BBC BLOGS - Fergus's Medical Files

Archives for December 2010

Keeping a sense of proportion about swine flu

Fergus Walsh | 14:14 UK time, Friday, 31 December 2010

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Scary headlines about swine flu can risk distorting the real threat posed by the H1N1 virus. There also seems to be a collective amnesia among many in the media about previous coverage of the virus.

The plain facts are these. So far, 39 people are known to have died with flu since October, the vast majority being infected with the H1N1 virus. That compares with nearly 500 deaths in the 12 months following the arrival of swine flu in April 2009.

That means we have been here before. Remember the media focus on swine flu in Britain in July 2009? It was intense for a few weeks. Then it dropped away.

Strangely, there was comparatively little media interest in the story in autumn 2009, despite there being three times the number of people critically ill than in the summer. I get the impression that many felt we had done enough on swine flu. Indeed there was criticism in the media that the whole issue had been overblown.
Well here we are again.

One key difference now, and it is of concern, is the sharply higher numbers in intensive care. Figures for England show that there are more than 700 people critically ill with suspected flu. That is many times the number last winter. But the level of flu in the community is higher as well. Flu rates vary from year to year so it really should not come as a huge surprise.

About one in five critical care beds (intensive care and high dependency) is taken up with flu cases, but the number of beds could be nearly doubled if necessary.

Dr Bob Winter, president of the Intensive Care Society said: "The majority of those we are seeing in critical care are either pregnant women, people who are overweight - usually spectacularly so, and those with underlying health conditions.

It is easier for us to cope with a big flu outbreak over Christmas and New Year than at any other time. This is because there is less elective (planned) surgery, such as big cancer operations. These account for many of those who are cared for in critical care and these operations do not usually happen at this time of year. So we are under pressure but we are coping."

Several thousand people a year die from the complications of flu, but in the past it was mostly the elderly and infirm. Since the advent of swine flu that changed. Of the 39 people to have died since October, all but one were under 65 and four were under the age of five.

That makes immunisation of at-risk groups, especially those under 65, extremely important.

Twenty-three of those who died were in an at-risk group for vaccination. The Health Protection Agency says where vaccination status is known of those who died, two out of 33 people had received their jab. Last year's pandemic vaccine was received by one person out of 30.

Last night the Joint Committee on Vaccination and Immunisation (JCVI) said it did not believe that healthy children under five should be given the flu vaccine.

Professor Andrew Hall, chairman of the JCVI said: "The committee considered the issue of offering vaccination to healthy children either 0-4 years and/or 5-15 years of age. However, although there is a high incidence of influenza-like illness currently in these age groups, a significant proportion of this is due to other viruses such as Respiratory Syncytial Virus (RSV). In addition, only a very small proportion of those with severe disease are in these age groups. Based on previous seasonal influenza epidemiology, it would be hoped that influenza circulation will have subsided within a month.

We do not believe that seasonal or pandemic vaccine should be used for these or other healthy person groups. The greatest gain will be achieved in increasing vaccine uptake in the clinical risk groups."

The JCVI urged those with chronic respiratory, neurological, heart and kidney disease, diabetes, the immunosuppressed and pregnant women to get immunised.

What about the rest of the population? Swine flu can strike down, and even kill healthy people - this was demonstrated last year. Fifteen of those who have died since October were not in at-risk groups. Just as in previous winters, flu jabs are available from large pharmacies for those who want to protect themselves from the virus.

But - and I feel like a scratched record here - the majority who get infected with swine flu (other strains are circulating too) will have an unpleasant illness which will resolve itself after a few days in bed, with plenty of fluids and if appropriate, some paracetamol. Another huge group who catch swine flu will show no symptoms at all - lucky them.

So it is worth keeping a sense of proportion about influenza. It has never been something to dismiss as trivial. But it is a sad fact that every winter some people do get seriously ill and even die after catching flu.

Is swine flu a worry?

Fergus Walsh | 19:30 UK time, Thursday, 23 December 2010

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A lot of people are asking is flu getting more serious? It comes after new figures showed 10 people have died from flu-related conditions in the UK in the past week, bringing the toll to 27 since October. Nine of those who died were children and nearly all the deaths have been from H1N1 swine flu.

To put the current death rates in context, 474 people died with H1N1 in the first year of the infection - up to April 2010. Since October this year there have been 27 deaths, so it is, sadly, what might be expected.

