MEDICAL MATTERS

[Tizer]

Another important medical `miracle' has hit the headlines this morning. Here's the press release from University College where a trial has taken place.
`Light therapy effectively treats early prostate cancer' LINK
20 Dec 2016: A new non-surgical treatment for low-risk prostate cancer can effectively kill cancer cells while preserving healthy tissue, reports a new phase III clinical trial in 413 patients led by Professor Mark Emberton, Dean of UCL Medical Sciences and consultant urologist at UCLH.
"The VTP therapy approach was developed by scientists at the Weizmann Institute of Science in Israel in collaboration with STEBA Biotech, and the European phase I, II and III trials were all led by UCL. The drug used in the procedure, WST11, is derived from bacteria at the bottom of the ocean. To survive with very little sunlight, they have evolved to convert light into energy with incredible efficiency. This property has been exploited to develop WST11, a compound that releases free radicals to kill surrounding cells when activated by laser light."

[Stanley]

I too saw that report and marvelled at the fact that it was the reaction of the derived compounds to light that triggers the toxic effect on the tumour. Talk about imaginative and inspired logic! I'll bet that whoever conceived it couldn't believe it at first! Hartley's 'pesky scientists'.....

[Tizer]

My New Year's resolution is to be more careful when accepting a high-quality chocolate-coated biscuit. I ate one when visiting a relative, attracted by the dark chocolate which I like. I didn't think much about it as we were all talking and enjoying ourselves. I noted a gingery taste but I can usually eat a basic ginger biscuit without serious results. That evening I had a sore, bloated stomach and the following morning the dreaded runs. I realise now that it was a posh biscuit with pieces of ginger in it and that's what inflamed my gut. Flavour due to a small amount of dispersed ginger isn't a problem, it's the big bits that do the damage.

[Stanley]

You've reminded me yet again Tiz how lucky I am, I can eat anything. It must be a bugger to have to be so careful..... Mind you, Apart from some 85% dark chocolate one in a blue moon when the fancy takes me I don't eat the stuff. But I like ginger paste in my stews.....
The current medical event is blood and urine sample today and Diabetes assessment next Wednesday. I've been comfort eating for the last three months but on the other hand I have fully espoused Wendy's advice about low carbs so I shall be interested in my blood analysis.

[Wendyf]

There's been a lot of pies and puddings mentioned Stanley!

[Stanley]

Not lately Wendy, I am being very strict with myself! I think I was eating for comfort..... Understandable but no good in the long run. Watch this space!
See THIS for a report of a credible study done in Canada and reported in The Lancet. It appears to show a clear link between living close to a main road and the incidence of dementia. It surveyed 6.6 million people over a long period and so looks sound......

[Tripps]

This was announced last night on the radio, and they said 'this does not prove a casual relationship' between the two. I think he meant causal.

I often wonder why I immediately go into sceptic mode when I read something like this. Ten years and six million participants seems impressive, but it is a timely fit into the current narrative against diesel particulates, and Nitrous Oxide. Does it mean we should not now build new houses near main roads?

[Whyperion]

I'd like to know what classifies as a main road. Those urban ones where the trams used to run in leeds with council semis and short terraces is one thing, the A40 western artertial another, and there is an elevated motorway passing quite close to peoples bedrooms into Manchester from the north - that has some acquostic barriers, but 'busy'? The F14 ? Jet at 7am from Brize Norton used to wake me when I lived in rural oxford, followed by the morning commuter on his motorbike, then the cockrels and cows got going, the first bus passed and I had to leg it for the second bus to work in the town.

[Tizer]

In a study like this you have to ask "Do the people who live close to busy roads choose to live there rather than further away or is the distribution random?" If it's random then the results are more meaningful. If some people deliberately seek out houses next to busy roads the is it possible that those people are coincidentally more likely to suffer dementia for some other reason. Put conversely, if people (like me) choose to live well away from busy roads do I avoid the dementia that I might otherwise have suffered? Or are we less likely to get dementia because we eat better, walk more, feel more contented etc and it's nowt to do with pollution from traffic? We can be confident that the study results show a statistical association between living close to a busy road and getting dementia but we can't assume that if we all move away from traffic we won't get dementia.

One aspect doesn't seem to have been mentioned. The study found no association between busy road living and Parkinson's disease. That strikes me as a bit odd because Parkinson's and dementia are associated.

[Stanley]

If it focusses attention on the general problem of air pollution in cities and has an effect on policies it's a good thing......

