregnancy, what impact that has for pregnant women, and what needs to change.Producer: Lorna Stewart.

Clarification of new evidence that Bisphosphonates for osteoporosis may actually weaken bones if people are left on them for too long ; Dietary change using FODMAPS to treat Irritable bowel syndrome when medicines have not worked; CRP testing for chest infections to identify which need antibiotics; And Mark eats humble pie for getting clinical terminology mixed up.

More than 6500 people are currently on the national transplant waiting list, hoping for an organ to be donated which might save their lives. Many of them will wait for years and, sadly, hundreds will die before a suitable organ becomes available. The low supply of organs remains the main restriction on performing lifesaving transplant surgery. The British Medical Association believes that moving to an opt-out donation system - where people who die without expressing whether or not they wish to donate their organs will be presumed to be willing to donate - would increase donation rates and save lives. The system has been in place in Wales since December 2015 and now the BMA says it's time the rest of the UK followed the Welsh model. Dr Margaret McCartney discusses with Dr Phil Banfield, chair of the British Medical Association Welsh Council. An area of medicine not often discussed on Inside Health is pathology. Mark visits the morgue at St Mary's Hospital in London to speak to pathologist Mike Osborn. What happens to your body after death? What is rigor mortis? And how much do crime dramas on TV get right?Finally, what time of day should you be taking your blood pressure medication? Millions of people take drugs to control their blood pressure and reduce their risk of heart attacks and strokes. Most people will take their medications in the morning but with many heart attacks and strokes happening during nighttime hours, just when the medication might be wearing off, should we be considering evening dosing instead? A new online trial has enrolled 21,000 people and aims to find out what time of day is best to take blood pressure medications. Mark speaks to Dr Amy Rogers from the University of Dundee who is in charge of the trial.Producer: Lorna Stewart.

New moves to test pregnant women for smoking by measuring carbon monoxide on their breath. How helpful are lifestyle targets like 10 portions of fruit and veg or 10, 000 steps a day? The incidence of thyroid cancer has tripled in 40 years, but many of the tumours picked up are on scans for something else and may never have caused harm. Mark Porter debates the issues. Plus this week's uncertainty question for Margaret McCartney and Carl Heneghan, to floss or not to floss?

Vitamin D , the sunshine vitamin, has been in the news again with claims that supplements could help ward off coughs , colds and flu. Dr Margaret McCartney takes a look at the study that generated the headlines.Whether or not a severely injured person will receive blood products at the scene of an accident depends on which air ambulance service they are attended by: some air ambulances replace lost blood with red blood cells, but others replace only with saline solution. Evidence from military casualties in Afghanistan suggests giving blood before patients reach hospital leads to better survival rates, but evidence from civilian populations in the UK is less clear. A new randomised controlled trial, being conducted by six air ambulance services, will investigate which course of action has the best outcomes for patients. Mark visits the Midlands Air Ambulance to hear more from lead investigator and trauma anaesthetist Dr Nick Crombie and critical care paramedic Jim Hancox.Phantom limb pain - pain in an amputated limb - is a common complaint among amputees. Pain medication rarely solves the problem and there is is no known cure. But now a trial in Sweden is using augmented reality to help patients relearn how to move their missing limb, and showing that chronic pain can be reduced. Mark talks to lead researcher Dr Max Ortiz.And Margaret McCartney takes a look at the evidence for that dinner party favourite - the sitting-rising test - which proponents have claimed can predict how long you might live.