For anyone with a loved one who is ill from the complications of flu, this is a worrying time. But there is no evidence that swine flu is getting more virulent, although there is more flu about than this time last year.

Flu viruses kill every winter, predominantly the frail elderly. Things changed with the advent of swine flu which mostly spares the elderly and causes most serious illness in younger people.

H1N1 remains the dominant flu strain this winter. It is worth stressing that for the vast majority it causes an unpleasant but mild illness which resolves after a few days bed rest, with plenty of fluids. Many of those infected have no illness at all.

For a sizeable minority though, flu can be serious. Of the 300 people in intensive care in England with suspected flu, nearly 250 are between the ages of 16-64. Most of those will have swine flu.

That is far more people in intensive care than at any point during the pandemic. At the height of the swine flu outbreak in July 2009 there were 63 people critically ill. Now it is five times that number.

But - if you can bear one more set of figures - compare flu levels now with November 2009. There was not that much flu around then, yet 173 people were in intensive care.

Looking back on my "Fergus on flu" posts, I remember there was an autumn/winter peak of intensive care hospitalisations in 2009 even as flu consultations with GPs were falling. It suggests swine flu can be a more serious illness in winter than in summer, although no virologist I have spoken to has been able to explain this fully.

Now that swine flu is a seasonal strain of flu, we should no longer see much flu outside of autumn and winter.

Crucially, there is no evidence that the H1N1 virus is mutating. Professor Peter Openshaw, director of the centre for respiratory infections at Imperial College London says it is behaving just as it did last year, during the pandemic.

He said: "It is targeting the same groups - pregnant women, asthmatics, people who are a bit overweight or frankly obese - those are the people who it is mostly hitting hard, like last year. They are predominantly between the ages of 20-55 and so it is not the elderly."

That does not mean that the elderly are immune from swine flu. If they do get it, it can be serious. Furthermore, other flu strains are circulating to which they are vulnerable.

Influenza is a vaccine-preventable disease. A disappointing 43% of people under 65 in at-risk groups have been immunised. For those 65 and over its is 68.5%.

The winter weather is also helping to spread flu. Professor Openshaw said these are ideal conditions:

"Flu is a RNA (ribonucleic acid) virus. RNA is very unstable genetic material and easily damaged by ultra-violet light. It is stabilised at low temperatures. In addition people try to escape the cold weather by crowding into small areas and sneezing over each other. Those things tend to make flu spread in the winter. People with respiratory diseases generally suffer a lot more in the winter but that is to a large degree because of the number of viruses circulating."

No-one can predict when the current flu outbreak will peak. In some areas of the UK perhaps half the population have already had swine flu - but that still leaves millions to get infected.

We can all do our bit to reduce infections. Remember the "Catch it, kill it, bin it" campaign. I am not suggesting that people refrain from kissing under the mistletoe. But do try to avoid sneezing on your relatives this Christmas.

update 24th December 17:45

The number of people in critical care in England with suspected swine flu continues to rise sharply. As of yesterday it had reached 460.

That is a huge increase on figures for 21st December when there were 302 people critically ill, and on 15th December when there were 182.

It's worth giving the breakdown of the age groups affected - they are mostly adults under 64:

under 5s - 26
5-15 - 17
16-64 - 366
65&over - 51

There are around 3,500 critical care beds (which includes intensive care and high dependency beds) in England.

The interim Chief Medical Officer, Dame Sally Davies, said:

"There is a lot of flu around at the moment, some of it serious. So an important message this week is to attend to simple but effective hygiene measures, carrying and using tissues, covering your nose and mouth when you cough and sneeze, immediately disposing of used tissue, and wash your hands regularly."

While most of us are getting into the swing of Christmas, spare a thought for the families affected and for the medical teams caring for them.

Saviour sibling first for Britain

Fergus Walsh | 19:55 UK time, Tuesday, 21 December 2010

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If you want a story of good cheer in the run-up to Christmas, then have a look at that concerning Max and Megan Matthews.


Max is a so-called "saviour sibling" who donated tissue which successfully treated his sister - it is the first time the entire process has been done in Britain. Previous cases - like that involving Charlie Whitaker - followed tissue typing in the United States (see my postscript below).