[Tizer]

The front page of The Times today has a headline: `Diesel cars pumping out twice the toxins of buses and lorries'
"Modern diesel cars produce more than twice as much toxic gas as a lorry or bus of the same age, analysis has found. There is less risk of inhaling dangerous levels of nitrogen oxides from standing beside a new lorry or bus with its engine running than standing beside a car, according to the research."

In the article they refer to the study we've just discussed above, saying: "Pollution also increases the risk of dementia for those living near a busy road, according to a study published this week". That's garbling the message again. We can only say "Pollution may increase the risk of dementia for....". As Tripps noted, it does not prove a causal relationship. It's no wonder the public have lost confidence in experts, scientists, technologists and engineers. Everything they report gets mangled by the news media on its way to the public brain.

I'm only able to see part of The Times article on the web so I searched for more information about this car v. bus problem. Curiously I found almost the same story in 2015 in The Guardian: LINK `Diesel cars emit up to four times more toxic pollution than a bus, data reveals'
Both articles seem to be based on work in a Norwegian lab. "At the Norway Centre for Transport Research, the researchers found “all [12 of] the tested heavy vehicles’ engines have very low emissions of NOx in real traffic” and that emissions had fallen tenfold from the previous models. But the seven diesel cars emitted four times more on average than the trucks and buses...The Norwegian team concluded: “Test results have shown by effective removal of NOx from the exhaust gases of heavy vehicles that it is possible with Euro 6 engines. This means that it is technically possible to achieve the same positive results for new generations of cars with diesel engines.” It goes on to say: "Tate said the reasons car manufacturers were not implementing the NOx reduction technology on cars were convenience and cost. The most common technology requires a chemical compound known as urea to be squirted into the exhaust gases, but a large urea tank would be heavy while a small one would require frequent refills." I think that diesel cars in America have to use this urea injection technology and that's the reason why VW's emissions problem is a bigger issue over there - all the urea equipment would have to be replaced to bring the US cars up to the required emissions standard.

[Stanley]

As far as my experience carries me, I have always believed that as soon as a prime mover has to be installed in a moving vehicle (and it applies to rail as well), compromises have to be made in terms of clean burn and overall thermal efficiency. When this is compromised by the fact that vehicles like cars sell on performance we see matters like the smart software that VW installed to get over the necessity of a clean burn on test and performance on the open road.
Going back to my time in Berlin in the 1950s I can remember how impressed I was by the fact that the police didn't use high powered cars but the bog standard Beetle. It would be possible now to design a small car with restricted performance that would satisfy every emission test but it will never be done because of the sales advantage of the Clarkson Factor......

[Tizer]

In a follow up to the busy road/dementia story the BBC has done this analysis article. It considers a lot more factors affecting the comparison and shows how complicated it really is. LINK
`Is it healthier to live in the countryside?'

[Stanley]

I can remember when 'wheezing after exercise' and the higher incidence of asthma and 'glue ear' were the hot topic 40 years ago. What struck me then was that the highest incidence of these problems in the UK wasn't in a polluted city but the Isle of Skye. Getting their air direct from the Atlantic and the low traffic levels would have made you think it would be healthier. I wondered at the time whether lack of ventilation in houses sealed up against the weather was a factor. As you point out Tiz, it's complicated.... I've always been puzzled by the fact that open gas rings and in burners the ovens and grills on gas cookers are legal but gas CH has to exhaust to the outside. Exactly the same products of combustion......

[Tizer]

I think the asthma and wheezing in those old cottages would have been due to dampness providing lovely conditions for mould growth. Even worse with earthen floors. They probably lived in a miasma of spores.

[PanBiker]

I picked this up from a post by Ken Hartley on Barlick Talk Facebook page. It could just as well go in the politics thread. It has this from a Times article on ambulance response times.

Patiently Waiting

You can search on postcode and this is the result for our area:



Very scary!

If you get an ambulance you don't want to be going to Blackburn, that's a 40 minute journey, your golden hour is gone, it's not good.

This probably explains why the emergency service could not get me an ambulance when I had 80% stroke symptoms. My lad took me to Airedale in 20 minutes, no use whatsoever if you don't have access to your own transport.

[Moh]

There is a good article in today's Mail on Sunday about two brothers who changed their dad's eating habits and his diabetes disappeared - some good recipes too.

[plaques]

I think you are being a bit harsh on the ambulance crews. They are a lot more than a taxi service to the hospitals. I believe all the emergency ambulances are crewed by well trained paramedics. From what I saw when I called one for my next door neighbour who had collapsed they gave him a full check over before moving him, carried him to the ambulance, and one continued to work on him as it departed. Locally, one of the biggest delaying problems as I see it is North Valley Rd at Colne. Talk about downtown Manhattan, How they manage to get through the traffic is a mystery.