A special debate on the current state of the NHS. Recorded in front of an audience at the BBC Radio Theatre London.The last few months have seen the service creaking under unprecedented demand, and there is likely to be worse to come. Something needs to give. Is it simply a matter of more resources, or do we also need to change our expectations of what the NHS provides? Is rationalisation and rationing the way forward?Dr Mark Porter discusses the issues with a panel including Clare Marx, president of the Royal College of Surgeons, Chris Hopson, chief executive of NHS Providers, David Haslam, chair of NICE, Prof Sir Nick Black, London School of Hygiene and Tropical Medicine and regular contributor Margaret McCartney GP. Issues discussed include whether the NHS should continue to be free at the point of use. Is there too much bureaucracy with too many bosses? Was the internal market evidence based, has it worked and was it fair? Rationing of treatments. And can the NHS be taken out of politics? Inside Health listeners set the agenda by emailing the programme - some of whom joined the audience - so thank you for all your input. Margaret McCartney writes: The NHS is never far from the headlines, but the last few months have depicted a service in crisis. It's been made clear that there will be no more money from central government - so what needs to give? Clare Marx, explained the angst of her members who wanted to operate on people but had been forbidden to. Nick Black, discussed the types of surgery that were now being placed off limits - like hip replacement surgery - even though they were very cost effective. Because of the way hospitals are funded, it is these useful operations that are being stopped rather than the much less cost effective prescription of some very expensive cancer drugs. Chris Hopson described tensions between the expectations being placed on the NHS to provide excellent care despite the funding gap to actually provide it. And David Haslam, chief executive of NICE, expressed his disquiet that patients could no longer expect a consistent service across the NHS. Instead, different Clinical Commissioning Groups decided themselves how many rounds of IVF to fund, for example. The result was a patchwork of provision, and was inherently unfair. Is rationing therefore the way forward? Some listeners had emailed in suggesting that the NHS shouldn't fund treatments for 'smokers, drinkers and the obese'. Others that people should pay for hospital meals, or there should be a charge made for GP consultations. We already have charges for some things - for example, prescriptions in England, or dental check ups for many people - but as Clare Marx pointed out, removal of teeth is the commonest childhood operation, so can we really say this policy has been successful? I don't believe that we have the evidence to show this is safe: the bureaucracy would be sizeable - I had to sign 12 bits of paper for a routine check when my kids and I last went to the dentist - and then there are unintended consequences. Paying for appointments turns us in to consumers - would doctors feel obliged to give us treatments that people want, even when they don't work well, aren't cost effective or do net harm? Listeners wanted to know if the NHS was over managed - and had strong opinions on how much could be saved if we got rid of middle managers in particular. But Chris Hopson pointed out that we spend less than the very efficient Germany on hospital managers, and Clare Marx said that hospitals are highly complex places needing a huge amount of organisation to run smoothly. For me it is a question of what managers are doing - is it of value to patients, or is it a waste of time?Nick Black argued that there was a great deal of waste still in the NHS - and suggested that the internal NHS market may have had some advantages to start off with, but now, the 4.5 billion a year estimated to be spent on it could be better used elsewhere. There is no doubt that the process of bidding and judging for commissioning costs time and money, but how to stop the problem of bad and wasteful policy in the first place? Could politics be taken out of the NHS? I was on my own, arguing that party politics had done avoidable harm to the NHS and that cross party working - as we see in the Health Select Committee and the National Audit Office - was possible. My fellow panellists argued that since the budget of the NHS was such a large amount of money it would be impossible to disentangle it from politics: but Chris Hopson pointed out that defence spending, for example, was ring fenced. The audience overwhelmingly voted to be taxed more to pay for the NHS. If we were sure that extra money would go on human level care, and not wasteful, non evidence based policy making, I would support it completely. But we are not, as a population, being given that option.

Prescriptions for over-the-counter items cost the NHS millions each year; in 2015 paracetamol prescriptions alone cost £87.6 million. Mark talks to Paula Cowen, medical director at Wirral CCG, one of a growing number of Clinical Commissioning Groups that are asking GPs to restrict prescribing of these items, and to Andrew Green, a GP and the prescribing policy lead at the BMA, who has reservations.Virtual Reality is being harnessed to help people recover from serious brain injury following accidents or strokes, and in conditions like Parkinson's disease and dementia. Mark visits a clinic in Salford where they're using virtual reality in neuro-rehabilitation.And treating sore throats with antibiotics. Sore throats are common accounting for 1.2 million GP consultations every year in England alone - and they affect many millions more who don't see their doctor. Most are viral and self-limiting, but around 1 in 10 are caused by a bacteria and may benefit from antibiotics. The tricky bit is telling the difference between the two but a new pharmacy-based test and treat initiative may help. Mark speaks to Peter Wilson, one of the authors of the pilot study, and Margaret McCartney is on hand to examine the evidence.