She was born with a rare inherited condition Fanconi Anaemia. Her body produced no blood cells so she needed transfusions to stay alive (another reason to become a donor - see my previous post). In and out of hospital with infections, it was a tough existence. But Megan is one of the most cheerful and uncomplaining nine year olds I have had the pleasure to meet.

The Matthews live in King's Lynn and Megan gets a lot of her treatment at Addenbrookes Hospital in Cambridge. When she began to exhibit signs of bone marrow failure, the hospital did a worldwide search for a donor, but none could be found.

Megan's parents wanted another baby - they also have an eleven year old son Stuart - but natural conception would have placed them at risk of having another child with Megan's condition. There would also be only a one in four chance of it being a tissue match.

By opting for IVF and Pre-Implantation Genetic Diagnosis they were able to select an embryo that was free of Fanconi Anaemia AND whose cells were able to cure his sister's bone marrow failure.

The IVF and tissue typing was done at Care Fertility in Nottingham, while the transplant took place at the Bristol Royal Hospital for Sick Children. The entire treatment was NHS funded.

The HFEA has granted more than twenty licences for saviour sibling treatment in the UK in recent years, but this is the first time that it has been successful here.

Max's umbilical cord was preserved at birth but not enough tissue was recovered, so he needed an invasive procedure to recover bone marrow stem cells.

Saviour sibling treatment raises ethical issues, especially when it involves a child having an operation to recover cells - clearly the child cannot consent.

Having met Katie Matthews, her children and doctors, it seems to me that great thought went into the decision to proceed with the treatment.

Mrs Matthews is adamant that Max is loved for his own sake, not for how he has helped his sister. There does seem to be a special bond between the two siblings.

She says Christmas has come early for the family and they are looking forward to being together without fearing that Megan will be in hospital needing treatment.

Whatever your views of the ethics of saviour siblings, that is surely something to celebrate amidst all the bad news this Christmas.

PS I have just had a message from Michelle Whitaker saying that Charlie is doing well, six years after his transplant.

Urgent appeal for blood donors

Fergus Walsh | 23:09 UK time, Monday, 20 December 2010

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Is your blood type O negative? Have you donated blood before? Are you in good health? If the answer to ALL of those questions is yes, then the NHS needs you - before Christmas.

Stocks of O negative are running low. There are about three days supply, instead of the usual five or more. Just 7% of the population are O negative, and they are often referred to as "universal donors". That is because their blood can be given to anyone - so it is especially useful to the health service.

Jon Latham from NHS Blood and Transplant issued this urgent appeal: "We would like O neg donors to have a look at our website - www.blood.co.uk - and see if there is a session available for them and then ring our call centre on 0300 123 23 23 for an appointment. If there is not a convenient appointment, please still come in and we will do our best to accommodate you. Bear in mind it is Christmas and the best gift is to save a life and this will save lives. "

Regular donors of all blood types are asked to keep their appointments in the coming weeks. The reason for the shortfall in blood is that the ice and snow have made it impossible for many people to get to donor sessions. Some sessions have even had to be cancelled.

I'm used to being filmed as part of my job but today was the first time that I have talked to camera whilst donating blood. But since I am O negative and was due to donate this week, it seemed a reasonable way of publicising the appeal.

If you haven't given blood before then why not consider making it a New Year's resolution? You need to be at 17 and generally healthy. Just 4% of the population donate blood, and the other 96% have a lot to thank them for.

One last point - on blood donation and aspirin. You can still be a donor if you take daily aspirin, but you must let the medical team know. They cannot use the platelets if you have taken aspirin in the past five days, but they can still use the red blood cells and plasma.

Brain surgery to relieve headaches

Fergus Walsh | 09:57 UK time, Friday, 17 December 2010

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Your headaches have got to be pretty bad to allow someone to drill a hole in your skull and then insert an electrode deep into your brain. That is what Barrie Wilson did. He suffers from cluster headaches, considered to be among the most excruciatingly painful of all medical conditions.

The procedure took place at the National Hospital for Neurology and Neurosurgery at Queen Square in London. Not only did Mr Wilson allow the surgical team to drill into his head, but he was awake throughout the operation. Fortunately, he did not feel any pain. A local anaesthetic numbed the scalp, and the brain has no sensory nerve endings.

Mr Wilson is one of those stoic individuals who refuses to be bowed down by what life throws at him. For years he had suffered daily bouts of horrendous headaches often lasting several hours. Yet he refused to be cowed into submission.

