May 20, 2015

The fear of dying in misery in a hospital is driving the assisted dying debate, says medical ethics expert

 The fear of a miserable death in a hospital bed rather than at home is driving public support for mercy-killing law in the UK, a Birmingham City University academic has warned.

Responding to a report published today by The Parliamentary and Health Service Ombudsman, listing some of the worst cases in recent years of terminally ill patients dying without dignity, Timothy James, senior lecturer in Medical Law and Ethics at Birmingham City University, said: “For most people, dying at home isn’t about autonomy, it’s about dealing with the fear of dying in a hospital with poor end of life care. The fear of dying in misery in a hospital is what is driving the assisted dying debate.”

“We’ve known for a long time now that the option should be available for terminally ill patients to die at home. We are seeing too many cases where proper pain control is not being given.“

Referring to care in the English NHS, the ombudsman’s report details some of the cases investigated over the last four years, including that of a 29-year-old male dying of cancer who was admitted to hospital and left without pain relief for 11 hours.

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May 19, 2015

Cholesterol drugs associated with 30% lower stroke risk in healthy older adults

Findings suggest drugs might be considered for preventing stroke in older populations
Use of cholesterol lowering drugs is associated with a one third lower risk of stroke in older adults without previous disease, finds a study published in The BMJ this week.
In high income countries, a growing proportion of heart disease and stroke occur in the oldest people. In France, for instance, people aged 85 years and over accounted for 43% of deaths from coronary heart disease and 49% of deaths from stroke in 2010.
Yet very few people over the age of 70 take part in trials testing cardiovascular drugs, so their benefit in the oldest people remains uncertain. However, lipid lowering drugs are widely used to prevent heart disease and stroke in older age groups. This is known as primary prevention.
So a research team based in France set out to determine the association between use of lipid lowering drugs (statins or fibrates) in healthy older people and long term risk of coronary heart disease and stroke.
They tracked 7,484 men and women (average age 74 years) with no known history of vascular events, such as heart attacks and strokes, living in three French cities (Bordeaux, Dijon, Montpellier).
Face to face examinations took place every two years. Trained nurses and psychologists also performed interviews and took various physical and cognitive measurements. Factors such as education, occupation, income and lifestyle were also taken into account.
After an average follow-up time of nine years, the researchers found that use of lipid lowering drug (statins or fibrates) was associated with a one third lower risk of stroke compared with non-users. But no association was found between lipid lowering drug use and coronary heart disease.
Further analyses, taking account of age, sex, body mass index, blood pressure and blood cholesterol levels, did not show any effect modification, either for stroke or for coronary heart disease.
In a population of community-dwelling older people with no history of vascular events, use of statins or fibrates was associated with a 30% decrease in the incidence of stroke, say the authors.
This is an observational study, so no definitive conclusions can be drawn about cause and effect. Nevertheless, if replicated, the study results suggest that lipid lowering drugs might be considered for the prevention of stroke in older populations, say the researchers.
Despite some limitations, they say their data “raise the hypothesis of protection against stroke related to long term use of lipid lowering drugs for primary prevention in older people, with no difference between statins and fibrates.”
They point out that, in their population, the incidence of stroke was low (overall, 0.47 per 100 person years) so a 30% reduction in stroke risk results in a limited number of avoided cases. However, “in other populations more exposed to the risk of stroke, a one third reduction in stroke risk, if confirmed, could have an important effect on public health,” says Christophe Tzourio, Professor of Epidemiology at University of Bordeaux and Inserm.
This study will not change guidelines, but the results “are sufficiently compelling to justify further research testing the hypothesis that lipid lowering may be effective in the primary prevention of stroke in older people,” says Graeme Hankey, Professor of Neurology at the University of Western Australia, in an accompanying editorial.
Meanwhile, for clinicians and patients, he says the decision to start statins for primary prevention of vascular disease in people over 75 “continues to be based on sound clinical judgment” after considering each person’s predicted vascular risk with and without statins, their predicted risk of adverse effects, and the patient’s own priorities and preferences for treatment.
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May 19, 2015

Alzheimer’s Research UK calls for new dementia research strategy as part of 100-day plan

On day one of the new Parliament, Alzheimer’s Research UK has called for the creation of a new dementia research strategy and a commitment to year-on-year increases in Government funding for research into the condition. As MPs meet in Parliament for the first time since the general election, the UK’s leading dementia research charity has outlined actions that should be taken in the first 100 days of Government to capitalise on research progress and help deliver new treatments sooner.

