Inside Health

The average five-year-old consumes their own body weight in sugar every year in this country - a scary illustration of the scale of the sugar problem. The new sugar tax is supposed to tackle this, but what's the evidence that a tax on sugary drinks alone will make a difference? Dr Margaret McCartney reviews the evidence from other countries, which have also used fiscal measures to nudge their populations into eating a healthy diet.PrEP - pre-exposure prophylaxis - is the latest advance in the ongoing battle against HIV. Studies show this preventive HIV therapy can reduce the risk of HIV infection by 86%. So the announcement by NHS England that it wasn't its responsibility to commission the drug has been met by shock and disappointment. Sexual Health and HIV consultant, Dr Jake Bayley, tells Mark that PrEP is a game changer in preventing HIV in high risk groups and the news that it won't be rolled out nationally, as expected, means the UK is falling behind in HIV prevention."We don't like to talk about our bottoms", Maureen Williams tells Inside Health is one reason why take up of bowel cancer screening across the country is so patchy. Maureen was one of the first people to receive the faecal occult blood test ten years ago as part of the roll out of the bowel cancer screening programme and despite having no symptoms, they found early stage bowel cancer. Ten years later Maureen campaigns for people to complete and return the potentially life-saving test. The clinical head of the Scottish Bowel Cancer Screening Programme talks to Mark about the new, simpler screening test called FIT, the Faecal Immunochemical Test, due to be rolled out in Scotland, and perhaps soon in the rest of the UK as well.Researchers in Taiwan have concluded that most patients who undergo surgery can start showering 48 hours after an operation - a finding that flies in the face of traditional thinking that scars need to be kept dry and under a dressing for a week or more, before getting wet. Consultant Surgeon Nicholas Markham from North Devon District Hospital details the dramatic changes for patients undergoing surgery, including keyhole surgery, changes in the use of anaesthetic, access to food and water and bed rest.

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

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

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

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

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

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

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

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

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

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

Prescriptions for nerve drugs pregabalin and gabapentin have risen dramatically in recent years and at the same time, concerns about abuse. Former prisoner and addict "Patrick" tells Dr Mark Porter that "gabbies" or "pregabs" are drugs of choice in jail and Dr Iain Brew, a GP who works in prisons, says misuse is a growing problem and there are examples of doctors being pressurised into prescribing them. Dr Cathy Stannard, consultant in pain medicine at Southmead Hospital in Bristol, chaired an expert group that drew up new prescribing guidelines for pregabalin and gabapentin and she tells Mark that more attention needs to be paid to emerging evidence of misuse. Many women say that if they've had one caesarean section, they feel pressurised to have another one and Sara describes how her medical team planted "a seed of doubt" about the potential risks to her baby which she says for her meant another C-Section was inevitable. But new guidelines from the Royal College of Obstetricians and Gynaecologists spell out that vaginal birth after a previous caesarean is a clinically safe choice, with a 75% success rate, the same as for first-time mothers. Inside Health's Dr Margaret McCartney discusses the history of changing attitudes to natural birth after caesarean and says why the new guidelines should give future mothers the confidence to discuss, well in advance of their birth, the best option for them. How do you fill in health check forms that ask for family history if you don't know who your family was? Inside Health listener Jessica is adopted and her heart health check suggested a very low risk of a stroke or heart attack when she couldn't answer the family history question. Mark and Margaret discuss how common this is, and what difference family knowledge would make to Jessica's risk (not much).Adrenaline auto injectors were first used in the 1960s when they were developed for soldiers to use during nerve gas attacks allowing them to self administer the antidote. But is a device designed to be used by fit, trained soldiers just as suitable for use in children and adults of widely varying size and weight? These concerns were raised by a coroner conducting the inquest into the death of a 19 year old student who died of anaphylactic shock caused by a nut allergy, despite her using her auto injector. The Medicine and Healthcare Products Regulatory Authority and also the European Medicines Agency have been looking into issue and Dr Robert Boyle, allergy specialist at St Mary's Hospital, Paddington and Director of the Paediatric Research Unit at Imperial College, London provided expert advice. He talks to Mark about the limitations of auto injector design and urges everybody who might use the devices to ensure they are confident about exactly how to use them.