Hernias, hands and varicose veins might not be treated on the NHS as such interventions are now on the 'not normally funded' list. This list is where local commissioners show what they are not prepared to pay for, unless circumstances are exceptional. Such prioritising is also known as rationing. Dr Mark Porter investigates if this new layer of bureaucracy is a cost effective use of resources or just delaying inevitable operations with the possible risk of creating emergencies that could cause harm.

Are preventable deaths in hospitals a good measure of the quality of care being offered to patients? It's estimated that there are 12,000 deaths a year in hospitals which could have been avoided, but what does that mean and should we be worried that that number could rise with the NHS under pressure?Mark Porter visits a 'poo bank' in Portsmouth where donated faecal matter is being frozen and stored for later use in patients with Clostridium difficile or C. diff.And midwife Mervi Jokinen and our own Margaret McCartney take a look at the evidence for waterbirths. Is giving birth in water less painful? And is it safe?Producer: Lorna Stewart.

Do funding requests hinder surgery on the NHS? GP referrals to specialists for common complaints are checked by a panel to make sure they're appropriate, but can the admin for funding requests be more costly and time consuming than the operation itself? Mark Porter meets an eye specialist in Reading who argues that it can. Plus a new genetic test that has been developed to identify women at risk of breast cancer more accurately. And lactose intolerance: there's a burgeoning number of lactose-free ads and products in the shops, but is need driving the market - or marketing driving the need?

Evidence suggests Paracetamol is neither as effective or safe as previously thought for chronic pain; Prostate cancer and new targeted treatments with fewer side effects plus feedback following last week's special edition; And is giving oxygen in heart attacks a help or hindrance? Margaret McCartney and Carl Heneghan debate the first in a new mini-series investigating uncertainty in medicine.

One in 8 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 reports 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.

Most of us say we'd like to die at home but few of us actually achieve this wish - something the NHS is keen to change. An award-winning GP surgery in Lancaster, The King Street and University Medical Practice, has transformed the way they care for patients reaching the end of their life, twice winning the Gold Standards Framework Quality Hallmark Award. Dr Nour Ghazal tells Dr Mark Porter what they've done to ensure their patients have a say in how and where they would like to die and Inside Health's Dr Margaret McCartney describes how important it is to broach that most difficult of subjects.Familial Hypercholesterolaemia, also known as FH means that you have inherited high cholesterol levels and the consequences of this, if you don't know about it, can be deadly. Over half of men with FH will have a heart attack before they are 55, a third of women with FH before they're 60. But a simple genetic test can identify the condition and with a good diet, exercise and lipid lowering drugs like statins, people can live long and healthy lives. Steve Humphries, Professor of Cardiovascular Genetics at University College London tells Mark that only 15,000 people in the UK have a diagnosis of FH but it's thought that almost a quarter of a million people could in fact have the condition. So the race is on to identify and diagnose the thousands who don't know that they're carrying the suspect genes. Lorraine Priestley-Barnham, an FH clinical nurse specialist at Harefield Hospital in Middlesex describes the cascade testing being rolled out across the country in a programme supported by the British Heart Foundation. And three generations of the same family, father Chris, daughter Joanne and grandson, six year old Alfie, tell Inside Health how they found out they have FH. Delirium - an acute confused state with hallucinations and psychosis - is incredibly common in hospitals. One in five patients can experience it, many more in intensive care. Fiona tells Mark about her own experience in ICU after major surgery last year, when she believed she was being held prisoner and experimented on. She tried to escape from the ward and her daughter, Catherine, describes how distressing it was to witness her mother in such a terrified state. Julie Darbyshire, Critical Care Research Manager at the University of Oxford has done some of the first research into patients' experience of delirium and ICU consultant pharmacist, Mark Borthwick, who has a special interest in the condition, tells Mark about the different types of delirium.