He said: "The last 14 years have been torment. I did not know from day to day, or from hour to hour, when I would get an attack, but you cannot let it beat you otherwise you may as well go into a corner and die. You must be strong-willed."

Dr Manjit Matharu is Mr Wilson's neurologist. "About one in 1,000 people suffer from cluster headaches, and a small proportion of these fail to respond to medication. They are living in agony - these are also known as suicide headaches because some people choose to end their lives rather than face the pain."

Given what he was going through, it is perhaps no surprise that Mr Wilson opted for deep brain stimulation.

I get the opportunity to witness many fascinating - and sometimes gruesome - operations but this one was especially interesting.

The neurosurgeon, Ludvic Zrinzo, wore a red cap bearing the motto: "Brains are Beautiful". Well I guess he should know as he sees them every day. Mr Zrinzo had to insert the probe about 8-9cm into the brain into the posterior hypothalamus - the area which triggers the headaches.

"How accurate do you need to be?" I asked.
"We like to be within 1mm of the target" he replied.

And he was. That is quite something. The electrode is connected to a pacemaker which emits a low electric current. This stimulation aims to block the damaging signals which trigger the cluster headaches.

Throughout the operation Barrie Wilson remained calm and seemingly at ease.

He said: "I felt no pain whatsoever. It was like going to the dentist - you expect pain but then it doesn't hurt. It was a surreal experience."

For Mr Wilson the treatment has been a huge success. Nearly four months after surgery, he has suffered just one headache and feels he has got his life back.

He said: "The only thing that used to ease the pain was pure oxygen. I needed to inhale this as soon as a cluster headache began otherwise it would last for hours. That meant I had to carry an oxygen tank everywhere, and so could do nothing on the spur of the moment. Now my wife and I are hoping to go to New Zealand to see two of our grandchildren. It's great."

Drilling holes in skulls - trepanning - is one of the oldest medical procedures, dating back thousands of years. Of course deep brain stimulation is a lot more sophisticated. The surgical team have MRI scans to guide them. The electrode used is made of titanium alloy. It is all hi-tech stuff. Yet the moment they started to drill into Mr Wilson's skull it didn't feel very hi-tech.

Our knowledge of the brain is more advanced than ever, but according to surgeon Ludvic Zrinzo, there is still a huge amount we don't know: "The brain is the final frontier. If you look at the number of neurons, synapses and connections, these vastly outnumber the stars in our galaxy, and we won't understand all the complexities for many generations to come."

Update: 20th December 22.05

Thanks for your comments on this remarkable story. A quick update on the brain and whether it can feel pain. I asked for further guidance from the neurosurgeon in this case, Ludvic Zrinzo. Since he spends his time doing brain surgery, I guess he should know...

He said: "The brain has no sensory nerve endings. Pain is felt when sensory nerve endings in the skin and other part of the body are activated by extreme hot /cold /pressure etc and transmit a pain message to the brain that is then interpreted as pain. Lack of sensory nerve endings in the brain means that manipulation of the brain itself does not result in pain."

The return of swine flu

Fergus Walsh | 16:50 UK time, Wednesday, 15 December 2010

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H1N1

 

It should be no surprise that swine flu is back. In recent days there has been a spate of headlines speaking of "shocked" doctors, alarmed by the return of "deadly" swine flu. What should we make of this, and should we be worried?

First off, the H1N1 virus, which sparked a pandemic last year, never really went away. Influenza is a largely seasonal phenomenon, with peaks every winter and very low background levels at other times. Flu pandemics are the exception, and as last year showed, they can begin in any season.

Anyone can get flu, at any age. For most, influenza causes an unpleasant but self-limiting illness which lasts several days. If you got a mild dose of flu last year then you may wonder what all the fuss is about. But for a small minority flu can be serious, even fatal. Last year, those under 65 were especially at risk from the complications of H1N1 and that pattern is continuing this winter.

The Health Protection Agency said last week that there have been 10 deaths due to H1N1 flu in the past three months. Most of those who died had underlying health conditions. The Royal College of GPs said today that there has been a "substantial increase" in all respiratory diagnoses in the past week, especially in the 5-14 and 15-44 age groups.