Dementia currently affects 850,000 people in the UK, costing the economy a staggering £24bn a year, with those numbers set to rise as the population ages. With no treatments yet able to tackle the diseases that causes dementia, the condition is the biggest killer of women and the third biggest killer of men in the UK. In recent years politicians have begun to recognise the need for research into dementia, but while funding for research has increased to £66m in 2015, a rise spending is still needed to bring it in line with other health conditions.

The Prime Minister’s Challenge on Dementia 2020, which was launched in February, included an aim for significant progress to be made towards developing a cure or disease-modifying treatment over the next five years. Alzheimer’s Research UK believes that to lay the ground to help achieve these aims, four key steps must be taken within the new Government’s first 100 days:

  • Support for the creation of a dementia research strategy, to maximise investment for research
  • Action to raise public awareness of lifestyle changes that can help lower dementia risk
  • A commitment to implementing recommendations from the Innovative Medicines and Medical Technologies Review, set up to speed up delivery of new treatments and  medical innovations
  • A commitment to year-on-year increases in funding for dementia research

For every six researchers working on cancer in the UK, just one works on dementia, with a significant funding boost still needed to attract more scientists to the dementia research field. Alzheimer’s Research UK argues that a doubling of government funding is needed over the next five years, to take spending to £132m by 2020.

Hilary Evans, Director of External Affairs at Alzheimer’s Research UK, the UK’s leading dementia research charity, said:
“In recent years we’ve seen a global movement to take up the fight against dementia, and this is a crucial moment for the UK to ensure that this momentum continues. If we are to achieve the Prime Minister’s vision for tackling dementia and deliver on the G7’s ambition for new treatments by 2025, a new strategy for research is vital. Dementia destroys countless lives across the UK, and we owe it to those affected to keep up the fight against the condition. Alzheimer’s Research UK is leading the way with an ambitious drive to increase our own investment, and government action is also vital if we are to make real progress and transform lives.”

 

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May 18, 2015

Study shows non-memory Alzheimer’s symptoms more likely in younger people

New research has shown that people with Alzheimer’s may not always experience memory loss as their first symptom of the disease, with younger people more likely to have problems with judgement, language or visual and spatial awareness than older people. The study of 7,815 people – one of the largest of its kind to date – suggests a need for greater awareness of the different symptoms of Alzheimer’s disease, the most common cause of dementia. Led by a researcher at UCL (University College London) and part-funded by Alzheimer’s Research UK, the UK’s leading dementia research charity, the research is published in the journalAlzheimer’s & Dementia.

Alzheimer’s disease, which currently affects half a million people in the UK, causes the death of brain cells and leads to a range of symptoms, including problems with thinking and memory and changes in behaviour. While memory loss is a typical early symptom of Alzheimer’s disease, some people can experience other, very different symptoms in the early stages of the disease. The researchers set out to investigate how a person’s age might affect the first symptoms they experience, looking at both cognitive symptoms – problems with thinking skills – and behavioural symptoms.

The team analysed data from 7,815 people in the US National Alzheimer Coordinating Center (NACC) database, which includes records on people attending Alzheimer’s disease centres across the US. Each participant had a diagnosis of Alzheimer’s, and a record had been made of the symptoms they had first noticed in the early stages of the disease. The average age of the group was 75, with the youngest person aged 36 and the oldest aged 110.

Although memory loss was the most common first symptom in all age groups, the results showed younger people were more likely than their older counterparts to report ‘non-memory’ problems first – including difficulty with judgement or problem-solving, problems with language, or a loss of visual or spatial awareness. In people under 60, a quarter reported that their first symptom was not memory loss, while one in five people in their 60s first had symptoms other than memory loss. This number fell to one in ten for people in their 70s, and one in 15 for those 80 years or older.