As cars were banned from central Paris this weekend and the health risks of pollution hit the headlines, Mark Porter examines the statistic that pollution kills 29,000 people a year in the UK.And he visits a pioneering clinic at Southampton General Hospital where falls in the elderly are seen as a risk factor for underlying health problems; 'Having a hip fracture is like having a heart attack or stroke' explains Dr Mark Baxter. 50% of people who have a hip fracture will have previously presented with a fall, but once they go on to break a hip, 1 in 10 elderly people may not be alive at the end of the month and up to 25% by the end of the year. Many elderly people are found to be on multiple treatments - blood pressure pills or bladder pills for example - that make people fall over. In recent years there has been much more attention paid to the cumulative burden of the side effects of medicines in the elderly - particularly the group of commonly used drugs known as Anticholinergics. And according to new research by a team at the University of East Anglia, taking Anticholinergics increases the risk of falls too - particularly in men.Following news of the Meningitis B vaccine in children, an Inside Health listener got in touch to ask why it wasn't being given to teenagers in light of data showing that there is a second peak in incidence in the disease among 15 - 19 year olds? Mark talks to Professor Andrew Pollard, Chair of the Joint Committee on Vaccination and Immunisation.And Inside Language: Dr Margaret McCartney and Professor Carl Heneghan demystify the terminology of medicine and research. This week, false positives and false negatives; when is something not what it seems, and when does it seem what it's not?

For five years the Cancer Drugs Fund has supplied seventy five thousand patients in England with cancer drugs, but its days are numbered. Spiralling costs have led to a reduction in the number of drugs the CDF will pay for, meaning newly-diagnosed patients may miss out. Dr Mark Porter talks to Vicky Rockingham about the anxiety that reform of the CDF is causing. Vicky is a mother of two, working full time, and receiving regorafenib paid for by the CDF for her rare type of gastrointestinal stromal tumour, or GIST. She tells Mark that the drugs from the CDF are giving her extra time with her family and enabling her to carry on working. And Jonathan Pearce, Chair of Cancer 52, an alliance of organisations that represent people with less common and rarer cancers like Vicky's, tells Mark why any new-model CDF must take into account individual patient needs. Regular Inside Health contributor, Dr Margaret McCartney, describes how patients access cancer drugs in Scotland, Wales and Northern Ireland and discusses with Mark the difficult decisions that access to expensive and innovative new cancer medicines present for the NHS.Last season's winter flu vaccine provided only limited protection to those who received it. An exceptional year where there was a mismatch between the flu virus that eventually circulated, and the vaccine that had been developed by international teams. The result was just 30% protection (down from its usual 70-80%). Dr Mark Porter asks the chair of the Joint Committee on Vaccination and Immunisation (JCVI), Professor Andrew Pollard, whether confidence in this year's vaccine could be dented.Babies, toddlers and pre-school children often seem to have bow legs and knock-knees and parents frequently turn up at their doctor's surgery asking for reassurance about the way their children walk. Manoj Ramachandran, consultant children's orthopaedic and trauma surgeon based at The Royal London and Bart's Hospital tells Mark that up to a quarter of the children referred to his clinics have normal, developmental lower limb variants. Children are naturally bow legged when they first walk and by the age of three, there's another natural re-alignment which tends to lead to knock knees. At both these ages his clinic receives a peak in referrals but by the age of seven, he says, most childrens' legs straighten up naturally.Inside Language: Carl Heneghan, Professor of Evidence Based Medicine at the University of Oxford and Dr Margaret McCartney continue to demystify the scientific language of medicine. This week, peer review.Producer: Fiona Hill.