[Wendyf]

There is a good article in today's Mail on Sunday about two brothers who changed their dad's eating habits and his diabetes disappeared - some good recipes too.

I put a link to the article in the "We are what we eat topic" Here
The film they made about it was very moving and inspiring.

[PanBiker]

I don't wish to denigrate the skills of the ambulance crews in any way, but the response times due to under funding and cut backs speak for themselves. We used to have a local fully crewed ambulance station in the town that effectively catered for the West Craven area of Barlick, Earby and surrounding villages. With cutbacks this has now gone, one of our original ambulance stations has been knocked down and replaced by flats and the one that replaced that (still in the town) has laid unused for the last few years and the site is due to be redeveloped for housing. Any temporarily resident ambulance that happens to be in Barlick will share the parking with the also scarce police vehicles, we simply don't have an effective service in the area any longer.

My comment regarding the transfer time once you have the ambulance is very relevant. I timed the journey on an off peak holiday day once when I was heading for the M6. It took 45 minutes from Barlick to get to junction 5 on the M65 for Royal Blackburn Hospital with a further 2 miles to go. As you correctly say it can take you 20 minutes or more on a good day to negotiate the North Valley onto the motorway. West Craven is definitely further out on the limb than what it used to be. Blackburn is a 23 mile journey Airedale is 14 miles. Thank goodness that given a choice we can still go to Airedale but the red light service does not automatically default to the closest option.

[David Whipp]

Ambulance response times are something me and Ken Hartley have been doggedly trying to see improved for four years now (it was my own blue light journey to Airedale that prompted us monitoring the situation).

The ambulance crews are themselves 'victims' of the way the service is organised. It works on a 'dynamic response' model, whereby ambulances are sucked into the busiest areas. When ambulance crews become available after handing over a casualty at hospital, they are deployed to the closest incident, and so a crew from Barlick may not return to their home station during a shift.

Even if we had more emergency ambulances, the effect of the dynamic response system would be to take them out of the area.

We did get a pilot 'community paramedic' post for Pendle (based at Earby). One part of the role was attending emergency incidents, but not travelling with casualties to hospital. Unfortunately, the post isn't now funded and was vacant the last I knew.

The problems are compounded by the chronic crisis in the health service and the shortage of paramedics, with 204 vacancies in the North West alone.

Not a 'healthy' situation.

[Tizer]

Mrs Tiz and I had lots of experience of emergency services and the like during the last 10 years with our parents becoming unable to look after themselves. Our experience is mirrored by that of Janice Turner writing her opinion article in The Times on Saturday. Her elderly mother came down from Rotherham to London to stay with Janice's family over Christmas and was taken ill. Janice had lots of trouble and worry trying to get help for her and everything took ages to happen. Her conclusion matches David's comment: "The ambulance crews are themselves 'victims' of the way the service is organised" and also it's affected by the way the hospital and the GPs work. She also makes the point that it's crazy that the ambulance crew, once it gets to hospital, has to stay with the patient until they are taken over by the staff. In her mum's case the crew were there for four hours until someone from the hospital took over responsibility. Apparently the regulations say they have to do this.

[Stanley]

Sorry P, just for once I think you have got hold of the wrong end of the stick, most unusual! I agree that those figures are dire and also with David that the ambulance men and women are as much victims as we are. Once again we are into cuts and austerity......You get back exactly what you put in!

[plaques]

As explained by David longer response times are inevitable if you work to a dynamic system. This is especially so if you group all the vehicles in larger and larger centres. Trying to devise an algorithm that sorts out priorities and shortest routes with an ever changing dynamic system is nye on impossible. Even Richard Feynman struggled with a static system. In my mind the root of the problem or should I say roots, is the target waiting times at GP surgeries plus the reluctance to invest in adequate A & E departments and then even more waiting target times within those departments resulting in a system where everyone pushes the problem down the road. Finally as Tizer said the ambulance is held up waiting to discharged its load before moving onto the next job. Yes, ambulance repose times may be getting longer but lets not forget who the real culprits are.

[Moh]

When I had my eyes tested in September the optician referred me for laser treatment to one eye, I was given a date for 4th Jan. which they then cancelled on 28th Nov. saying I would be contacted shortly. I heard nothing so I rang this morning (15 mins. holding on 'phone) to be told there are no clinics - I said there are always clinics - she said they are full and it is up to the consultants if and when they put extra ones on. She said ideally I should be seen by Jan. 18th - so I said give me a date then, she said she couldn't as there are no clinics !!!