Alcohol, cancer treatments, hair, halitosis

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Following the latest figures on deaths from alcohol, Dr Mark Porter talks to liver transplant expert Dr Varuna Aluvihare from King's College London, the largest liver transplant centre in Europe.

Targeted cancer therapies - thousands of people with cancer are to have their genes mapped as part of a new drive towards treatment tailored to the individual. But what's in it for the patient? Mark discusses with Prof Peter Johnson, chief clinician for Cancer Research UK.

Mark talks to Dr Paul Farrant about caffeine - is there a benefit to having it in your shampoo?

Halitophobia - fear of bad breath and what can be done to help. Tim Hodgson and Claire Daniel from the Eastman Dental Hospital in London explain.

Available now

28 minutes

Last on

Wed 30 Jan 2013 15:30

Programme Transcript - Inside Health

THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT.  BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

 

 

INSIDE HEALTH

 

TX:  29.01.13  2100-2130

 

PRESENTER:  MARK PORTER

 

PRODUCER:  PAMELA RUTHERFORD

 

 

Porter

Coming up in today's programme:  Targeted cancer therapies - thousands of people with cancer are to have their genes mapped as part of a new drive towards treatment tailored to the individual. But what's in it for the patient?

 

Clip

I feel I've made a complete recovery.  I've got away lightly.  It feels like I have and I think it is down to the treatment and of research and development - they worked magic.

 

Porter

Also coming up:  Caffeine - it's a natural component of coffee, tea, cola and chocolate, but what's it doing in your shampoo? And, continuing the personal hygiene theme: Are you worried that you have bad breath? I will be finding out why it is often imagined, rather than real - and what can be done to help people with … halitophobia.

 

But first alcohol, and new figures for England and Wales from the Office for National Statistics showing that while the alcohol related death rate has fallen significantly in Wales, after peaking in 2008, the figure in England remains flat.

 

Six thousand seven hundred and thirty three people died from alcohol related causes in England between 2010 and 2011 - two-thirds of whom were men - with men and women in the North West being twice as likely to die from heavy drinking as their peers in parts of the South East.

 

Varuna Aluvihare is a transplant liver specialist at King's College Hospital in London and joins me now.

 

Varuna, I suppose the good news is that the figures are flat or levelling off anyway, whereas they were rising 10 years ago.

 

Aluvihare

Liver disease takes a long time to develop, so we are really at the coalface, not really seeing the benefit of the figures flat lining and we're seeing I think - the transplant centre's right at the top of the tree and what we see there is really percolating up to us and I still think the NHS is facing a big alcohol crisis.

 

Porter

So this is when consumption has been rising up until five, five, six years ago, you're actually seeing the repercussions of that and repercussions like what?

 

Aluvihare

Well I mean you know when you're training to be a doctor you get to know certain diseases and when you should see them and if you told me 20 years ago, when I was a trainee doctor interested in liver disease, that I would be seeing young people, at the age of 20, 25, desperately sick, coming to see me in need of a transplant I would have fallen off my chair - I think it's something that I would never have believed was possible.

 

We always thought patients were in their 50s, 60s, sometimes 65, 70, we are now seeing patients who are in their 20s and 30s and transplanting people in their 30s with a condition that I used to think was a disease of later years in life.  So I think that's one significant change and I think that's something that all liver centres are seeing is a much younger population.  And of course the vast majority of patients aren't in those extreme groups but we're seeing - but the other group of patients are the 55, 65 - people who we may all know.  And they're gently and very slowly doing damage that we don't recognise until your liver says enough.

 

Porter

Because they don't regard themselves as problem drinkers, possibly because of the way that they drink.  I mean let's look at this thing about consumption - obviously the more you consume the more at risk you are but does it matter when you consume those units?  I mean looking at this - if I do it all on a Friday and Saturday night, whether I'm drinking wine at a dinner party or vodka in a bar in Newcastle.

 

Aluvihare

I think there are two dangers:  There's the danger of the alcohol consumption that we would probably all recognise to some extent in ourselves, which is that you don't really give your liver a break on any day and then there are certain evenings when you go out with friends and even a sensible responsible adult would probably drink a little bit too much.  So there's that pattern of drinking which does actually seem to lead to liver scarring and ultimately sclerosis and the desperate problems.  There's also another group I think which are really chaotic drinkers and we see this now both in young women and men who will not drink maybe for a couple of days but will take all of their weekly allowable limit in one day and it's not the only day they drink on, so of course they carry on drinking three or four days and each of those days they maybe drinking their entire weekly limit and that's binge drinking and that also would appear to be very harmful.