The Meningitis ACWY Vaccine was introduced last year to protect teenagers from year 9 in school to those starting university or college. But there seems to be confusion about how to get the jab and many parents remain unaware of the threat posed by Meningitis W. Inside Health's resident GP, Dr Margaret McCartney takes a closer look at headlines reporting that women should be given testosterone for low sex drive. Plus, half of all people with heart failure also have iron deficiency so might iron be a clue to a new type of treatment? And Mark Porter visits his local patch in Gloucestershire where doctors are offering allotments on prescription.

Several decades ago, if you had a mini stroke or a transient ischaemic attack, it wasn't unusual for your doctor to tell you to rest in bed with the reassuring words that you'd been lucky. Follow up was casual to say the least, because it was thought that your chances of having a major stroke within the month was negligible. Dr Mark Porter talks to Peter Rothwell, Professor of Clinical Neurology at the University of Oxford, whose research transformed the way mini strokes are treated. TIAs are now seen as medical emergencies requiring urgent treatment. Taking aspirin straight after a TIA, his team's research also showed, could reduce the chance of a major stroke over the next few days by a staggering 80%. Headlines this week from a New Zealand study suggested midwife-led births mean worse outcomes for babies compared with doctor-led care - contradicting other research in the area. Inside Health's Dr Margaret McCartney assesses the new study and concludes the evidence still points to midwife-led care providing reassuringly good outcomes for low risk pregnancies.Imagine being sick for hours, days at a time, recovering for a few weeks, only for the whole cycle to start again as regular as clockwork. Roger McCleery has Cyclic Vomiting Syndrome and every couple of months he's so sick he ends up in hospital, from where he told Mark about the life-changing nature of this unpleasant condition. Consultant paediatric gastroenterologist, Sonny Chong from St Helier Hospital in Surrey who has a special interest in CVS, outlines the possible causes and treatments.Hospitals are getting noisier but in intensive and critical care, 24 hour operations, the noise can be intense, as loud as a busy restaurant with peaks of sound as loud as a pneumatic drill. Researcher Julie Darbyshire, critical care research programme manager at the Kadoorie Centre for Critical Care at the Nuffield Department of Clinical Neurosciences, has been involved in efforts at intensive care units across the Thames Valley to identify excess noise and take steps to muffle it. Peter Edmonds tells Mark how much sleep he missed being in ICU when he was a patient and Matron and Clinical Director at Oxford University Hospitals NHS Foundation Trust, Matt Holdaway, outlines how staff have embraced efforts to cut noise levels.

Breast Cancer and Bisphosphonates; an old drug for treating weak bones can reduce the risk of breast cancer spreading, but many post menopausal women are missing out. Why? Alcoholism and Baclofen; another old drug with a new use, this time a muscle relaxant to help people with an alcohol problem and news of three new trials recently presented in Germany. Complex Regional Pain Syndrome, a rare condition that often occurs after an injury or surgery and results in life changing pain. And why are some generic, non-branded medicines so expensive?

A new medical movement in Wales is urging patients to take more control of the decisions about the care and treatment they receive. Called Choosing Wisely, it calls for a more equal doctor-patient relationship, an end to "doctor knows best". Dr Paul Myers, chair of the Academy of Medical Royal Colleges in Wales discusses the initiative with Dr Mark Porter and with Inside Health contributor, Dr Margaret McCartney.A new way of tracking cancer, through the blood, not from a biopsy of the tumour, is exciting oncologists worldwide. A liquid biopsy, a simple blood test, is proving to be a hugely promising development in cancer treatment. Circulating tumour DNA is measured in the blood, giving doctors the chance to target new treatments for the particular type of cancer. Dr Mark Porter talks to one of the pioneers in this field, Dr Nick Turner at The Royal Marsden Hospital and team leader at the Institute of Cancer Research about what liquid biopsies could, in the future, mean for cancer care. Traditional advice to parents has been to delay the introduction of foods like peanuts and eggs when they wean their babies onto solid food, in order to reduce the risk of food allergies later in life. But conventional wisdom has been turned on its head with a new body of evidence suggesting the opposite is true. In a new survey of the latest data, the Director of Imperial College's Paediatric Research Unit, Dr Robert Boyle, tells Mark that the two most common childhood food allergies, to peanuts and eggs, may be prevented by introducing them early.How accurate are parents when they're measuring out liquid medicine for their children? Not at all, according to a new study. Dr Margaret McCartney discusses the findings that 84% of the 2,000 or so volunteer parents made at least one error, and 20% made a big error. Scary stuff. But there's advice on how to avoid giving your sick child the wrong dose.