Are league tables listing surgical outcomes the best way to assess your surgeon or are high risk patients being turned away as surgeons keep an eye on their figures? New data published this week list the clinical outcomes for heart surgery - cardiac surgeons are just one speciality from an ever expanding list of doctors whose performance is now published in league tables and subject to public scrutiny. But what impact has their introduction had on patient care? Sam Nashef, a consultant cardiac surgeon at Papworth Hopsital, discusses this issue with Mark Porter.Recent research in schools in Wales suggest that as many as one in 12 primary school children get them at this time of year - and that compares favourably with Australian research, which suggests the figure's much higher - closer to one in five. Resident sceptic Dr Margaret McCartney explains which treatments are supported by evidence.Lyn e-mailed Inside Health to understand why she often feels colder than other people. How, she asked, do we regulate our body temperature and are some people better at it than others? George Havenith is Professor of Environmental Physiology and Ergonomics at Loughborough University, and Mike Tipton, Professor of Human and Applied Physiology at the University of Portsmouth, provide answers.And in the next of our special series demystifying the language of research and statistics Carl Heneghan, Professor of Evidence Based Medicine at the University of Oxford and Dr Margaret McCartney unpack the concept of surrogate markers. These feature increasingly in medical research and can involve everything from blood test results, to the pattern on your heart trace or ECG.

Dr Mark Porter presents a programme devoted to questions from the listeners.Dr Mike Knapton from the British Heart Foundation answers a question about whether aspirin can protect against a second heart attack.A number of people asked about the treatment of vertigo. Vertigo is a symptom of a variety of conditions ranging from migraine and Meniere's, to strokes and tumours, but by far the most common is a condition called BPPV - benign paroxysmal positional vertigo. It is caused by debris floating around in the fluid in the balance sensors of the inner ear and typically affects people over 40. And there is a relatively simple way to treat it called the Epley movement, which is much underused. Dr Louisa Murdin, consultant in vestibular and balance disorders at Guy's and St Thomas's hospitals in London, explained how she uses the technique.Dr Margaret McCartney and Mark discuss why doctors sometimes use patronising language when talking to patients.Carpal tunnel syndrome - which normally eventually affects both hands - is caused by pressure on the median nerve as it passes under the flexor retinaculum ligament at the wrist - close to where the clasp or buckle on your watch would sit. The classic story is pins and needles affecting the thumb side of the hand and sparing the little finger, and often worse during the early hours of the morning.Dr Jeremy Bland, consultant in clinical neurophysiology at King's College Hospital London, and Kent and Canterbury Hospital, where he runs one of the few NHS clinics dedicated solely to carpal tunnel syndrome, explains why people wake up with symptoms and why wearing a splint can be helpful.Osteoporosis features regularly in our in-box - particularly concerns about bisphosphonates, the gold standard treatment for the bone thinning condition. Every year in the UK around 300,000 people break a bone - such as a hip or wrist - following a relatively trivial injury because their bones are weaker than they should be. Most are middle aged and elderly.Drugs like alendronate and etidronate are prescribed to make bones stronger after a fracture. Peter Selby, Professor of metabolic bone disease at the University of Manchester and a consultant at the Manchester Royal Infirmary, answers queries about how long these drugs should be taken.

From this week all UK babies will be vaccinated against that most feared disease, meningitis B, the first country in the world to take this step. But the decision to include Men B in the national immunisation programme has come too late for parents, Freya and Ross. A year ago their baby daughter, Harmonie, nearly died after contracting the infection. Her arms and legs as well as the tip of her nose had to be amputated because of the resulting sepsis. Sue Davie, Chief Executive of Meningitis Now tells Mark that the vaccine is great news and will save many lives. But she hopes in the future that it will be offered to older babies and young children, as well as another at risk group, adolescents. Mental health problems have long been linked to fluctuating hormone levels, at times of menstruation, childbirth and menopause. Dr Michael Craig who runs the Female Hormone Clinic at the Maudsley Hospital in London discusses the role of hormone replacement treatments.Statins are the most commonly prescribed medicines in the UK. They work to lower the level of cholesterol in your blood. There's been considerable debate about when doctors should start prescribing statins and NICE, the National Institute for Health and Care Excellence, had been keen for GPs to be paid to put more patients on the cholesterol-reducing drugs. Dr Margaret McCartney outlines the controversy and NICE Deputy Chief Executive, Professor Gillian Leng, tells Mark that the health advisory body has listened to concerns and why their new statins targets are now to be tested in the field.Young, healthy, sporty people don't get heart attacks. Except when they do. Dr Stuart Miller, Clinical Director of Sport and Exercise Medicine at the University of Bath admits that he was shocked when he had a heart attack, even though he cycles, swims and eats a healthy diet. Sanjay Sharma is professor of cardiology at St George's Hospital in London and he tells Mark how common unexpected heart attacks are. Producer: Fiona Hill.