So swine flu is "out there", but so many people caught it last year that there is a reasonable level of immunity in many communities. The 10 recent fatalities can be compared with 474 confirmed swine flu deaths in the UK in the first 12 months of the virus circulating (up to mid-April 2010). It would be wrong to suggest that virus is somehow more deadly or more serious than previously. Around one in five of those who died from swine flu last year had no underlying medical problems, among them pregnant women and children.

In recent weeks several people have needed specialist emergency treatment due to lung failure, using machines which pump oxygen into the blood outside the body (ECMO). Pregnant women, and those with underlying health conditions are among those most vulnerable to the complications of H1N1.

It is worth stressing that flu is a vaccine-preventable illness. The Health Protection Agency has urged people in at-risk groups to get immunised. The seasonal flu vaccine is always trivalent - so it protects against the three most likely circulating strains of flu. This year the vaccine contains antigens against the influenza type A strains H1N1 and H3N2 and against flu B which mainly affects young children.

From this year all pregnant women are being offered the trivalent seasonal flu jab (last year they were offered the monovalent (single antigen) H1N1 vaccine due to the pandemic). Other groups offered the flu jab are those aged 65 and over, people with breathing problems, heart, kidney or liver disease, diabetes and those who have a suppressed immune system. NHS Choices has a full list of those eligible for a free flu jab.

So far this flu season two thirds of people in England over 65 have been immunised. Four in ten people under 65 in an at-risk group have received the jab. Flu viruses alter every year, which is why people are offered an annual jab. So if you got a flu vaccine last year (seasonal or pandemic), it does not mean you are definitely protected now.

By the way, you may have missed it, but the swine flu pandemic is over. The term "pandemic" is a largely bureaucratic one in relation to influenza. It was in August that the World Health Organization declared the pandemic over because the H1N1 virus had "largely run its course".

This was not meant to indicate that the virus was on the way out, rather, that it was now acting alongside other flu strains.

The WHO director general Margaret Chan gave this warning in relation to swine flu:

"It is likely that the virus will continue to cause serious disease in younger age groups, at least in the immediate post-pandemic period. Groups identified during the pandemic as at higher risk of severe or fatal illness will probably remain at heightened risk, though hopefully the number of such cases will diminish.

In addition, a small proportion of people infected during the pandemic, including young and healthy people, developed a severe form of primary viral pneumonia that is not typically seen during seasonal epidemics and is especially difficult and demanding to treat. It is not known whether this pattern will change during the post-pandemic period, further emphasising the need for vigilance."

So swine flu is back and we can expect H1N1 to be a dominant strain for many years, until the next flu pandemic arises.

Aspirin, cancer risk and a personal decision

Fergus Walsh | 00:00 UK time, Tuesday, 7 December 2010

Comments (58)

From now on I am going to take a daily low-dose aspirin. I intend to continue doing this for the next 25 years. It's a decision which every middle-aged person in Britain is going to have to consider in the light of research suggesting that aspirin significantly cuts the death rate from many common cancers.

You can read my report on the Lancet study and an abstract of the research paper.

I cannot say for sure that I am doing the right thing. If I get an intestinal bleed in a few months time and am taken to hospital needing a blood transfusion, then it will be easy to argue that I got it wrong.

That sort of adverse drug incident, for which aspirin is a known risk factor, is easy to track. The absence of disease is a more subtle effect, because who can say for sure why some people get cancer and others do not?

It is the new research showing aspirin's apparently protective effect against cancer which has persuaded me. This, I must stress, is a personal decision.

As a 49-year-old in reasonable health with no obvious signs of cardiovascular disease, I've made my own choice. I think it would be dishonest of me to write a long article about this issue and then fail to answer the obvious question - are you going to take aspirin? But I am certainly not trying to encourage anyone else to follow my example.

The Lancet paper

In the Lancet paper researchers, from Oxford University, Edinburgh, Dundee, London and Japan analysed eight trials, some dating back to the 1970s, which had allocated volunteers to daily aspirin or a dummy pill. The original trials were looking at cardiovascular disease, and the data on cancer had never been fully investigated or published.

By dusting down the data and then following up many of the patients health records, the researchers came up with some remarkable results. Those allocated aspirin for between four and eight years had about a 25% lower risk of dying from cancer. This protective effect continued long after the trials had ended. Indeed, after 20 years, their overall risk dying from cancer was still 20% lower than the placebo group.