Porter

Looking at the people in your hospital who are very ill and being considered for transplant because of alcohol, I mean if there's something about these people, of the younger ones, is there a common feature?

 

Aluvihare

I used to think so, I think as a doctor it's probably an easier thing to say well there's something different about them but actually when you get to know some of those patients well you realise there is an element of there but for the grace of god that you didn't go down that route.  So I think the large majority of those people in my opinion are relatively normal people who are just pushing the boundaries further than is really good for them and then they get into desperate trouble when addiction kicks in.  So I think it would be wrong to think of them as another group of people from the rest of us.

 

Porter

Is it true that there are a subset of the population who are more susceptible to the effects of alcohol, but we just simply can't - we don't know who they are?

 

Aluvihare

Well we do know some things, I mean we know women, for example, unit per unit, are more damaged by the same quantity of alcohol consumption.  We do know that, for example, more own background and people who are of Asian and South East Asian descent actually are more susceptible to alcohol related harm for the same unit of alcohol.  That may be related to body size and fat distribution or other genetic factors.  I think there's no question there's a spread of susceptibility, as with every complex disease amongst the population.

 

Porter

The safest thing is to assume that you are susceptible?

 

Aluvihare

Absolutely, the safest thing is to assume the worst.

 

Porter

If these figures do represent a topping off of consumption in the UK when would you hope that in units like yours you might see a resulting fall in the amount of work you're doing?

 

Aluvihare

Well I think what will happen - and unfortunately with liver disease in general there's an explosion of liver disease that keeps people like me and our unit in business and so I think when alcohol gradually declines and we see the benefit of that something else will probably come along with it, another form of hepatitis or obesity, which is just round the corner and I think we'll be sitting here maybe in five years talking about that rather than alcohol.  However, the benefit will take probably five to 10 years and we certainly aren't seeing it at the coalface, even though the statistics give a cautious reason for being slightly optimistic.

 

Porter

Varuna Aluvihare thank you very much.  And there's a link to those latest figures from the Office for National Statistics on our website, go to bbc.co.uk/radio4 and click on I for Inside Health.

Now new approaches to treating cancer and what they may mean for you. Barely a week passes without some form of cancer story hitting the news, but there have been consistent phrases used in much of the coverage recently - namely genetic mapping and targeted therapies.

 

David Cameron highlighted the added impetus being given to the analysis of the genes of people with cancer, to help doctors tailor new treatments to the individual. And this week the Institute of Cancer Research in London launched its Tumour Profiling Unit to do just that.

 

But what is tumour profiling - and what is in it for the patient?

 

Professor Peter Johnson is Chief Clinician for Cancer Research UK and is currently conducting trials into new targeted therapies.

 

Johnson

I think the way that we diagnose cancers is changing, we all know that there are many different sorts of cancer, it's not just one illness, but what's becoming increasingly clear as we get more detailed information about the make-up of cancers at the very detailed level of the genetic code is that everybody's cancer is different.  So some people, for example, with a cancer which has spread around the body may have some chemotherapy which is very successful and shrinks it right down and other people it may be completely resistant.  They all look quite similar under the microscope, for example, but when you look down and see what molecular events have taken place, what changes have taken place, in the genetic code during the development of a particular cancer it can be very different from one person to another.  And up until now we haven't really had very good tools for distinguishing these different patterns of behaviour but we're hoping that by getting this very detailed knowledge now that we'll start to be able to unravel that.

 

Porter

And does that have implications for treatment now - I mean do we have the tools to tailor treatment depending on what a cancer's individual genetic make-up is?

 

Johnson

There's been an extraordinary switch in the last 10 years in terms of what cancer researchers are looking to bring into the clinic.  It's a bit like the ordinance survey - in the old days, in medieval times, we had maps which had a vague outline of the British Isles with pictures of dragons around the outside and nobody knew very much about what lay beyond.  Nowadays we've gone through the ordinance survey and we're up to Google Earth, so that you can see an amazingly detailed satellite picture and you can see if somebody's cut the grass in the garden next door.  So the level of detail that we're getting in cancer cells is rather analogous to that and this is a much more sophisticated way of attacking a cancer than what we've tended to previously which is to give what are essentially cancer treatment dependent on quite old fashioned technologies.