Why more than 1 in 10 people having emergency abdominal surgery die within 30 days of their operation. Which thermometers parents should use and which they should not. Vitamins and dementia - a controversy dividing scientists. Could taking B vitamins lower the levels of the amino acid homocysteine and slow the onset of Alzheimer's disease? Absolute risk v relative risk.

The Off-Patent Drugs Bill aims to prevent people missing out on life-saving treatments, but doctors can already prescribe drugs off-licence so why do we need a new law? Pre-diabetes - a new label that could apply to as many as 1 in 3 British adults, but is it a useful to know this? The importance of diagnosing sepsis early and how to recognise the key signs. Plus Dr Margaret McCartney and Dr Carl Heneghan explain the meaning of the phrase 'all cause mortality'. Presented by Dr Mark Porter.

Elite athletes are far more likely to use asthma inhalers than the general population. Do the stresses and strains of competition bring on asthma-type symptoms or does an inhaler give a performance advantage to individual sportsmen and women? Dr Mark Porter talks to sports physician Dr Babette Pluim about her review of the use of inhalers in sport.One hundred and fifty thousand knee arthroscopies are performed every year in the NHS with most of them involving surgery to smooth, remove or repair damaged cartilage, the meniscus. But there are concerns that we do too many arthroscopies in the light of evidence that intervention isn't always required. Andrew Price, Professor of Orthopaedic Surgery at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at the University of Oxford, tells Mark when surgery is useful and Inside Health's Dr Margaret McCartney reviews the mounting body of evidence that has called into question some knee surgery. Dr Annabel Bentley, former Medical Director of Insurance at the private health insurers, BUPA, describes how, back in 2011, there was an instant (and subsequently sustained) reduction of 9% in knee arthroscopy claims. The drop came weeks before a new checking process, to confirm the surgery was in line with best practice, was introduced.Pelvic Girdle Pain is a condition that affects one in five pregnant women. It causes discomfort in the pubic region, the hips and lower back and gets worse as the pregnancy progresses. Some cases can be mild but more severe forms can leave a woman needing crutches, or even a wheelchair, to get around. But there is help out there and official advice is for women to get help early and not to suffer in silence. Mark visits the Rosie Maternity Hospital in Cambridge, and speaks to new mum Joanna Welham and Women's and Men's Health Physiotherapist, Claire Brown, about what treatment is available.Medically unexplained symptoms, sometimes known as MUS, cause problems for both patient and doctor, and they're common, up to a fifth of a GP's workload, and around half of all specialist referrals, costing the NHS more than £3 billion a year. Rona Moss Morris is Professor of Psychology as Applied to Medicine at King's College London and she believes the NHS fails such patients. She tells Mark what she thinks needs to change, starting with the name, MUS.Producer: Fiona Hill.

What is the evidence that taxing sugary drinks will help to tackle obesity? Low libido in women - what is Hypoactive Sexual Desire Disorder and where did the diagnosis originally come from? Is it a label that will liberate millions of women or a construct to market new drugs? Plus Mark visits Europe's largest robotic pharmacy at a brand new hospital in Bristol.