The research was led by Professor Peter Rothwell, a clinical neurologist at Oxford University, who two months ago published a study which found that a daily low dose of aspirin cut cases of bowel cancer by a quarter and deaths by more than a third.

How aspirin affects cancer

The mechanism by which aspirin appears to protect the body against cancer is not clear. But Professor Rothwell said laboratory tests suggested aspirin intervenes at a very early stage to prevent cancers developing.

He said: "When cells divide there is a chance that the DNA in the daughter cells will be faulty. The body has an mechanism whereby either the faulty cells commit suicide (known as apoptosis) or they self-repair. Aspirin appears to enhance the suicide or the repair."

Conflicting research

The trouble is, that there has been lots of conflicting research about the risks and benefits of taking aspirin.

We already know that aspirin can protect those at increased risk of heart attack and stroke. But for healthy adults without a history of cardiovascular disease, the benefits are very small and seem cancelled out by the increased risks of bleeding from the stomach and gut.

The last report I did on aspirin, in 2008 was about a study in the British Medical Journal. It looked at 1300 adults in Scotland with diabetes who had no previous symptoms of heart disease. It found that aspirin had no protective cardiovascular effect. The study authors said the research added to evidence that aspirin should not be routinely used for patients at higher of heart attack and stroke unless they already had symptoms of disease.

In the past two years, many GPs have been taking healthy middle-aged patients off aspirin.

A game changer?

The question now is, do the findings on cancer change things? Professor Rothwell said it would be helpful if new guidance was issued in the light of the new findings. There are guidelines from the American Heart Association and the European Society of Cardiology, but these pre-date the cancer research. NICE may also decide to review the role of aspirin. The tablets themselves cost just a few pence.

Professor Rothwell did not go so far as to urge people to take aspirin, but he said the evidence was beginning to look compelling. He said people might want to consider taking low-dose daily aspirin (75 mg) from the ages of 45-70 or 50-75. After the age of about 75 the benefits of aspirin were likely to fall away, whereas the risk of gastric bleeding rose considerably.

Another expert on the effects of aspirin, Professor Peter Elwood, from Cardiff University, said people should make the decision themselves as to whether to take aspirin. "It is up to the man in the street to weigh up the risks of getting cancer, having a heart attack or stroke and setting that against the risk of being rushed to hospital with internal bleeding". But he added the risks of dying from a gastric bleed were "small".

Professor Elwood, an epidemiologist, who did some of the first research into the effects of aspirin on heart attack and stroke, said doctors were good at treating disease, but when it came to preventing ill-health then people had to make their own judgements.

But that is hardly an easy decision for people to make. Very few will have time to read the latest research, let alone weigh it against other studies. At some point the medical profession will need to come to a considered view and issue guidance.

Cancer Research UK suggested that anyone considering taking aspirin every day should talk first to their GP. I'm not sure that family doctors will welcome being inundated with requests for a consultation on this topic, but I suppose patients could mention it if they are at their GP for something else.

Professor Alastair Watson, an expert in translational medicine at the University of East Anglia, also urged people wishing to take aspirin to discuss it with their GP. Nonetheless, he added that the research was "further proof that aspirin is, by a long way, the most amazing drug in the world."

Peter Sever, Professor of Clinical Pharmacology and Therapeutics at Imperial College London, agreed that the research was exciting, but he said it was still not possible to decide whether daily aspirin use was advisable for those without cardiovascular disease.

He said: "We have to remember that aspirin is not a safe drug and it causes harm. And until such time as we know what the numbers are - how many cancers are prevented against how many people suffer significant bleeding then we cannot answer that question."

There will be many who will label aspirin a wonder drug, but the Lancet research raises several issues. For example, we do not know what the effect of very long-term use of aspirin might be.

Professor Rothwell said: "There might be some unexpected hazard from taking aspirin over many years, still yet to be discovered".

We also don't have sufficient evidence for the effects of aspirin on the incidence of breast or ovarian cancer, but this should emerge in the next few years.

For the record, Professors Rothwell and Elwood both take aspirin every day. Elwood has been doing this since the mid-70s, whereas Rothwell, who is 46, has been taking aspirin for two years.

Professor Elwood said taking aspirin at night, with calcium, appeared to enhance its effects. Since milk is a good source of calcium and can reduce stomach irritation, he suggested some new trials should test the effects of taking aspirin with a glass of milk.