 

Porter

But that looks to the future of cancer therapy, that if we can identify what's gone wrong we can then hopefully come up with a drug that treats that but what have we got at the moment?  I mean if I was to come and see you with a type of cancer and have it - have the genes analysed in that would it affect my treatment today?

 

Johnson

There are some cancers where we're already doing this.  The earliest example of this was Chronic Myeloid Leukaemia, a type of slow growing leukaemia, starts in the bone marrow with a particular abnormality in the chromosomes where a gene is turned on and we now have a molecule called Imatinib or Gleevec which can specifically target the bit that's gone wrong and turn those cells off.  And amazingly taking the tablet with this drug in it can turn somebody's blood from being full of leukaemia cells to being normal again in a matter of a few weeks.  And this was really the first example of how targeting a molecular abnormality that we found in a cancer cell could really make a difference and we've got more examples of that coming through all the time.

 

Porter

And would that apply to everybody with that type of leukaemia?

 

Johnson

Pretty much everybody who has that particular sort of chronic leukaemia, treatment with drugs which target that abnormality will be successful in getting them better.  Unfortunately some people - the leukaemia then develops resistance and starts to go round the block that we've put in the road and in other types of cancer it seems that the blockade we put in the signal pathways the cancer very quickly founds a way round and a matter of a few months later it starts growing again and we have to go back and look again and see what's changed during that time.

 

Porter

And that's because the genes have changed, it's undergone some form of mutation?

 

Johnson

Cancer cells unfortunately are pretty clever and they often have more than one abnormality, they almost always have more than one abnormality, so they're capable of opening up a way round a blockade if we put it in.  What we'd like to do is as we understand how they do that we can use these drugs in combinations so that we can back them into an evolutionary dead end and really stop them growing altogether.

 

Porter

One area Professor Johnson's team is looking at is the use of genetic profiling and targeted therapy in the treatment of lymphoma - cancer of the lymph glands and parts of the immune system. Paul is part of a trial to assess whether doing genetic profiling and adding in a new type of cancer treatment is more effective than conventional chemotherapy alone;

 

Paul

The aching in my shoulder turned out to be a tumour, the lump on my belly turned out to be a tumour and it was pretty much rife - it was everywhere.  I was told it was already at an advanced stage.  Came back a few days later from the first cycle of chemo, he said to me would I be interested in signing up for this clinical trial.  By this stage I was feeling pretty grotty, so it was a no brainer, I said yeah where do I sign.  I've never even heard of molecular targeting so it was all completely new to me but I mean at this stage my head was all over the place.  I just knew it sounded a good thing, so that's why I agreed to do it.  I actually had four cycles of the combined treatment, they did the scan - the treatments were working so well that it was already attacking the lymphoma and the tumours had already started disappearing, the lymphoma had retracted a hell of a lot.  And I was speaking to one of the surgeons there and he'd seen the scans and he said he was - sort of seemed quite gobsmacked at how quickly it had receded.

 

Johnson

When we talk to patients, for example, with lymphoma about the ways in which we're trying to change treatment we run trials where we say we'll send your lymphoma off, we'll make a detailed analysis of which genes are turned on and which genes are turned off in this lymphoma and from knowing that we may be able to make some predictions about what sort of drugs would be likely to be helpful for it.  What seems to be important in lymphoma is that as these tumours develop - and these are cancers of the white blood cells called lymphocytes which live in our lymph glands all over the body - as these develop some genes come to be switched on when normally they should be switched off.  We have tens of thousands of genes in every cell of our body and whether a cell becomes a white blood cell or a bowel cell or a breast cell is determined by which genes are turned on and which ones are turned off and cancer cells often turn on the wrong genes at the wrong moment which makes them grow in an uncontrolled way.  And we can see that in some sorts of lymphoma, which look exactly the same down the microscope, the patterns of genes that are turned on and off may be completely different and that matters because some sorts which have a pattern of genes turned on behave very badly and if they don't have those genes turned on they're much easier to treat.  So what we want to do is take the ones that have got the bad set of genes turned on, look at the signals that are turned on by those genes and use targeted agents to switch them off again.