Diabetes in pregnancy, gestational diabetes, is on the increase, and the risks to mother and baby if this condition is untreated, are very serious. Around one in fourteen pregnant women will develop GD, but the risk is much greater according to age and weight of the mother, whether there's a history of diabetes in the family and in certain ethnic groups. Dr Mark Porter visits The Rosie Maternity Hospital in Cambridge, where Dr Helen Murphy introduces him to the specialist teams that enable 70% of the women diagnosed there to manage their diabetes through diet and exercise, rather than medication. The UK's National Institute for Health and Care Excellence, NICE, has introduced new guidelines for diagnosing gestational diabetes which differ from international thresholds backed by the World Health Organisation. Mark talks to researcher Dr Claire Meek from The Rosie, one of the authors of research published in the journal Diabetologia, which found that up to 4,000 women, at risk of serious birth complications, would be missed under the new UK criteria. The teams at The Rosie are shunning the new NICE guidelines and continuing to follow the WHO thresholds. Professor Rudy Bilous, who runs the Diabetes in Pregnancy Service at the James Cook University Hospital in Middlesbrough and chaired the development group at NICE that produced the new diagnostic guidelines, tells Mark that he's confident that the thresholds, which were drawn up using the latest available evidence, are set at the right level. Weight loss properties and low carbohydrate diets: listener Mark Robins from Southampton describes his success following a low carb diet (he lost nearly four stone in a year) and Inside Health's Dr Margaret McCartney and Susan Jebb, Professor of Diet and Population Health at the University of Oxford discuss the evidence behind weight loss and low carb diets.The number of children who say they are afraid of injections is increasing and Dr Amy Baxter, a paediatric emergency doctor from Atlanta, Georgia and an expert in needle pain, has shown a link between the number of jabs and fear of needles. UK children have up to 15 vaccinations, with the new Meningitis B on the horizon, so managing that fear is important. Dr Baxter tells Mark what parents and health care professionals can do to help, and saying "Sit still, don't move, this will only hurt a bit", isn't recommended!Producer: Fiona Hill.

Across England, selected GP surgeries are trialling 7-day working, but there are reports that take-up has been so low in some areas, particularly on Sundays, that pilots have been abandoned. Dr Margaret McCartney and Dr Mark Porter investigate where the pressure for extended opening hours is coming from. Mark visits Herefordshire where Taurus Healthcare, a federation of local GPs, is running a late night/weekend service. Managing Director Graeme Cleland describes the high take-up of the service after an initial slow start, and says new patients have been treated, showing previously latent demand in the system. Mike Dando is a wheelchair user with spina bifida and diabetes, and before the pilot started a year ago, he would have to wait in all day for a district nurse to dress his ulcerated legs. Now he just makes an appointment at a time convenient for him. But at the end of this year the seed money provided by the Prime Minister's Challenge Fund runs out, so what will happen to the Herefordshire pilot? Chair of the local Clinical Commissioning Group, Dr Andy Watts, says without extra funding, the pilot service is unlikely to continue and deputy chair of the BMA's GP Committee, Dr Richard Vautrey, calls for investment in current GP practices rather than expensive additional services.Doctors in the UK have been warned by public health officials to be on the lookout for people who become ill after travelling to South Korea. Middle East Respiratory Syndrome (MERS) has killed 27 people in the region and there are 174 confirmed cases of the disease. Nearly five hundred people have died worldwide after the virus first emerged three years ago, in Saudia Arabia. Jonathan Ball, Professor of Molecular Virology at the University of Nottingham, describes how coronaviruses like MERS (and SARS) jump to humans via an intermediary animal. In the case of MERS, that's via the Dromedary camel.Nitrous Oxide or laughing gas has a long history of recreational use but in recent years, there's been an exponential growth in use among teenagers and young people. Founder of the Psychedelic Society, Stephen Reid, describes the physical effects of laughing gas and tells Mark why he believes the gas shouldn't form part of the government's planned clampdown on legal highs. But Dr Paul Seddon, respiratory paediatrician from Queen Alexandra Children's Hospital in Brighton, warns that increased use could mean increased health problems, like the case of the teenager girl with a collapsed lung admitted to his hospital after inhaling the gas.Producer: Fiona Hill.

Cervical screening in older women has hit the headlines, but reports have not explained whether these women being diagnosed after 65 have attended screening. Concerns about an outbreak of Hepatitis E in Nepal that could kill pregnant women; A new technique being trialled in the UK to treat enlarged prostate; and Dr Margaret McCartney on statistical significance.

Treating low sex drive in women. Expert panels in the USA have voted in favour of a drug that has been dubbed 'Pink Viagra', but there are serious reservations. Outdoor swimming is the new trend for 2015, but should you take the plunge or go in slowly? Strokes in the under 55's have recently been reported to be on the increase: Dr Margaret McCartney takes a closer look at the evidence. And unpicking tricky terms to understand your health - causation versus association. Presented by Dr Mark Porter.