When the researchers compared the people’s first reported behavioural symptoms, they also found age differences. The most common behavioural symptom was apathy or withdrawal, but compared to older age groups, younger people were more likely to experience depression or other behavioural symptoms such as anxiety. In contrast, older people were more likely to have had psychosis, or no behavioural symptom at all, compared to those who were younger.

Dr Jo Barnes, Alzheimer’s Research UK Senior Research Fellow at UCL and the study’s lead author, said:
“Our results highlight the many different ways Alzheimer’s can affect the brain, causing problems with several different cognitive processes, not just memory. Brain imaging studies have suggested that the disease may be more likely to affect different parts of the brain in younger people, and this may help to explain some of the different symptoms seen in our study. Importantly, however, even in older groups not all people with Alzheimer’s report memory loss as their first warning sign of the disease.

“An awareness of symptoms other than memory loss is vital for helping to diagnose Alzheimer’s, particularly for those people whose early symptoms are not typical of the disease. Our findings suggest a need for doctors to use tests that do not solely or disproportionately focus on memory, but which also take into account some of the different ways that Alzheimer’s can manifest.”

Dr Eric Karran, Director of Research at Alzheimer’s Research UK, said:
“All too often Alzheimer’s is thought of as being a disease characterised only by memory loss, but this study shines a light on some of the other distressing symptoms people with the disease can experience. A greater understanding of these symptoms could not only help people receive a diagnosis earlier, but could also aid public awareness of the disease and help improve support services. Further research to investigate why younger people are more likely to experience different symptoms in the early stages of Alzheimer’s could provide useful insights into the disease. It’s worth noting that some of the people in this study may have been wrongly diagnosed with Alzheimer’s, and these results highlight the need to develop more accurate tests for the disease. If we are to find better ways of diagnosing Alzheimer’s early and new ways to treat the disease, continued investment in research is vital.”

 

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May 13, 2015

DEMAND FOR PRIVATE FERTILITY TREATMENTS IN UK MORE THAN DOUBLES IN ONE YEAR

  • UK enquires into private fertility treatments have more than doubled (up 112%) in the past 12 months
  • Egg freezing has seen the sharpest annual rise in demand of all fertility treatments, with enquiries up 407% for UK treatments, and to Spanish clinics up 867%
  • The age of women seeking fertility treatments is falling – 49% of traffic to fertility clinics now comes those aged 25-34 years, up from 38% last year
  • UK enquiries into fertility testing, IUI (intrauterine insemination) and embryo donation are up 242%, 188%, and 183% respectively in the past 12 months
  • IVF enquiries in the UK are up 161% but Greece, Cyprus and the Czech Republic are hot spots for Brits seeking this treatment abroad

Enquiries from UK patients into private fertility treatments have more than doubled (up 112%) in the past 12 months alone, according to new research from private healthcare search engine, WhatClinic.com.

Topping the list of the most popular treatments in the UK is egg freezing which, in the past 12 months alone, has seen a 407% increase in enquiries. Whilst the treatment is offered to those undergoing chemotherapy or radiotherapy, or for those who object to storing embryos for religious or moral reasons, it is also sought by those who wish to postpone childbearing. Of all UK users searching for this treatment in the past 12 months, 43% were between the ages of 25 and 34 and more than one in 10 (12.8%) were aged 18 to 24.*

Nearly half (49.3%) of all traffic to UK fertility clinics in the past year was from those between the ages of 25 and 34, compared with just 38.5% the year before.**

Increasing numbers of women are seeking fertility testing privately, with UK enquiries into these treatments skyrocketing by 242% in the past year alone. Intrauterine insemination (IUI) – a procedure which separates fast-moving sperm from the more sluggish or non-moving, to be placed in the womb close to the time of ovulation – has also seen a surge in enquiries. These have almost tripled (up 188%) in just 12 months. Closely following this in terms of demand is embryo donation, with more people seeking the donation of remaining embryos from couples who have undergone IVF, which has seen a sharp 183% rise in enquiries in one year.

Private IVF treatment has also seen a rise in demand, with enquiries up 161% in the past year. Whilst the NHS can fund the treatment, only three rounds are offered to women under the age of 40,*** which explains why, for some couples seeking this treatment, going private is the only option.