 

Porter

Let's go 10 years forward and hopefully having identified mutations, the genes that are turned on, the genes that are turned off - all of these things - you come up with a set of new targets, a set of new drugs, but to use them properly you need to know what the genetic make-up is of my cancer - how much does it cost at the moment to analyse that in a typical patient?

 

Johnson

The cost of a proper molecular analysis of somebody's cancer at the moment is probably a few thousand pounds.  Now a few years ago it would have been a few million pounds, so the cost of these things - a bit like the cost of laptop computers - is coming down all the time as the technology advances.  And the exciting thing for cancer researchers is to see the speed at which our ability to analyse cancers is picking up.

 

Porter

So do you expect, looking forward, that genetic testing will become routine for all patients with cancer?

 

Johnson

I think in a very few years' time we are going to be routinely sending people's cancers off to be analysed at a very detailed genetic level as well as looking at them down the microscope in order to see what sort of cancer they are.  And I think an enormous amount of our treatment in the future is going to be driven by our molecular understanding and the information we get out of that process.

 

Porter

Professor Peter Johnson. And for more information on the new Tumour Profiling Unit that opened this week visit our website bbc.co.uk/radio4 and head for the Inside Health page.

 

This is part of the programme where you set the agenda by e-mailing us via insidehealth@bbc.co.uk or sending a tweet containing the hashtag insidehealth to @bbcradio4.

 

First some feedback, and the item on sunbeds during which Gary Lipman, Chair of the Sunbed Association, implied that most of the cancers caused by sunbeds were not that serious. Retired cancer specialist Trevor Roberts begs to differ:

 

Roberts

I've just listened in disbelief to the representatives of the sunbed industry referring to non-melanoma skin cancer as "lesions" and greatly diminishing their severity.  He said that these are true cancers, now I have 30 years plus experience of treating skin cancers and I know that both types of non-melanoma skin cancer can sometimes spread to other parts of the body, can be lethal, can be disfiguring and the surgery or radiotherapy required to treat and cure them in itself may also be disfiguring.  These lesions are not completely benign and innocuous.

 

Porter

Last week's item on dry mouth prompted quite a response too - Diane, Pat and Mary all e-mailed us to ask why our specialist covered everything but Sjogren's syndrome? A condition that affects as many as half a million people in the UK.  Well it didn't fit the listener's symptoms - who was troubled by a dry mouth in the morning - but for completeness sake here is Dr Pepe Shirlaw.

 

Shirlaw

So for your population with dry mouth patients - are they mouth breathing, have they had head and neck radiotherapy, have they had radioactive iodine or are they on a medicine to stop their saliva production and if it's none of those then they've got dry eyes and aching joints there's a disease called Sjogren's that you should think about.

 

Porter

And that is?

 

Shirlaw

It's an autoimmune connected tissue disease, that's a technical way of describing it but it - essentially patients have dry mouth and dry eyes because their tear glands aren't working and their saliva glands aren't working and their joints are inflamed.  And they would normally go to a rheumatology clinic or a clinic like mine - an oral medicine clinic - to investigate why they've got these three types of symptoms.

 

Porter

Dr Pepe Shirlaw.

 

Two weeks ago Inside Health's Margaret McCartney examined new research suggesting a link between asthma and the amount of junk food children ate, with the risk of asthma increasing amongst those who ate junk food more than three times a week. But what qualifies as junk food asks Ann Green who listened on a podcast from Washington.  So Margaret, explain yourself:

 

McCartney

I'm delighted to and I'm sorry for not being clearer at the time.  So the questionnaires were asked to children aged 13 and 14 and to the parents of six and seven year old - the two groups that the study looked at - and they were asked a long list of questions about what their diet consisted of.  Which was:  Over the last 12 months, on average, how often, on average, did your child eat or drink the following meat, seafood, fruit, vegetables, green and root, pulses, peas, beans and lentils, cereal, pasta, including bread, rice, butter, margarine, nuts, potatoes, milk, eggs and fast food/burgers.  So this is very much left to the child or the parents to decide what constituted fast food/burgers.