In the last of the current series Mark Porter answers your feedback on sex education, off licence use of drugs and drinking smoothies instead of eating fruit.Plus hospital bed numbers have been halved over 25 years, while admissions have rocketed - up by 3 million in the last decade alone; Inside Health discusses how hospitals have been coping.Plus calls for frailty to be an official diagnosis rather than simply a general description - Mark Porter examines the implications.

Mark Porter visits a very smelly laboratory to find out how your gut bacteria could be influencing your weight - and more besides.Doctors have written to the authorities asking for permission to use the drug Avastin instead of the more expensive alternative, Lucentis, to treat patients with age related macular degeneration (AMD) - the commonest cause of blindness in older people. Inside Health investigates.And new research into peanut allergy, turning conventional wisdom on its head, that every parent should know.

The big news in public health this week with the parliamentary vote on the introduction of standardised cigarette packets. A move the tobacco industry has resisted fiercely. Inside Health discusses the evidence for the sort of impact the policy might have on the nation's smoking habits?The difficult issue of when and how to tell children about sex. Schools throughout England are to be offered new guidance to help them with sex education in PHSE classes for KS3 and KS4 pupils. But, the classes are still not going to be made a statutory part of the curriculum. Inside Health's Margaret McCartney examines the evidence.And a listener has asked about gallstones after a recent scan had shown debris or sludge in the gallbladder.Plus news from Las Vegas, New York and the UK on trends in plastic surgery.

Recent research was widely reported as concluding that 30 year old guidance to limit saturated fats had been overturned and should never have been introduced - and that we can now eat as much butter, cheese, sausages and pies as we like.But, as ever, the real story is a bit different. Inside Health debates the real evidence and hears from Sweden that rumours of change in its guidance have also been misreported.As big companies try to attract female employees by offering 'egg freezing' as a corporate carrot, Dr Mark Porter examines the success rates and implications for women wanting to start a family.And checking your moles - how to tell the difference between the sinister and the innocent.

New drug-driving legislation which comes into force next week applies to some medicines too. Particularly morphine based painkillers taken by hundreds of thousands of people in the UK, many of whom could inadvertently find themselves on the wrong side of the law.And planning for a good death - an Inside Health listener says he believes it's better to die earlier from heart disease than go on to develop cancer later in life. Is he right?Plus as many as 1 in 10 university students in the UK are now thought to be dabbling with smart drugs to help them revise and boost exam performance. Inside Health talks to leading experts about cognitive enhancers.

After recent headlines that running too much can be bad for your heart, Mark Porter talks to the Medical Director for the London Marathon to get an insider's perspective. A novel psychological approach to weight loss that asks why people are eating too much rather than just giving dietary advice. Plus new treatments for Hepatitis C and statistics showing a reduction in binge drinking in young adults.

With the NHS facing significant and enduring financial pressures, as people's need for services continues to grow faster than funding, what impact is all this having on NHS staff? New advice about flying if pregnant and new research that links drinking one can a day of a sugary drink to an earlier onset of puberty. Plus the sensitive issue of FGM.

Diagnosing Cancer - why does the UK still lag behind much of Europe and what is being done about it? The American dream - personalised medicine based on your genes. Plus do headphones damage hearing?

With widespread reports of a link between dementia and commonly used medicines, Inside Health assesses the risks.Why women are more likely to die from heart disease than men with cardiologist, Dr Laura Corr.With more and more people choosing to adopt a gluten free diet, Mark explores the possible health benefits for people who don't have coeliac disease. Is the real problem wheat intolerance, irritable bowel syndrome, or too much hype?Boilers on prescription: a new idea being investigated by one Clinical Commissioning Group.And new research that links having a weekend lie-in with an increased risk of obesity-related diseases, like diabetes.

Mark investigates reports that the UK faces an epidemic of "mutant flu".Just a month after NICE calls for more weight loss operations to be done, there are proposals to slash the amount hospitals are paid to do the procedures - a move that could see many hospitals stop offering the operation.Six packs and big guns - there is growing concern about steroid abuse by young men on a quest for the perfect body.And Dry January - Mark looks at the science behind going on the wagon for a month.