Of course, it is perfectly possible that some new study will change things yet again. But for now, aspirin and a glass of milk will be part of my evening routine.

Can finger length predict your risk of disease?

Fergus Walsh | 00:00 UK time, Wednesday, 1 December 2010

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I can guarantee that after reading this, if you are male, then you will examine the length of your fingers. Well, I did anyway. Why? Because a study in the British Journal of Cancer (Rahman_et_al.pdf) suggests that men whose index finger is longer than their ring finger were significantly less likely to develop prostate cancer.

I've done a brief report about it which is on the health pages.

This research needs several health warnings and caveats. Just because your index finger is longer than you ring finger, it does not mean that you are in the clear with regards to prostate cancer. In fact, in the study 347 men (22.8%) whose index finger was longer than their ring finger, had prostate cancer. But that compared to 936 (30.8%) of the healthy controls giving an odds ratio of 0.67. In plain terms it means those men whose index fingers were longer were a third less likely to have prostate cancer. And just because your ring finger is shorter, or the same length as your index finger, it does not mean you will get prostate cancer. Important that we clear that up at the start. Have you looked at your fingers yet?

Furthermore, since this appears to be the first study linking relative finger length to prostate cancer risk, it is absolutely crucial that the findings are repeated in other studies. The medical literature is littered with examples where apparently sound research findings are disproved upon later, broader analysis.

But if the findings are replicated, then it would provide an easy predictor of relative cancer risk.

Professor Ros Eeles from the Institute of Cancer Research and the Royal Marsden Hospital is one of the report authors. She explained that the patients involved in the study were asked a whole load of questions about lifestyle and so on, and the team had decided to include one question about relative finger length. There were not expecting such a definite result.

"We were very surprised by the findings", she told me. "But there is a good biological explanation: we know that exposure to male or female hormones in utero determines how long your fingers are. We also know that prostate cancer is driven by testosterone levels later in life. Now we have a biologically plausible explanation for some of the early risk factors."

So can relative finger length predict your risk of any other diseases?

Professor Eeles said a previous study had found a link between exposure to hormones while in the womb and the development of osteoarthritis in men and women, again linked to having an index finger shorter than ring finger.

The research paper contains some comfort for men with comparatively long ring fingers in these terms: "In men, long ring fingers compared with index finger length reflect a more masculine profile, for example, more likely to father a child and a higher sex drive". Really? And what is the reference source for this claim? It is an article in the Daily Mail from 2000 (this reference was in the press version sent to me but is not in the final article attached above).

The newspaper article and this latest paper on prostate cancer risk make repeated mention of research by Professor John Manning at the University of Liverpool. There are suggestions of a link between finger length and heart disease, breast cancer, autism and even musical ability. But the study groups seem to involve very small numbers of people.

Professor Manning has also suggested an association between prenatal exposure to testosterone, the ratio of digit length and male homosexuality in a study of 176 men.
And there's another study about finger length and depression involving 102 people.

So that's osteoarthritis, heart disease, breast cancer, autism, musical ability, sexual preference and depression, not to mention sex drive, male fertility and now prostate cancer. Oh, and I forgot to mention, sporting ability, exam success, aggression and earning power. All from finger length?

The new hand pattern research in the British Journal of Cancer is interesting, not least because it involves a decent number of volunteers, but I sincerely hope it doesn't give men with short, stubby index fingers any sleepless nights chewing on their fingernails.

update 1 Dec 18:30

A few extra details. The trial asked men to look at their right hands, not their left. The researchers told me previous studies suggested the differences in digit ratio are more obvious in the the right hand - no-one has yet been able to give me a convincing reason why this should be. The Hox genes influence both finger length and the development of sex organs.

You are right to point out that this issue of digit ratio has been around a long time, but most previous studies have been small.

Another weakness of this research is that the men involved did not have their fingers measured, but instead looked at a diagram and "self-reported". The authors freely admit this is may lead to error but they felt it was unethical to x-ray them all.

I am grateful to Dr Lophatananon from Warwick Medical School for allowing me to include the diagram that was shown to all the men on the trial.

Finally Professor John Manning is now at Swansea University and drew my attention to a recent study on digit ratio and its possible relation to alcohol and tobacco consumption. The research is based on analysis of a large internet study conducted by the BBC in 2005.

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