The following table shows the average costs of fertility treatments in the UK, as well as the change in demand over the past year:

Private Treatment

% change in enquiries over past 12 months

Average price UK (£)

Egg Freezing

407%

£2,084

Fertility Test

242%

£362

Intrauterine Insemination (IUI)

188%

£718

Embryo Donation

183%

£1,942

In Vitro Fertilisation (IVF)

161%

£2,256

Artificial Insemination

137%

£988

Intracytoplasmic Sperm Injection (ICSI)

89%

£3,279

Egg Donor

68%

£2,623

Fertility Specialist Consultation

40%

£163

Sperm Assessment

15%

£125

Preimplantation Genetic Diagnosis (PGD)

5%

£3,480

Sperm Freezing

-9%

£380

There’s also growing numbers of Brits seeking fertility procedures at overseas clinics. Egg freezing has not only seen the largest increase in enquiries in the UK, but also abroad. Spain has developed an international reputation as an IVF destination, and UK patients are following this trend with enquiries into egg freezing at Spanish clinics up by 867% in the past 12 months. More UK patients are also seeking IUI treatments there too, with enquiries in the last year rising by 250%.

With private IVF typically costing £2,256 per round in the UK, it’s easy to see why people are shopping around. Other top overseas locations for this are Greece, Cyprus and the Czech Republic, all of which offer cheaper IVF than the UK. IVF treatment in the Czech Republic, which has seen the highest volume of fertility enquiries to overseas clinics from the UK in the past year, costs £735 per session on average, less than a third of the cost of the same treatment at home.

The following table shows the fertility treatments overseas that have seen the largest increase in enquiries from Brits over the past year, as well as the price difference to the UK:

Treatment

Country of clinic

Increase in enquiries (%)

Average cost UK (£)

Average cost local (£)

Savings in cost vs UK (£)

Egg Freezing

Spain

867%

£2,084

£1,887

£197

In Vitro Fertilisation (IVF)

Greece

412%

£2,256

£2,173

£83

Egg Donor

India

280%

£2,623

£1,353

£1,270

Intrauterine Insemination (IUI)

Spain

250%

£718

£584

£134

In Vitro Fertilisation (IVF)

Cyprus

200%

£2,256

£1,845

£411

Preimplantation Genetic Diagnosis (PGD)

Cyprus

173%

£3,480

£3,874

-£394

Intracytoplasmic Sperm Injection (ICSI)

Czech Republic

162%

£3,279

£198

£3,081

Fertility Specialist Consultation

Turkey

115%

£163

£85

£78

In Vitro Fertilisation (IVF)

Czech Republic

64%

£2,256

£735

£1,521

Fertility Specialist Consultation

Bulgaria

61%

£163

£13

£150

In Vitro Fertilisation (IVF)

South Africa

50%

£2,256

£1,789

£467

In Vitro Fertilisation (IVF)

Poland

44%

£2,256

£1,135

£1,121

Artificial Insemination

Spain

18%

£988

£594

£394

 

Gynaecologist Mr Kiron Bhal, of Cardiff-based Infiniti Healthcare, comments:“More women are pursuing careers and delaying childbirth to later in life which can lead to difficulties conceiving.

“I am seeing an increasing number of women requesting egg freezing in their 20s and 30s, and choosing to have an IVF cycle when they are in a settled relationship, so there is a trend emerging of younger women, aware they may choose to have children at a later, and less fertile, time of life seeking treatment while they are still young.”

Emily Ross, director of WhatClinic.com, comments: “The cost of private fertility treatment is considerable, especially for those who are not immediately successful. The NHS  does provide IVF but provision is limited. A broad variety of social and economic factors are influencing the increase in demand for private fertility treatment, including egg freezing, demand for embryo donation and IVF.

“Medical tourism has flourished for fertility treatment but, unlike dental work or plastic surgery, cost is not the main driver for looking further afield. While there are significant savings to be made, savvy consumers also travel to avail of the groundbreaking techniques, and to work with worldwide experts at clinics with the highest success rates.

“Fertility treatment can be an emotional, frustrating and expensive process. Finding a clinic that can support you, and deliver the best results while also remaining affordable is no easy thing.”

 

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