Dr Mark Porter talks to leading experts about treating alcohol dependence with a pill and whether the required counselling services are available to make it work.And Mark finds out the state of his arteries when he has a new blood test to predict his risk of heart attack. Plus what does the evidence tell us about how often to visit the dentist?

Should fruit juice be dropped from the 5 a day fruit and vegetable recommendations?A&E in a mild winter - why has the NHS been stretched to near breaking point over the festive period?Dr Mark Porter visits a busy pain clinic to find out why prescribed opioid painkillers for long term non-cancer pain often do more harm than good.And resident sceptic and GP Dr Margaret McCartney outlines her New Year resolutions.

Financial incentives for GPs - do they work? Mark Porter learns there are parallels between the latest £55 to diagnose dementia and an incentive to diagnose depression which didn't work and was dropped. Are walk-in CT Scans a good idea - two experts who authored recent reports address concerns about people arranging their own scans. Hot Flushes feedback; plus the new generation of anti-coagulants offering an alternative to warfarin.

As more NHS operations are done in the private sector, how much do we know about patient safety in private hospitals? Kits to self-monitor warfarin have been recommended by NICE, so why is the uptake so poor? Hyperbaric medicine - using high doses of oxygen to accelerate healing; And sick day rules - the medicines you should stop taking while you are unwell to reduce kidney damage.

Inside Health examines advice for when parents should and shouldn't send their sick children to school. Is this another example of the nanny state, or a useful guide?Hip replacements and knee replacements are well known treatments but now a new trial is looking into the effectiveness of ankle surgery for arthritis.Margaret McCartney reveals the origin of the word hypochondria.Plus, how effective is HRT for the commonest symptom of the menopause, hot flushes?And Inside Health answers listeners' questions on Guillain-Barré syndrome, what are the causes and treatments.

Ebola - how do they predict how it's going to spread, and why estimates have risen so rapidly.In the UK there are 22 million prescriptions a year for morphine type painkillers, costing over 300 million pounds - but do they actually work in non-cancer pain?And a simple blood test that can tell if your recurrent chest infections might be due to an immune problem.Plus thyroid problems and pregnancy.

Dr Mark Porter reports on sleep apps, can they help with common sleep problems such as sleep apnoea? A new study reveals the failure of antibiotics for simple infections. Margaret McCartney reviews the evidence and asks is it worth having a flu jab? Plus who is eligible for NHS continuing health care.

Dr Mark Porter goes on a weekly quest to demystify the health issues that perplex us.

Dr Mark Porter examines how powerful lobbying groups like the food and alcohol industries steer public health policy in the direction that suits them most.

Dr Mark Porter examines the hidden conflicts of interest that may affect how your GP or specialist treats you. He discovers that the advice patient groups give you is also not immune to the influences of organisations such as pharmaceutical companies.

Are conflicts of interest in medicine out of control and undermining public trust, or an over-hyped concern? Dr Mark Porter investigates the hidden influences affecting your health.

Dr Mark Porter finds out about the latest research investigating why people with HIV very rarely get multiple sclerosis. What does it mean for the cause of MS and possible future treatments? Also in the programme how much is black skin at reduced risk of skin cancer from exposure to the sun? Why iron overload can often go undiagnosed and the training for the nose that can help recover a lost sense of smell.

Mark Porter investigates a new research trial which shows that paracetamol doesn't help back pain. And why are blood thinning drugs being overused in NHS hospitals? New laws on limits for driving on prescribed drugs come into force in March 2015. Which prescription drugs are included and what does it mean for people taking them? Also in the programme, can any medications help get rid of kidney stones?

Some media coverage has suggested that there is a link between eating junk food and the rise of conditions like Crohn's disease and ulcerative colitis which involve inflammation of the digestive system. Mark Porter questions the evidence. As school's out for summer Mark finds out why teachers' voices need a rest. He also examines whether cholesterol lowering spreads and drinks do what they suggest. Also in the programme: is frying with olive oil harmful or the healthy choice?

Switzerland looks set to be the first country in Europe to halt routine breast screening; yet in the UK a review of the same evidence came to the opposite conclusion. Dr Mark Porter asks how two groups of experts can arrive at such different decisions, and examines the harms and benefits of screening for breast cancer.