 

Porter

So essentially what we're saying is that in that study junk food qualified as fast food/burgers?

 

McCartney

Yeah and it was really whatever the children or their parents decided to put in that box.  And the researchers didn't go back over and check what it was people actually meant by that, so it was people's own descriptions of what they felt was fast food.  And of course children could have been having very wholesome pre-prepared burgers made by their parents' hand at home that would have still ticked that box for burgers but actually would have been potentially very healthy indeed.

 

Porter

Margaret, thank you for clearing that up. And, last but not least:

 

Parkinson

Hi, my name is Sinita Parkinson and my question is about hair.  There has been a trend in recent months for shampoos infused with caffeine, they claim to strengthen hair and prevent hair loss.  I was just wondering what the science is behind this theory, what effect caffeine has on the hair and scalp?

 

Porter

Questions we put to Dr Paul Farrant consultant dermatologist at Brighton and Sussex University Hospitals Trust and a specialist in hair loss.

 

Farrant

Shampoos very rarely stay in contact with the scalp for any length of time, so any active ingredient has to be on contact with the skin for usually minutes for it to have any effect.  The question then is whether caffeine as an ingredient has anything other than normal cleaning properties.  There is some research using lab based in-vitro studies, so this is growing artificially hair follicles that has shown some benefit of adding caffeine and that seemed to reverse any negative effect of testosterone which slows down hair growth and actually showed a slight benefit.  But in-vitro conditions they're grown for days, because you have to calculate whether the hair's growing, so it takes a number of days to see that change, the hair follicles are bathed in solutions and the hair follicles are bathed continuously for a number of days.  So that's not going to be the same situation as applying a shampoo that may be, if you're very lucky, on the scalp for a couple of minutes.  There is a rationale that you may be able to get chemicals to absorb through hair follicles, however, in genetic hair loss - and this is certainly true of male pattern hair loss - the bit that is being influenced is right down the bottom of the hair follicle, what's called the hair bulb, so anything applied to the surface has to be able to get right down to the hair bulb and it has to stay there and exert an effect, it's not just a case of breaking through the skin and being absorbed into blood vessels because that will just transport the caffeine away, it has to sit around that hair bulb for probably days and needs to be a continuous thing.  And that's where we don't have the science.  I think there is science that shows that caffeine can stimulate hair growth in a dish, there is a science that shows that caffeine can penetrate through the scalp and through hair follicles.  What we don't know is whether caffeine can actually get right down to a hair bulb, stay around the hair bulb, exert a beneficial effect that will cause hairs to grow longer and thicker.  I certainly wouldn't recommend buying it thinking that you're suddenly going to go back 10 years and have a full head of hair.  There may be some slight effect but there are no real studies in humans evaluating the effect of these caffeine based shampoos to promote hair growth in the long term.

 

Porter

Dr Paul Farrant in whose house, I suspect, you won't find any caffeine enriched shampoos.

 

Please do get in touch if there is a health related issue that is confusing you - you can e-mail me via insidehealth@bbc.co.uk.

 

From bad hair, to bad breath. Halitosisis is a tricky problem for us GPs - not because we are particularly prone to it you understand, but because we are often the last port of call for desperate patients. People complaining of persistent bad breath often end up coming back to their GP after their dentist has checked their mouth, and various specialists have looked at their throats, lungs and stomach. So what can the GP add if there is no abnormality to find? Well the first thing he or she can do is actually check that their patient has bad breath. Offering to smell someone's breath can be embarrassing for both parties, but it is essential as I discovered when I met Tim Hodgson - Consultant in Oral Medicine at the Eastman Dental Hospital in London.

 

Hodgson

I think the most important thing to say to these individuals is:  Is it there or is it not?  And you've got to be very careful how you say it because often these people are coming to you with a problem that they feel is real.  And then if you turn immediately around to them and say this is not real you can run into problems but I think it's very important, within the first discussion, to smell the breath - because that's the gold standard test - and if they haven't got bad breath you can say at that moment in time they don't have halitosis but it's possible that in times previously that they had.  And it's often the case that people have halitosis, address their gum health...

 

Porter

And gum health being the most common cause?