Is it useful as a public health message to compare obesity and smoking? Controversy in Rome behind a new trial that suggested Blood Pressure targets should get lower. And after a rise of medicating for ADHD over 25 years, the numbers of prescriptions for children has now plateaued. Is this a good news story or is there something more complicated behind the change in trend?

Kevin Fong explores how doctors cope when things go wrong

The real lives of junior doctors today.

Was there ever a golden age in which to train to be a doctor?

Vivienne Parry asks if the NHS can deliver the benefits of genomic medicine for all

With over 50 confirmed cases of people in the UK with the Zika, Dr Margaret McCartney reviews the latest advice for people worried about the virus. Keyhole surgery for the hip. Dr Mark Porter finds out how hip arthroscopy is increasingly being used to treat problems caused by hip impingement. Sion Glyn Jones, Professor of Orthopaedic Surgery at the University of Oxford and consultant orthopaedic surgeon at the Nuffield Orthopaedic Centre describes which groups appear to benefit most from hip arthroscopy, and Amanda, who had to wait 8 years before keyhole surgery on one of her painful hips, tells Mark about the transformation the operation made to her life. Mark and Margaret discuss the benefits of the "yellow card" system, which allows patients and health professionals to report side effects of drugs.And, as more and more people in the UK are surviving, or living with cancer, thanks to recent advances in treatment, choosing the best approach when faced with a life-limiting disease can be difficult. When cure rates approach 100% for early bowel cancer, advising a patient to have surgery is much easier than recommending aggressive chemotherapy for a hard-to-treat tumour when there's only a slim chance of a cure. Consultant oncologist Sam Guglani, from Cheltenham General Hospital, discusses with Mark the different factors that can influence and impact on the unique relationship between doctor and patient when faced with such choices.

Has media coverage of statins caused people to come off the drugs? An unusual neurological itch on the arms or back that is often misdiagnosed. Plus Ghrelin, the hormone that makes your tummy rumble and an unexpected surgical side effect that may help in the quest for people to lose weight. And the story of how Viagra was discovered.

Every three minutes somebody in the UK develops dementia, so when it's claimed that tailored computer brain training can reduce cases of dementia and cognitive decline by a third over a decade, people sit up and take notice. The research claiming the 33% reduction for the group of people whose "processing function" was targeted for brain training, hasn't yet been published - so isn't peer-reviewed - but the preliminary data by a US team was presented to the Alzheimer's Association International Conference in Toronto this week. Dr Doug Brown, Director of R&D at the UK's Alzheimer's Society speaks from the Canadian conference to Dr Mark Porter and says there's widespread excitement about the potential of brain training to protect against dementia. Dr Margaret McCartney urges caution, warning it's too early to make claims before the full data is available.James is a young man with a high pressure sales job, but every year in the summer months he is crippled by agonising headaches. He's one of the 100,000 people in the UK who suffers from cluster headaches, so called because they come in disabling bouts, lasting for 4-6 weeks at a time. Inside Health visits a new one-stop multidisciplinary rapid-access headache clinic at St Thomas's Hospital in London, where James is getting treatment. Dr Giorgio Lambru, who heads the new service, tells Mark why it's so vital that patients with cluster headaches have to be seen, diagnosed and treated quickly.Years after cardiac rehabilitation became a standard part of therapy for heart attacks, the same post-treatment care still isn't routinely available for people who've had cancer, despite decade-old guidance from NICE suggesting that it should be. The UK's first clinical trial to measure holistic cancer care is hoping to provide the evidence that will demonstrate the type of support and rehabilitation that really works. Professor of Nursing Annie Young from Warwick Medical School and University Hospitals Coventry and Warwickshire NHS Trust tells Mark that after treatment, patients can feel abandoned and vulnerable.#hellomynameis is a hugely successful social media campaign which highlights the importance of healthcare staff introducing themselves to patients. It was launched by Dr Kate Granger after her experience of being in hospital. Kate died at the weekend from cancer, aged just 34. Dr Margaret McCartney describes the enormous impact of Kate's campaign throughout the NHS.