 

Hodgson

Yeah and after that they're left with this perception that they've still got halitosis even though they've corrected the cause.  And that's sometimes reinforced by family members, friends and relatives and often they come along with a very considered construct that people on their bus or on the tube are turning away from them or covering their face or won't talk to them directly because they feel they've got bad breath.  And they look - almost looking for people who are avoiding them because of their bad breath.

 

Porter

And that reinforces their notion that they've got...

 

Hodgson

Yeah so it reinforces and it helps build a construct in their own head.

 

Porter

As a rough guide what sort of proportion of people that you see here with halitosis would in your mind not necessarily have a real problem but have a perceived problem - are they a significant minority?

 

Hodgson

I would say probably 80% of patients referred with halitosis to our service don't have halitosis.

 

Porter

Do they believe you when you smell their breath and say look I can't smell anything?

 

Hodgson

Some do and others don't.

 

Porter

Working alongside Tim Hodgson at the Eastman Dental Hospital is clinical psychologist Claire Daniel.

 

Daniel

For some of these people they may well have had halitosis in the past, so they've set up this way of thinking, we work in a cognitive behavioural way which basically looks at the way in which people think, the way in which they feel, what they do and physical symptoms and how they interact.  So this patient in the past may well have halitosis, they've set up this belief system thinking about their breath, maybe they're focusing on their breath and as Tim said they've had past experiences of people reinforcing that they've got halitosis.  Now even if the halitosis disappears some patients may well remain quite anxious about that and so they will keep focusing on their potential symptoms.  And they become very biased in the way in which they see and hear information, so they'll become very focused on the negative stuff that will reinforce their beliefs and will sort of ignore the other bits of information that may well support a more helpful, more realistic way of thinking about their situation.

 

Porter

So when a doctor or a dentist tells them that they haven't got bad breath they say well that's not true or I haven't got my bad breath today but trust me I had it yesterday because I saw someone in the pub wince.

 

Daniel

Yes absolutely, so it's either well yes it's okay today but it wasn't yesterday or it won't be tomorrow.  But also some people initially will be reassured by somebody saying they haven't got bad breath but as we know reassurances for people who believe they have medical difficulties can only be short lived for most people, so they'll feel very reassured in the consulting room then they'll go home and their whole belief system will trigger again and may be reinforced by other people, so their anxiety maintains.

 

Porter

Looking at this from the outside Tim's got perhaps the easy part of the job, he's the one who said look I don't think you have halitosis and he then does the referral to you...

 

Daniel

Absolutely.

 

Porter

... and you've got to do something about what's quite a complex problem, so what can you do and how successful might you be?

 

Daniel

It's very complex.  Cognitive behavioural therapy for anxiety about health in general, we don't set out to tell people that they're wrong, we set out to try and help people understand what's going on.  So we don't just talk about their physical reported symptoms, we'll talk about the way in which they're interpreting things, the way in which they're thinking about things and how those interpretations actually may be unhelpful.  They might seem helpful to the patient, like go to the doctor, go to the dentist, focus on their breath to check, maybe clean their teeth, but actually in the long term they can be very unhelpful and maintain the problem.  So we help people to take a broader outlook on their situation.  We don't tell them what it's not, we help them to understand what it could be and then we help them to develop evidence to support what it could be rather than maybe what it's not.

 

Porter

And practically what is involved - I mean how often do you see them?

 

Daniel

So we'd see people maybe every week, every two weeks...

 

Porter

Is this one on one?

 

Daniel

Yes one on one for this particular condition.  One on one, so one patient with one psychologist, for about 50 minutes about - on average about eight times.

 

Porter

And in terms of success rate - how effective is it?

 

Daniel

I would say we do help, particularly with halitosis, we probably help about 80-90% of people...

 

Porter

That's pretty good.

 

Daniel

... but I wouldn't - but then it's a continuum, we might help some people just a little bit and I think with things like anxiety about health it's a lifelong issue, we're not just going to suddenly stop people's anxieties, it's about helping them to live with uncertainty and live with a degree of anxiety about their condition.  So they'll still have times when they think their breath smells.

 

Porter

Clinical psychologist Claire Daniel.

 

Just time to tell you about the next Inside Health when I will be investigating a side effect of cancer treatment known as chemo-brain, and learning more about virtual autopsies - using a CT scanner, rather than a scalpel, to perform post mortems. Technology that has already been shown to be fit for a king - join me next week to find out why?

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