What is Papilloedema? The condition has been in the headlines as an optometrist was found guilty of manslaughter after missing abnormalities in the eyes of an eight year old child. Plus, Margaret McCartney debates the accuracy of screening young people for Sudden Cardiac Death in Sport. How to diagnose early miscarriage in women who are bleeding in early pregnancy? And the serendipitous story of how the anti-clotting agent warfarin was first discovered.

Care.data, the scheme to build an enormous database containing the medical records of all English patients has been scrapped. Dr Mark Porter investigates the fall-out following the cancellation of this expensive programme, which foundered on concerns about confidentiality and public and professional trust. Chair of the national EMIS user group and Sheffield GP Dr Geoff Schrecker and GP Dr Margaret McCartney discuss the scale of the failure of the care.data programme and outline what needs to happen in the future if valuable patient data is to be used for the public good.Twelve hundred adults and children die every year in the UK from asthma attacks, and these grim statistics have remained stubbornly consistent for decades. But there is light on the horizon as researchers in the field begin to stratify the disease; identifying patients with different types of asthma and treating them accordingly. Mark visits the Churchill Hospital in Oxford where some pioneering work has taken place to develop new diagnostic tests and new treatments. Ian Pavord, Professor of Respiratory Medicine at the Nuffield Department of Medicine, shows Mark the new FENO breath test for nitric oxide to test inflammation - soon to be available for use in general practice.Acne Rosacea is a debilitating and painful condition. It's characterised by redness, spots and inflammation on the face and affects both sexes but mainly women. Dr Bav Shergill of the British Association of Dermatologists discusses latest treatments.And the first in a new series dedicated to happy accidents that have altered modern medicine. First off, the pacemaker. Dr Margaret McCartney and Carl Heneghan, Professor of Evidence Based Medicine at the University of Oxford, tell the remarkable story of the serendipitous discovery of this life-saving device.

David Haslam, chair of NICE, discusses with Mark Porter how doctors should treat patients with 'multi-morbidity', the millions of people receiving many different drugs for many different conditions. There's plenty of trial data for starting treatments, but a dearth of evidence for stopping them! And one-shot radiotherapy during surgery for breast cancer may help 20,000 women in the UK. Rather than daily hospital visits for radiotherapy over 5 weeks, a dose is given straight to the open wound during the operation. It is quicker, cheaper and much more convenient, so why isn't it more widely available?

NHS health checks or 'mid-life MOTs' have hit the headlines as new research claims they are a success. The aim is prevention - of diabetes, heart attacks and strokes - but their introduction has been controversial amid criticism they are not evidence based or cost effective. Resident sceptic Dr Margaret McCartney debates the issues with National Clinical Advisor Dr Matt Kearney.And putting the family back into planning. As more couples leave it later before starting a family there is growing concern from fertility experts that many people don't know enough about when female fertility starts to decline. Professor Adam Balen and Professor Joyce Harper discuss the issues. And how accurate is the perception, often reported in the media, that fertility 'drops off a cliff' in the mid to late thirties? Professor Richard Anderson reviews the so called 'broken stick' study, a mathematical model which first defined the sharp drop off of female fertility.And another instalment of Inside Language where Dr Margaret McCartney and Professor Carl Heneghan examine the terms used in evidence based medicine and why they matter. This week, adjustment and how researchers allow for factors that might skew their findings.